Aspiration Of Thyroid Nodules Research Articles

American Thyroid Association Policy Statement: Impact of Changes in Fine Needle Aspiration Biopsy Reimbursement on Clinical Care of Patients with Thyroid Nodules in the United States.

Introduction: The Clinical Affairs Committee of the American Thyroid Association has developed this statement to describe recent changes in the billing and coding of ultrasound-guided fine needle aspiration procedures of thyroid nodules, and to raise awareness of the adverse consequences that have arisen as a result. Review: A reduction in payment of ultrasound-guided fine needle aspiration procedures was enacted by the Centers for Medicare and Medicaid Services in 2019. The Clinical Affairs Committee has sought to examine the effects of the change in reimbursement on the care of patients with thyroid diseases. Summary: The historical background of the changes in payment structure for ultrasound-guided fine needle aspiration of thyroid nodules is discussed. The years 2019 and 2020 saw a significant decline in claims for ultrasound-guided fine needle aspiration procedures, concomitant with a shift in the performance of these procedures away from non-facility outpatient settings and a rise in costs to the health care system. Conclusion: Several negative consequences of the decrease in reimbursement for ultrasound-guided fine needle aspiration of thyroid nodules have arisen. This has led to significant concern among clinicians who care for patients with thyroid diseases regarding delays in patient access to care and diagnosis, and a diminished pool of qualified thyroid specialists to perform these procedures in the future.

7663 Inheritable Forms of Differentiated Thyroid Cancer in a Predominantly Hispanic Pediatric Population

Abstract Disclosure: E.A. Delgado: None. A. Martinez: None. N. Solano: None. D. Baboun: None. C. Brathwaite: None. F. Alkhoury: None. C.L. Bustamante Escobar: None. A. Carrillo-Iregui: None. Background: PTEN Hamartoma Syndrome (PHTS) and DICER1 Syndrome are uncommon hereditary conditions causing benign and malignant tumors. Patients exhibiting DICER1 mutation have 5.3% likelihood of developing a tumor before reaching the age of 10, rising to 31.5% by 60. In PHTS, 75% face thyroid issues, with a 21%-38% thyroid carcinoma risk. Pediatric surveillance protocol data is scant; thus, gathering comprehensive data is vital for early tumor detection and management. Objective: Our aim is to determine the prevalence of the hereditary genetic syndromes DICER1 and PTEN associated with differentiated thyroid cancer (DTC) in a predominantly Hispanic pediatric population. This research addresses a knowledge gap in an underrepresented demographic, with the goal of improving diagnosis and management. Methods: Following approval from the Institutional Review Board, we conducted a retrospective examination of medical records from 2012 to 2023, focusing on 213 patients who underwent Ultrasound-Guided Fine Needle Aspiration (US-FNA) for thyroid nodules. Our analysis includes demographics, histopathological diagnoses, and molecular screening results. Results: Participants were predominantly Hispanic children (80%) ranging in age range from 8 to 18 years. The mean age at diagnosis was 15 years (SD± 2.49). Molecular biomarkers for thyroid disease were available in 57 of the 213 patients studied. The predominant genetic mutations identified were BRAF V600E (n=17, 30%), and RET (n=8, 14%), with PTEN showing positivity in 8.7% (n=5) and DICER1 positivity in 12.2% (n=7) of the cases. The analysis identified DTC in 64.9% (n=37) out of the total cohort with molecular markers. Subgroup analysis revealed that within the PTEN-positive subgroup, 20% developed papillary thyroid cancer, while the DICER1-positive subgroup exhibited a 14% incidence of the same cancer type. Inherited forms of thyroid cancer (DICER1 and PTEN) collectively contributed to 5.4% of DTC in our study population. Conclusion: Existing research has indicated inheritable thyroid cancer makes up around 5% of pediatric DTC. Our Hispanic-focused data aligns with prior research in broader populations, reporting low but still significant prevalence of inheritable conditions in thyroid nodules in children and adolescents, The reported cases underscore the significance of screening individuals with thyroid abnormalities for genetic mutations. Additionally, screening individuals with previously diagnosed inherited cancer syndromes for thyroid abnormalities is crucial. Future studies conducted on larger cohorts should investigate the prevalence of inheritable thyroid cancer conditions for further recommendations in surveillance strategies for children or adolescents with genetic mutations such as PTEN and DICER1. Presentation: 6/1/2024

Cytomorphological Features for Fine Needle Aspiration of Thyroid Nodules Post Radioactive Iodine Treatment

Cytomorphological Features for Fine Needle Aspiration of Thyroid Nodules Post Radioactive Iodine Treatment

The Bethesda System for Reporting Thyroid Cytopathology in theAfrican American population: A tertiary centre experience.

The reported risk of malignancies (ROM) remains controversial for fine needle aspiration (FNA) of thyroid nodules in the African American (AA) population. Herein, the ROM along with frequency was assessed for each of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) diagnostic categories. The electronic pathology archive of a large academic hospital was retrospectively searched for cytopathology reports of thyroid nodules in AA patients (2010-2019) and Non-African American (NAA) control cases. The patients' demographic, thyroid nodule characteristics, FNA results using TBSRTC and surgical diagnoses were recorded, whenever available. Three hundred ninety-one cases were identified, 317 females (81.1%) and 74 males (18.9%) with median age 50.0 (SD = 14.4). The mean size of the nodules was 2.1 cm (SD = 1.4). The Bethesda categories were: 5.4% (I), 35.0% (II), 35.3% (III), 7.7% (IV), 3.3% (V) and 13.3% (VI). The overall ROM of thyroid nodules was 43.8% (89/203) on surgical follow-up (203/391). The ROM in each Bethesda categories were: 33.3% (I), 11.6% (II), 35.2% (III), 15.8% (IV), 83.3% (V) and 100% (VI) on surgical follow-up. The frequency of thyroid nodules was higher in AA females; however, the ROM was higher in AA males (48.3%) compared with AA females (41.2%). The ROM in Categories I, II and III was higher than those reported in the TBSRTC while being similar in Categories IV, V and VI. The overall risk of thyroid malignancy in our AA patient population was higher than those in the literature. The overall ROM of thyroid nodules in AA males was higher than of AA females.

Accuracy of ultrasound in predicting thyroid malignancy: a comparative analysis of the ACR TI-RADS and ATA risk stratification systems.

Thyroid nodules are very common in clinical practice, and ultrasound has long been used as a screening tool for their evaluation. Several risk assessment systems based on ultrasonography have been developed to stratify the risk of malignancy and determine the need for fine-needle aspiration in thyroid nodules, including the American Thyroid Association (ATA) system and the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). The aim of this study was to compare the performance of the ATA and ACR TI-RADS systems in predicting malignancy in thyroid nodules based on the nodules' final histopathology reports. We performed a retrospective review of medical records to identify patients who underwent thyroid surgery at King Abdulaziz University from 2017 to 2022. The ultrasound features of the nodules with confirmed histopathology (benign versus malignant) were evaluated. Both ATA and ACR TI-RADS scores were documented. The analysis included 191 patients who underwent thyroid surgery and fulfilled the inclusion criteria. Hemithyroidectomy was performed in 22.5% of the patients, and total thyroidectomy was performed in 77.0% of them. In all, 91 patients (47.6%) were found to have malignant nodules on histopathology. We then compared the histopathology reports with the preoperative ultrasonographic risk scores. The estimated sensitivity and specificity in identifying malignant nodules were, respectively, 52% and 80% with the ATA system and 51.6% and 90% with the ACR TI-RADS system. Both ATA and ACR TI-RADS risk stratification systems are valuable tools for assessing the malignancy risk in thyroid nodules. In our study, the ACR TI-RADS system had superior specificity compared with the ATA system in predicting malignancy among high-risk lesions.

THE CORRELATION BETWEEN BETHESDA SYSTEM AND ULTRASOUND-BASED TIRADS FOR REPORTING THYROID CYTOPATHOLOGY

Objectives: To correlate the screening ability of ultrasound-based TIRADS with the FNAC-based Bethesda system when the latter is kept as a gold standard. Material and Methods: A cross-sectional study was conducted in the Histopathology department, Rehman Medical Institute, Peshawar 15th June 2022- 14th June 2023. A total of 363 patients from any age group of either gender diagnosed with thyroid nodules were included in the trial. All the participants underwent ultrasound followed by ultrasound-guided fine needle aspiration of thyroid nodules. TIRADS and Bethesda grading was done for each participant. Demographics and grading scores were recorded. Keeping Bethesda scoring as gold standard diagnostic performance of TIRADS grading was calculated. Results: Mean age of the patients was 46.68 ± 12.28 years with a female-to-male ratio of 2.3:1. TIRADS grading revealed 210 (69.8%) from TIRADS 2 while 70(82.4%), 12(50%), and 09(23.7%) patients were from TIRADS 3, 4 and 5 categories respectively. Bethesda grades were 301(82.9%), 21(5.8%), 09(2.5%), 28(7.7%), and 04(1.1%) from Bethesda 2, 3, 4, 5, and 6 categories respectively. The sensitivity of the TIRADS was 93.8%, specificity 89.1%, positive predictive value 45%, negative predictive value 99.3%, and a diagnostic accuracy of 89.5%. Conclusion: TIRADS grading has a high diagnostic ability when Bethesda scoring is kept as the gold standard. It can be used effectively in segregating benign from malignant nodules and is recommended for screening patients presenting with thyroid nodules. Keywords: Biopsy, Fine-Needle, Sensitivity and Specificity, Thyroid Nodule

Global scientific trends on thyroid disease in early 21st century: a bibliometric and visualized analysis.

Bibliometrics has been used to analyze the literature in the field of thyroid disease studies in the early 21st century, indicating the changes in current international study trends. In this study, a bibliometric analysis of data retrieved from the Web of Science (WoS) database was conducted, and the publication trends and thematic evolution in the field of thyroid disease research from January 1, 2000, to November 16, 2022, were analyzed. A total of 69283 articles related to thyroid diseases were evaluated for their characteristics, including annual publication volume, countries, journals, institutions, authors, keywords, and references. VOSviewer was utilized to perform the analysis of co-authorship, co-citation, co-occurrence and descriptive. The annual publication volume of thyroid disease research literature showed a fluctuating upward trend from 2000 to 2021, exceeding 5,000 articles for the first time in 2021. The United States (16120 counts, 678255 cities) ranks first in terms of publication volume and citation. Thyroid (n=3201) and Journal of Clinical Endocrinology&Metabolism (n=140399) are the most prolific and cited journals, respectively. The organization with the highest publication volume and citation frequency is Harvard University (1011 counts, 59429 cities), Miyauchi Akira (n=422), Schlumberger, and Martin (n=24839) possess the highest publication volume and citation frequency, respectively. Co-occurrence analysis of 307 keywords with frequencies of more than 20 resulted in 6 clusters (1): Thyroid dysfunction and diseases (2); mechanism of occurrence and development of thyroid cancer (3); autoimmune thyroiditis (4); scope and postoperative management of thyroid surgery (5); fine needle aspiration of thyroid nodules (6); radioactive iodine therapy for thyroid cancer. Active monitoring, thermal ablation, Lenvatinib, and long noncoding RNA refer to the latest keywords. Discussing the six clusters helps scholars to determine the scope and direction of studies. Over the past two decades, the literature related to thyroid diseases has increased year by year, with closer collaboration between countries, institutions, and authors. In this study, the global trends, research hotspots, emerging subjects, and basic knowledge of literature related to thyroid diseases were respectively elucidated, which will facilitate researchers in this field to seek better development.

The Diagnostic Utility of Repeat Fine-needle Aspirations of Benign Thyroid Nodules.

Objective This study aims to analyze the diagnostic utility of multiple repeat FNA on thyroid nodules with initially benign diagnosis. Methods In a 5-year period, 1658 thyroid nodules with initially benign FNAs were retrospectively reviewed and followed for subsequent resection and repeat biopsy. Results Out of 2150 thyroid nodules, 1658 (77.1%) were diagnosed as benign on FNAs. The average age was 57.4 years (range 11-93 years), and most were females (83.8%). Repeat FNA was performed on 183 benign nodules, of which 141 (8.5%) were sampled a second time and 42 (2.5%) had 2 or more repeat samplings. For the benign nodules without repeat FNAs, 124 had benign resection. Of cases with one-time repeat FNA, most (n=101) remained benign on repeat FNAs, 13 of which were benign on resection. Eleven had atypical repeat FNAs, 5 were resected, 4 of which were benign and one was atypical follicular neoplasm with HRAS and TERT promoter mutations. Of cases with multiple repeat FNA, most (n=35) were still benign on repeat FNAs, one had benign resection. Two had atypical repeat biopsies, one was PTC on resection with CCD6::RET fusion. The positive predictive value significantly decreased from 41.1% on single FNA to 8.3% on one-time repeat (p<0.001) and 16.7% on multiple repeat (p=0.002). The total cost for workup of previously benign nodules was $285,454. Conclusions Repeat FNA biopsies did not provide an additional diagnostic value in the evaluation of benign thyroid nodules, and often led to unwarranted follow-up procedures and significantly increased health care cost.

Comparison of Cytological Adequacy between 23- and 25-Gauge in Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules: A Single-Center Prospective Study.

Approximately 15% of fine-needle aspiration (FNA) of thyroid nodules are considered nondiagnostic. Several factors are potentially involved, including clinical and nodule features but also the gauge (G) of the needle used. However, few studies have compared the cytological adequacy obtained with different gauge needles and the data are controversial. We aimed to evaluate cytological adequacy results using 23- or 25-G needles. This study is an observational and prospective study of thyroid nodules submitted to ultrasound-guided FNA. The procedure was performed randomly using 23- or 25-G needles. The samples were reported by different cytopathologists who were blinded to the information of the gauge of the needle used. Statistical analysis was performed to compare cytological adequacy of FNA between the two groups. A total of 177 thyroid nodules were included - 98 (55.4%) using 23-G and 79 (44.6%) using 25-G needles. The 23-G group presented a higher rate of cytological adequacy (69.4% [68/98] vs. 46.8% [37/79], p = 0.002). No differences were found between the two groups regarding patient or nodule characteristics. On logistic regression, 23-G needles correlated with better cytological adequacy (unadjusted OR 2.57 [95% CI: 1.39-4.77]), even after adjusting for nodule dimension, location, and type of cytology (slides +/- additional liquid-based cytology) (adjusted OR 2.44 [95% CI: 1.23-4.84]). The gauge of the needle used was found to be an independent predictor of cytological adequacy, with 23-G needles providing more adequate samples. Further investigation is needed to confirm our results in order to stablish the optimal diagnosis technique.

The Analgesic Efficacy of Lidocaine/Prilocaine Cream during Fine-needle Aspiration Biopsy of Thyroid Nodules: A Randomized Double-blind Clinical Trial

Introduction: Fine-needle aspiration biopsy (FNAB) method is an effective method in diagnosis and approach to patients with thyroid nodules that create pain. This study investigates the analgesic effect of lidocaine/prilocaine cream during fine-needle aspiration (FNA) of thyroid nodules to reduce discomfort in patients during the procedure. Materials and Methods: In a double-blind clinical trial, two groups including patients with thyroid nodules who were rubbed with lidocaine + prilocaine 5% on their skin before FNA and patients with thyroid nodules, who have had topical placebo cream applied to their skin before FNA, were recruited. The Numerical Rating Scale was used to check the pain level. The Chi-square test, Fisher’s exact test, independent t-test, and Mann–Whitney’s nonparametric test were used for data analysis in SPSS software. Results: The average pain sensation in the intervention group is lower than the scores obtained in the control group, but despite the existing difference, this difference was not statistically significant (P = 0.7). The investigations showed that with the increase in the size and diameter of the thyroid nodules, the amount of pain that the patient feels during the procedure is reduced. Moreover, increasing the size of the nodule significantly reduces the amount of pain felt by the patient in the intervention group (P = 0.04). Conclusion: The results of this study indicated that the use of lidocaine/prilocaine cream in patients who are candidates for thyroid nodule biopsy did not have a significant effect on reducing their pain in contrast with literature. Therefore, based on the findings of the study, the use of lidocaine/prilocaine cream in these patients does not offer any significant decrease in pain sensation compared to using just a placebo.

Bethesda Category III thyroid nodules: descriptive cytological aspects of a series

BackgroundThe Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is used for cytopathological diagnosis of fine needle aspiration (FNA) of thyroid nodules (TN). Diagnosis of Bethesda Category III (CIII) has estimated malignancy rates of around 10%-30%, which vary between different institutions. Objective. To review cases of FNA interpreted as CIII thyroid nodules. To evaluate cytopathological criteria used to interpret FNA for CIII thyroid nodules and the associations between cytological and radiological aspects. To determine the malignancy rate of thyroid nodules classified as CIII, based on the correlation with surgical procedure. Methods. Retrospective study of FNA’s cytologic criteria of TN classified as CIII, carried out between 2010 and 2016. The patients included in the study were those who underwent the first FNA in the service and who were diagnosed with CIII. The patients had their cytological slides and medical records reviewed to detect the conduct flow followed after the CIII diagnosis. All cases that had histological slides available of their thyroidectomy products, total or partial, reviewed. The associations between clinical, histological and cytological findings were statistically studied. Results. Among 63 patients with resected nodules, 17 (27%) were malignant, 13 of which were papillary thyroid carcinomas. Among the benign cases, 18 patients (28.1%) had chronic lymphocytic thyroiditis/Hashimoto’s thyroiditis. Papillae (p = .004) was the criterion best associated with the diagnosis of malignancy. Conclusion. The malignancy rate was consistent with the rate of malignancy predicted in the TBSRTC. It is important to point out that the sample of this study is relatively small, which compromises specific evaluations and reduces the robustness of the observed data. CIII is extensively studied in the literature, however there is still a need for more precise studies regarding the correlations between cytological findings and other parameters. Probably, more than other categories, CIII may require a combination of cytological, radiological and clinical interpretation, with pathology leading role in this diagnosis process.

A 12-year Experience with 298 Fine Needle Aspirations of Thyroid Nodules in a Single Institution: Analysis of Bethesda System of Thyroid Cytopathology Reporting and Cytohistopathological Correlation

A 12-year Experience with 298 Fine Needle Aspirations of Thyroid Nodules in a Single Institution: Analysis of Bethesda System of Thyroid Cytopathology Reporting and Cytohistopathological Correlation

Photoacoustic Tomography Combined with Ultrasound Mapping for Guiding Fine-Needle Aspiration of Thyroid Nodules: A Pilot Study

This study aims to explore the feasibility of fine-needle aspiration biopsy (FNAB) under dual modal photoacoustic tomography(PAT)/ultrasound (US) imaging. A total of 25 patients who have thyroid nodules with thyroid imaging reporting and data system (TIRADS) 3 and 4 (malignant risk &lt;85%) were recruited. The specimens obtained from the PAT/US-guided FNAB were collected for cytology analysis. Cytological diagnoses for the 25 patients were classified in perspective of the Bethesda system for reporting thyroid cytopathology diagnostic category (DC) I: 4%(1/25); DC II: 12% (3/25); DC III: 20% (5/25); DC IV: 8% (2/25); DC V: 32% (8/25); and DC VI: 24% (6/25). The DC I nodule exhibited inadequate cytology and had structural characteristic of predominant calcifications in PAT/US mapping. The DC V-VI nodules showed lower photoacoustic (PA) signals compared to the DC I-IV nodules. Regions with a high PA signal demonstrated a significant number of erythrocytes in FNAB cytology. Moreover, nodules with microcalcifications did not show a significant difference compared to their surroundings in the PA signal, while nodules with macrocalcifications gave higher PA signals compared to their surroundings. The conclusions are as follows: combining US with PAT can evaluate the structure and function of thyroid nodules in vivo. This study demonstrates that dual modal PAT/US imaging has the potential to be an effective clinical tool to guide FNAB of thyroid nodules.

SAT556 An Unusual Case of Papillary Thyroid Carcinoma With Biallelic MEN1 Variants In a Patient With MEN1

Abstract Disclosure: E. Chuki: None. M. Raffeld: None. J. Klubo-Gwiezdzinska: None. S. Gubbi: None. S. Jha: None. Introduction: Multiple endocrine neoplasia (MEN1) syndrome is caused by germline variants in MEN1. Papillary Thyroid Cancer (PTC) is not regarded as a canonical MEN1-related endocrine tumor. Pathogenic variants in MEN1 are rare in PTC. Herein, we report an MEN1 patient with biallelic loss of MEN1 in PTC.Clinical case: A 59-year-old Hispanic female presented with asymptomatic hypercalcemia due to primary hyperparathyroidism [serum calcium: 13.9 mg/dl (8.4-10.2), PTH: 314 pg/ml (15-65) and 25 hydroxy vitamin D: 15 ng/ml (33 – 100)]. Physical examination was unrevealing for any neck mass or lymph nodes. Kidney function was normal with no history of or imaging evidence of kidney stones or calculi. Bone densitometry revealed osteoporosis [lowest T-score of -2.7 in spine]. Germline genetic testing was performed given large size of the parathyroid tumor and biochemical presentation suspicious for parathyroid cancer. A pathogenic MEN1 p.Ile54Serfs*65 was identified. A neck sonogram and 99-technetium sestamibi scan showed a 4.1 cm left parathyroid adenoma and incidental 3.5 cm, heterogeneous right thyroid lobe nodule having smooth margins without microcalcifications, and no cervical lymphadenopathy. Thyroid function studies were normal. Fine needle aspiration of right thyroid nodule revealed epithelial neoplasia containing many atypical cells with enlarged nuclei, nuclear grooves, fine chromatin, and moderate amounts of granular to oxyphilic cytoplasm. Patient underwent left inferior parathyroidectomy and right thyroid lobectomy. Histology was consistent with parathyroid adenoma and a hyperplastic adenomatous thyroid nodule with a 1.1 cm focus of classic PTC with minor follicular and oncocytic components, limited to the thyroid with clear margins and no lymphovascular invasion (pT1bNxMx). Genetic sequencing of the PTC (TSO500 gene panel) revealed two pathogenic frameshift variants in MEN1 p.I54fs*65 and p.D33fs*82 at variant allele frequency (VAF) of 53% and 42% respectively, TERT promoter (TERTp) variant [C228T (c.-124C&amp;gt;T)] at VAF of 44.8% and an NRAS p.Q61K variant at VAF of 39%. The two MEN1 variants were in trans to each other on opposite alleles, suggestive of a second-hit leading to a loss of biallelic function of MEN1.Conclusion: PTC in MEN1 has been rarely reported in the literature [1]. However, per our knowledge, this is the first report of a PTC with second-hit in the MEN1 gene. Somatic MEN1 pathogenic variants have been reported in occasional cases of thyroid oncocytic tumors and NRAS is more frequently associated with follicular or oncocytic thyroid tumors. Thus, whether this tumor should be regarded as a rare manifestation of the MEN1 syndrome is unclear. The histopathologic and molecular characteristics of thyroid tumors in MEN1 warrant further investigation. Reference: 1. Desai et al. Ann Surg Oncol 2001;8(4):342-6. Presentation Date: Saturday, June 17, 2023

THU222 Malignancy Risk In Nodules Classified As Atypia Of Undetermined Significance In A Predominantly Hispanic Free-standing Children’s Hospital

Abstract Disclosure: D. Baboun: None. N. Solano: None. A. Martinez Sanchez: None. C. Brathwaite: None. R. Restrepo: None. F. Alkhoury: None. A. Carrillo-Iregui: None. Background: During the last 3 decades, there has been an increase in pediatric thyroid cancer. Ultrasound-guided fine needle aspiration (US-FNA) of thyroid nodules continues to be the main modality for histopathological evaluation. Thyroid nodules reported as atypia of undetermined significance (AUS) present a challenge to clinicians in deciding on surgical intervention versus observation (1). Objective: The purpose of this study is to determine the rate of malignancy in cases classified as AUS in the predominantly Hispanic population treated at a free-standing children’s hospital. Methods: Upon Institutional Review Board approval, we performed a retrospective chart review from 2012-2022 of 211 patients who underwent US-FNAs of thyroid nodules. We analyzed demographics and histopathological diagnoses. Results: The majority of our population identified as Hispanic (80.10%). There were 167 (79.10%) females and 44 (20.90%) males, and the age range was 4-21 years. Two hundred eleven patients underwent a total of 232 US-FNAs. The Bethesda distribution is as follows: 29 (12.50%) nondiagnostic, 98 (42.24%) benign, 45 (19.40%) AUS, 21 (9.05%) follicular neoplasm, 9 (3.88%) suspicious, and 30 (12.93%) malignant. Of the AUS group, 33 of the 43 patients underwent surgery. Of the surgical specimens, 16 (48.48%) were malignant, and 17 (51.52%) were benign. Of the 10 patients who did not undergo surgery, 2 underwent a repeat US-FNA with benign results, 5 were monitored, and 3 did not return for a follow-up. Conclusions: In our experience, patients with US-FNAs classified as AUS have a rate of malignancy of 48.48%, which is consistent with the published rate of higher incidence in the pediatric population than in the adult population. Thus, our results support the current recommendation of surgical intervention rather than observation in these pediatric patients. Molecular markers are a useful tool for determining management of thyroid nodules in adults; however, further research in the pediatric population is needed to have standardized recommendations. Reference: (1) Rossi, E.D. et al., Cancer Cytopathology. 2017 Aug 125:594-603. Presentation: Thursday, June 15, 2023

Tissue Parathyroid Hormone Washout: A Reliable Method for the Localization and Exclusion of Parathyroid Adenomas.

Background and objective Accurate identification of parathyroid adenoma (PA) is essential for minimally invasive treatment of primary hyperparathyroidism (PHPT). The aim of this study is to evaluate the results of parathyroid hormone (PTH) assay in aspirates of suspicious neck lesions and to clarify its reliability in determining whether the lesion is of parathyroid origin. Methods A total of 134 lesions (104 imaging-suspected PA and 30 concomitant thyroid nodules as a control group) of 101 patients were retrospectively analyzed. Patients with positive, negative, or never scintigraphy were included in our study. Ultrasound (US) was performed again and US-guided tissue fine needle aspiration with PTH washout (PTH-WO) was performed from suspicious lesions. A PTH-WO level higher than the patient's serum PTH levels is proposed for a positive test, and a PTH-WO level lower than the upper limit of the laboratory PTH level is proposed for a negative test. A definitive diagnosis was made postoperatively histopathologically. Results PTH-WO levels (median (IQR)) were significantly higher in the positive group (n = 93, 5000 (1600) ng/L) compared to the negative group (n = 11, 17 (13.1) ng/L) and thyroid nodule aspirate group (n = 30, 14 (4.3) ng/L) (p < 0.001). Among 93 PTH-WO-positive lesions, 42 lesions (45.1%) were not identified by parathyroid scintigraphy (PS), 20 (21.5%) lesions were suspiciously PS, and 33 lesions (35.4%) were negative or suspicious byfirst US findings. Of the 93 patients localized with PTH-WO, two were cystic PAsablated by aspiration. The final pathology result of 91 operated patients proved PA. The sensitivity, specificity, negative predictive value, and positive predictive value of the PTH-WO were observed as 1.00, 0.82, 0.09, and 0.91, respectively. Conclusion Comprehensive repeated US and PTH-WO from the lesion increase the accurate localization of PAs. PTH-WO is a highly reliable method for differentiating parathyroid lesions from other cervical lesions.

Repeat Fine Needle Aspiration for Thyroid Nodules Classified as Follicular Neoplasm: Evaluation of Cytologic, Molecular, and Histologic Outcomes

Repeat Fine Needle Aspiration for Thyroid Nodules Classified as Follicular Neoplasm: Evaluation of Cytologic, Molecular, and Histologic Outcomes

Clinicopathologic Outcomes of Thyroid Nodule Aspirates Cytologically Suspicious for Hurthle Cell Neoplasms: A Retrospective Institutional Review

Clinicopathologic Outcomes of Thyroid Nodule Aspirates Cytologically Suspicious for Hurthle Cell Neoplasms: A Retrospective Institutional Review

Influencing Factors and Prediction Model of Performance of Needle Visualization in Fine Needle Aspiration of Thyroid Nodules

Objective To investigate the influencing factors and establish a model predicting the performance of needle visualization in fine-needle aspiration (FNA) of thyroid nodules. Methods This study prospectively included 175 patients who underwent FNA of thyroid nodules in the Department of Ultrasound in China-Japan Friendship Hospital and compared the display of the needle tips in the examination of 199 thyroid nodules before and after the application of needle visualization.We recorded the location,the positional relationship with thyroid capsule,ultrasonic characteristics,and the distribution of the soft tissue strip structure at the puncture site of the nodules with unclear needle tips display before using needle visualization.Furthermore,according to the thyroid imaging reporting and data system proposed by the American College of Radiology,we graded the risk of the nodules.Lasso-Logistic regression was employed to screen out the factors influencing the performance of needle visualization and establish a nomogram for prediction. Results The needle tips were not clearly displayed in the examination of 135 (67.8%) and 53 (26.6%) nodules before and after the application of needle visualization,respectively,which showed a significant difference (P<0.001).Based on the positional relationship between the nodule and capsule,anteroposterior/transverse diameter (A/T) ratio,blood supply,and the distribution of subcutaneous strip structure at the puncture site,a nomogram was established to predict the probability of unclear display of the needle tips after application of needle visualization.The C-index of the prediction model was 0.75 (95%CI=0.67-0.84) and the area under the receiver operating characteristic curve was 0.72.The calibration curve confirmed the appreciable reliability of the prediction model,with the C-index of 0.70 in internal validation. Conclusions Needle visualization can improve the display of the needle tip in ultrasound-guided FNA of thyroid nodules.The nomogram established based on ultrasound features such as the positional relationship between the nodule and capsule,A/T ratio,blood supply,and the distribution of subcutaneous strip structure at the puncture site can predict whether needle visualization is suitable for the examination of nodules.

Multimodality US versus Thyroid Imaging Reporting and Data System Criteria in Recommending Fine-Needle Aspiration of Thyroid Nodules.

Background Current guidelines recommend the use of conventional US for risk stratification and management of thyroid nodules. However, fine-needle aspiration (FNA) is often recommended in benign nodules. Purpose To compare the diagnostic performance of multimodality US (including conventional US, strain elastography, and contrast-enhanced US [CEUS]) with the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) in the recommendation of FNA for thyroid nodules to reduce unnecessary biopsies. Materials and Methods In this prospective study, 445 consecutive participants with thyroid nodules from nine tertiary referral hospitals were recruited between October 2020 and May 2021. With univariable and multivariable logistic regression, the prediction models incorporating sonographic features, evaluated with interobserver agreement, were constructed and internally validated with bootstrap resampling technique. In addition, discrimination, calibration, and decision curve analysis were performed. Results A total of 434 thyroid nodules confirmed at pathologic analysis (259 malignant thyroid nodules) in 434 participants (mean age, 45 years ± 12 [SD]; 307 female participants) were included. Four multivariable models incorporated participant age, nodule features at US (proportion of cystic components, echogenicity, margin, shape, punctate echogenic foci), elastography features (stiffness), and CEUS features (blood volume). In recommending FNA in thyroid nodules, the highest area under the receiver operating characteristic curve (AUC) was 0.85 (95% CI: 0.81, 0.89) for the multimodality US model, and the lowest AUC was 0.63 (95% CI: 0.59, 0.68) for TI-RADS (P < .001). At the 50% risk threshold, 31% (95% CI: 26, 38) of FNA procedures could be avoided with multimodality US compared with 15% (95% CI: 12, 19) with TI-RADS (P < .001). Conclusion Multimodality US had better performance in recommending FNA to avoid unnecessary biopsies than the TI-RADS. Clinical trial registration no. NCT04574258 © RSNA, 2023 Supplemental material is available for this article.