Aspiration Of Thyroid Nodules Research Articles

Utility of including BRAF mutation analysis with ultrasonographic and cytological diagnoses in ultrasonography-guided fine-needle aspiration of thyroid nodules

This study investigated the role of BRAF mutation analysis in thyroid fine-needle aspiration (FNA) samples compared to ultrasonographic and cytological diagnoses. A total 316 patients underwent ultrasonography (US)-guided FNA with BRAFV600E mutation analysis to diagnose thyroid nodules. One hundred sixteen patients with insufficient US images (n = 6), follow-up loss (n = 43), or unknown final diagnosis (n = 67) were excluded from the study. Comparisons between US diagnoses, cytological diagnoses, and BRAF mutation analysis were performed. Of 200 thyroid nodules, there was US diagnosis with 1 false negative and 11 false positive cases, cytological diagnosis with 10 false negative and 2 false positive cases, and BRAFV600E mutation analysis with 19 false negative and 2 false positive cases. The sensitivity, specificity, positive and negative predictive values, and accuracy of BRAFV600E mutation analysis were 83.2%, 98.1%, 97.5%, 86.6%, and 91%, respectively. Of the 18 nodules with Bethesda category III, 9 were true positive, 6 were true negative, 3 was a false negative, and none were false positive on BRAF mutation analysis. In conclusion, we recommend that BRAFV600E mutation analysis only be performed for evaluating thyroid nodules with Bethesda category III, regardless of US diagnosis.

Molecular testing in the diagnosis of differentiated thyroid carcinomas.

Different genetic mutations and other molecular alterations in papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) can be detected in fine-needle aspiration (FNA) of thyroid nodules, and can be used successfully to ameliorate cancer diagnosis and management of patients with thyroid nodules. The greatest experience has been obtained with the diagnostic use of BRAF mutation that is strongly specific for malignancy when detected using well-validated techniques. The strongest diagnostic result can be obtained testing FNA samples for a panel of mutations that typically involve TERT, BRAF, PAX8/PPARγ, RAS, and RET/PTC. Finding any of these mutations in a thyroid nodule provides strong indication for malignancy and helps to refine clinical management for a significant proportion of patients with indeterminate cytology. The use of molecular markers, as TERT, BRAF, PAX8/PPARγ, RAS, and RET/PTC, may be considered for patients with indeterminate FNA cytology (FNAC) to help guide management. In patients with indeterminate TIR3 FNA, the combination of precise molecular marker expression analysis with molecular mutations evaluations could ameliorate significantly the accuracy of cancer diagnosis. However other prospective studies are needed to identify more accurate molecular markers. Finally, the knowledge of these molecular pathways has permitted the development of new targeted therapies for aggressive TC.

Efficacy of surgeon-performed, ultrasound-guided lymph node fine needle aspiration in patients with thyroid pathologic conditions

BackgroundAlthough the concept of surgeon-performed fine needle aspiration of thyroid nodules is established, experience with surgeon-performed lymph node fine needle aspiration is scant. We aimed to study the efficacy of surgeon-performed lymph node fine needle aspiration in patients with thyroid pathologic conditions. MethodsThis is an institutional review board–approved study of patients with thyroid pathologic conditions who underwent surgeon-performed lymph node fine needle aspiration between 2002 and 2017. Efficacy and utility were analyzed. ResultsA total of 201 patients with benign nodular goiter (n = 30) and thyroid cancer (n = 200) underwent 230 lymph node fine needle aspirations (89 during preoperative workup, 141 at postoperative follow-up). Insufficient aspiration rate was 6% and indeterminate cytologic results 3%. In 91% of patients with suspicious lymph nodes, definite diagnosis could be obtained by fine needle aspiration; 51% (n = 118) of fine needle aspirations indicated metastasis from thyroid cancer and 40% (n = 91) benign findings. Sensitivity and specificity of lymph node fine needle aspiration in diagnosing nodal metastasis were 92% and 89%, respectively. Cytologic testing and thyroglobulin washout indicated 95% concordance. On logistic regression, spherical shape, microcalcifications, cystic appearance, and loss of hilum on ultrasound independently predicted lymph node metastasis. ConclusionOur data indicate that an adequate surgeon-performed lymph node fine needle aspiration is highly accurate in diagnosing nodal status in thyroid pathologic conditions. We recommend adoption of this technique, when feasible, to develop an efficient, comprehensive thyroid practice.

Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules: Pearls and Potential

Abstract Thyroid nodules are a commonplace clinical problem. Ultrasound-guided fine-needle aspiration biopsy is often the first step in the diagnosis and management of these nodules. We provide a review of technical considerations, performance, and techniques for thyroid nodule ultrasound-guided biopsy.

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Objective: This study evaluated the prevalence of nondiagnostic results, diagnostic performance, and complications of core-needle biopsy (CNB) compared with repeat fine-needle aspiration (FNA) for thyroid nodules with previous nondiagnostic FNA findings.Methods: The Ovid-MEDLINE and EMBASE databases were thoroughly searched for studies evaluating CNB or repeat FNA for thyroid nodules with initially nondiagnostic FNA results. Pooled proportions of nondiagnostic results of CNB and repeat FNA were calculated. A meta-analysis was performed to evaluate the diagnostic accuracy of CNB and repeat FNA for a diagnosis of malignancy using a bivariate random-effects model. Complication rates were also evaluated.Results: A review of 52 articles identified 4 eligible articles, involving 1,028 patients with 1,028 thyroid nodules, which were included in the meta-analysis. CNB demonstrated significantly lower rates of nondiagnostic results (6.4%) than repeat FNA (36.5%) (P<.0001). In the 3 studies that analyzed the diagnostic accuracy of CNB in diagnosing malignancy, CNB demonstrated significantly higher summary estimates of sensitivity (89.8%) than repeat FNA (60.6%) (P = .022), but summary specificity did not differ between CNB (99.2%) and repeat FNA (99.0%) (P = .576). None of the patients who underwent CNB or repeat FNA experienced any major complications.Conclusion: CNB demonstrates lower rates of nondiagnostic results and higher diagnostic accuracy than repeat FNA. CNB, rather than repeat FNA, can be utilized to diagnose thyroid nodules previously nondiagnostic on FNA.Abbreviations:CI = confidence intervalCNB = core-needle biopsyFNA = fine-needle aspirationSROC = summary receiver operating characteristicUS = ultrasound

A comparison of fine needle nonaspiration cytology versus fine needle aspiration for thyroid nodules: a Meta-analysis

Objective:To evaluate the differences of smear quality and diagnostic accuracy between thyroid nodules and fine needle nonaspiration cytology (FNNAC) and fine needle aspiration cytology (FNAC).Method:Databases were used to search the literature on FNNAC and FNAC. All statistical analyses were performed using Review Manager 5.3 Software.Result:A total of 10 studies were included in the study. Meta-analysis showed no significant difference in FNNAC and FNAC between low, middle and high quality smears. There was no significant difference in diagnostic accuracy.Conclusion:There were no difference in obtaining the smear quality and diagnostic accuracy, the person doing the piercing can freely choose which way according to the habit.

Aspirin Increases the Risk of Nondiagnostic Yield of Fine-Needle Aspiration and Biopsy of Thyroid Nodules

Background: The link between the diagnostic yield of thyroid fine-needle aspiration and biopsy (FNAB) in patients taking antithrombotic or anticoagulant medications (AT/AC) remains poorly characterized. Objectives: We studied the risk of obtaining a nondiagnostic sample with ultrasound-guided thyroid FNAB in patients taking AT/AC medications. Methods: This is a retrospective cohort study using medical rec­ords of 556 patients who underwent thyroid FNAB. All cytology samples were reported using the Bethesda classification. For patients with a nondiagnostic cytology, logistic regression was used to calculate OR for patients taking AT/AC medications. Multivariate regression was used to adjust for potential confounding variables including age, cystic ultrasound features, presence of eggshell calcifications, number of passes performed, cystic aspirate on FNAB, and position of the nodule. Results: Out of 556 patients, cytology results were available for 547 patients. Of these, 46 subjects were taking aspirin and 1 was on warfarin. Among the entire cohort, 17.5% of the subjects had a nondiagnostic cytology. Among the patients on AT/AC medications, 34% had a nondiagnostic result compared to 16% for those not taking them (OR = 2.70, p = 0.003). The subgroup of patients taking aspirin had similarly higher odds of a nondiagnostic cytology (OR = 2.78, p = 0.002). These differences remained statistically significant after multivariate adjustment. Conclusions: This is the first study to demonstrate a 3-fold independently greater risk of a nondiagnostic FNAB cytology in patients taking aspirin. Our results highlight the importance of evaluating the need for continuation of aspirin in patients undergoing thyroid FNAB as this may impact the diagnostic yield of the procedure.

Ultrasound requested by general practitioners or for symptoms unrelated to the thyroid gland may explain higher prevalence of thyroid nodules in females

BackgroundA higher prevalence of thyroid nodules/carcinoma in females is well-known from the literature. The reasons for this difference are not fully explained. We intended to assess gender variation in the referral for ultrasound-guided fine needle aspiration (FNA) of thyroid nodules, to study reasons for gender referral differences, and to assess differences in nodules characteristics between genders. MethodsIncluded were 272 consecutive patients, with 290 nodules submitted to FNA. Patients were questioned on the reason why ultrasound (US) examination was required. Electronic medical records were reviewed. Nodules' ultrasound/cytological characteristics were assessed. Variables studied: referral cause; referral pattern (hospital-specialist versus general-practitioner); number of nodules; age, thyroid function; nodule size, TIRADS classification, resistive index, Doppler pattern, Bethesda categorisation. Variables were compared between males and females referred for FNA. Significant variables were assessed with logistic regression. ResultsOf the 272 patients, 215(79%) were women with a female:male referral ratio for FNA of 3.8:1. Non-parametric statistically significant differences (p < 0.05) were found between genders in: thyroid function, nodule size, referral pattern and referral cause. Nodule size and thyroid function tests became non-significant in logistic regression. Cause and referral pattern remained significantly associated with gender. Referral by a general-practitioner was associated with a 2.6-fold increase in odds of referring a female. Causes unrelated to the thyroid were associated with a 3.2-fold increase in odds of female reference. ConclusionsA referral bias might be responsible for the higher rate of thyroid nodules in female patients, both due to referral by general practitioners and due to causes indirectly related to the thyroid gland.

Does sedation offer better outcomes than local anaesthesia for thyroid FNA in adult patients?

To examine the potential benefits of sedation in adults undergoing fine needle aspiration (FNA) of thyroid nodules. This retrospective study compared the outcomes of sedated and non-sedated FNA patients. A total of 860 patients underwent 1698 FNAs of thyroid nodules. The mean patient age was 52.4±14.4 years, and 80.2% of patients were women. The non-sedated group consisted of 782 patients with 1543 (93.5%) FNA procedures. The sedated group consisted of 66 patients who underwent 107 (6.5%) FNAs. There was no statistical difference between these groups with respect to age, gender, nodule size, nodule vascularity, non-diagnostic sample rate and post FNA hematoma (P > .05). Performing FNA of thyroid nodules in adult patients under sedation is not associated with a higher diagnostic yield or lower bleeding rate when compared to local anesthesia. Sedation should be judiciously used on only very anxious patients due to the increased overall cost.

Contributory Factors to Hemorrhage After Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules with an Emphasis on Patients Taking Antithrombotic or Anticoagulant Medications

Background: Thyroid nodules are a common clinical problem and ultrasound-guided fine needle aspiration (US-FNA) biopsy is widely used for evaluation of thyroid nodules. However, few studies have addressed the contributing factors to hemorrhage after US-FNA of thyroid nodules. Objectives: To assess the contributory factors related to patient characteristics, ultrasound (US) features of the thyroid nodules, and the US-FNA procedures to affect hemorrhage complications after US-FNA of thyroid nodules. Patients and Methods: Between March 2014 and April 2015, 366 consecutive patients who underwent US-FNA of thyroid nodules were enrolled in this retrospective study. The characteristics of hematomas, including the location, maximum size, and clinical course, were assessed. The relationships between hematomas and factors related to the medical characteristics of patients, US characteristics of the nodules, and FNA procedural factors were analyzed. Results: Data on 365 nodules in 321 patients who underwent US-FNA of thyroid nodules were analyzed. Minor hemorrhagic complications developed in 14 (3.8%) of the 365 nodules. There were no statistically significant differences between patients taking or not taking an anticoagulant or antithrombotic (P = 0.270). Factors related to increased risk of hematoma were male sex (P = 0.031), larger maximum size (P = 0.002), a cystic or predominantly cystic nodule (P < 0.0001), a probable benign nodule (P < 0.0001), thicker needle size (P < 0.0001), and a greater number of the needle passes (P = 0.005). Conclusion: US-FNA can be performed safely even in patients taking anticoagulant or antithrombotic agents. Factors related to hemorrhagic complications are male sex, larger nodules, cystic or predominantly cystic nodules, probably benign nodules, thicker needles and a greater number of needle passes.

Factors that Influence Sample Adequacy in Liquid-Based Cytology after Ultrasonography-Guided Fine-Needle Aspiration of Thyroid Nodules: A Single-Center Study

Objective: The factors that influence the acquisition of adequate samples during liquid-based cytology (LBC) remain unclear. This study aimed to identify factors that affect cytological adequacy in LBC after ultrasonography (US)-guided fine-needle aspiration (US-FNA) of thyroid nodules. Study Design: From January 2017 to May 2017, a single radiologist performed US-FNA to diagnose 112 thyroid nodules in 112 consecutive patients. Based on US findings after US-FNA, the size, location, position, composition, calcification, and vascularity of each nodule, as well as the US-based diagnosis, were investigated by the same radiologist. Blinded to US information, a single cytopathologist investigated cytological adequacy, cytological cellularity, and Bethesda category. Results: Of the 112 thyroid nodules, cytological adequacy was achieved in 91.1% (102/112). Thyroid nodules with sizes ≥20 mm or those that were predominantly cystic showed a higher rate of cytological inadequacy (p < 0.05). Thyroid nodule location, position, calcification status, and vascularity did not influence cytological adequacy, nor did US-based diagnosis (p > 0.05). Nodule composition or calcification significantly influenced cytological cellularity (p < 0.05), whereas nodule size, location, position, vascularity, and US-based diagnosis did not (p > 0.05). Conclusions: Most investigated factors did not influence cytological adequacy or cellularity.

A Comparison of Ultrasound-Guided Fine Needle Aspiration versus Core Needle Biopsy for Thyroid Nodules: Pain, Tolerability, and Complications.

BackgroundTo compare pain, tolerability, and complications associated with fine needle aspiration (FNA) versus core needle biopsy (CNB).MethodsFNAs were performed using 23-gauge needles and CNBs were performed using 18-gauge double-action spring-activated needles in 100 patients for each procedure. Patients were asked to record a pain score using a 10-cm visual analog scale and procedure tolerability. Complications and number of biopsies were recorded.ResultsThe median pain scores were similar for the FNA and CNB approaches during and 20 minutes after the biopsy procedures (3.7 vs. 3.6, P=0.454; 0.9 vs. 1.1, P=0.296, respectively). The procedure was tolerable in all 100 FNA patients and in 97 CNB patients (P=0.246). The mean number of biopsies was fewer in the CNB group (1.4 vs. 1.2, P=0.002). By subgroup analysis (staff vs. non-staff), no significant difference was detected in any parameter. There were no major complications in either group, but three patients who underwent CNB had minor complications (P=0.246).ConclusionFNA and CNB show no significant differences for diagnosing thyroid nodules in terms of pain, tolerability, or complications.

Thyroid Nodules Cytopathology Applying the Bethesda System with Histopathological Correlation.

Background:Fine-needle aspiration cytology remains a valuable screening tool for preoperative management of thyroid nodules. However, the rates of false-negative and false-positive diagnosis remain a challenge for pathologists.Objectives:To assess the value of thyroid fine-needle aspiration as a screening tool and its accuracy of diagnoses relative to final histological diagnoses.Patients and Methods:A chart review was conducted of all adult patients who underwent fine-needle aspiration of thyroid nodule(s) and were subjected to thyroid surgery at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between January 2007 and June 2014. The fine-needle aspiration results were correlated with final histopathology results.Results:Of the 408 aspirates from 373 patients, the Bethesda System for Reporting Thyroid Cytology (BSRTC) diagnostic categories were as follows: nondiagnostic in 26 aspirates (6.4%); benign in 128 (31.4%); atypia/follicular lesion of undetermined significance in 52 (12.7%); follicular neoplasm/suspicion for a follicular neoplasm in 83 (20.3%); suspicious for malignancy in 23 (5.6%) and malignant in 96 (23.5%). The comparative histopathological diagnoses were benign in 192 (47.1%) and malignant in 216 (52.9%) aspirates. The calculated risk of malignancy in the fine-needle aspiration categories was 34.6% in diagnostic category (DC) I, 15.6% in DC II, 50% in DC III, 52% in DC IV, 95.7% in DC V and 100% in DC VI. The sensitivity of fine-needle aspiration with BSRTC was 88.9%, specificity was 75.6%, positive predictive value was 79.7%, negative predictive value was 84.4% and accuracy was 81.5%.Conclusion:The results of this retrospective study demonstrated higher risks of malignancy in DC I, DC II, DC III and DC IV than that of the original BSRTC definition, along with a higher specificity and positive predictive value for cancer diagnosis, and a lower sensitivity and negative predictive value.

Cytomorphological analysis of categories in the Bethesda system and its accuracy in predicting thyroid neoplasms

Background: Fine-needle aspiration (FNA) cytology is a keynote modality in diagnosis and screening of thyroid nodules. The management of thyroid nodules largely depends on FNA; thus, it is challenging for the pathologist to distinguish the neoplastic nodule from benign ones and further, categorize the malignant tumors wherever possible. Due to the lack of uniform criteria for specimen adequacy and terminology, “The Bethesda System for Reporting Thyroid Cytopathology (BSRTC)” was designed. Objective: The objective of this study was to review the Bethesda thyroid FNA classification system in evaluation of thyroid nodules. Materials and Methods: This study was conducted over 4½ years. Fine-needle aspiration was done by palpation or ultrasound-guided, using a fine (25 or 27G) needle, and cytological smears were prepared using Giemsa, hematoxylin and eosin, and Papanicolaou stain. These smears were then examined and classified according to the BSRTC. Results: Of the 504 cases analyzed, benign lesions were the most common (78.9%), followed by malignant (4.2%), suspicious for follicular neoplasm/follicular neoplasm (4.2%), atypia/follicular lesion of undetermined significance (3.9%), and suspicious for malignancy (3.6%). Good cytohistological correlation (94.4%) was observed. Only 5.2% smears were nondiagnostic. Limitations: Small sample size for which histopathological follow-up was available. Conclusions: The BSRTC is a systematized 6-tier classification system for thyroid nodule aspirates. It is based on a complete literature analysis and is a unified risk-based reporting system.

The impact of repeat FNA in non-diagnostic and indeterminate thyroid nodules: A 5-year single-centre experience.

FNA is a well-established method for the preoperative diagnosis of thyroid nodules, but limitations still reside among non-diagnostic and indeterminate samples. The objective of the present study was to assess the impact of repeat FNA in thyroid nodules primarily classified as non-diagnostic and indeterminate, with the evaluation of the diagnostic resolution rate after the reassessment of the nodule. We retrospectively collected all cases of thyroid FNA at our institution in the last 5 years that had one or more repeat aspirations of the same nodule, calculating the percentage of samples with change in the diagnostic category. Additional collected data included sex, age and interval between the repeat aspirations. One hundred and seventy-eight specimens from 167 patients (140 female, 27 male) with a median age of 56 years (range 11-90) were included in the study. Among the 86 cases primarily classified as non-diagnostic, 25 (29.1%) remained in the same category after the first reassessment and only 18 (20.9%) after the second repeat aspiration. Among the 40 indeterminate cases, only 10 (25%) retained their status after the second aspiration, with no change after the third assessment. Repeat aspiration of non-diagnostic and indeterminate thyroid nodules had a positive impact in both groups, with diagnostic resolution rates of 80% and 75%, respectively. The present study therefore endorses the use of such strategy for the initial follow-up of nodules with no definite diagnosis, especially in low-resource centres with limited access to modern molecular technologies.

Preliminary study of confounding factors of elastography and the application of fine-needle aspiration in thyroid nodules with indeterminate elastography

To investigate confounding factors of real-time ultrasound elastography (RTE) and to evaluate the diagnostic performance of ultrasound (US)-guided FNA for thyroid nodules with indeterminate elastography compared with conventional US. This study included 244 nodules with indeterminate elastography caused by several confounding factors (large or small size, deep location, isthmic or paratracheal location, calcification, thyroiditis, conflicting results between conventional US and RTE), and corresponding prevalences of malignancy were calculated. Additionally, conventional US and US-FNA data were collected and compared. The prevalences of malignancy of confounding factors were 74.1%, 75.0%, 73.3%, 46.2%, 27.3%, and 53.2%, respectively. Sonographic features (border, margin, echogenicity, echohomogeneity, and microcalcification) were significantly different between benign and malignant thyroid nodules (p < 0.05), and most of them exhibited good sensitivity but unsatisfactory specificity and accuracy. While US-FNA exhibited better performance with a sensitivity of 96.9%, a specificity of 99.1% and an accuracy of 98.0% in the diagnosis of malignancy. Given that indeterminate RTE is inevitable with a rather high malignant risk due to several confounding factors, our study revealed that US-FNA was a valuable tool in nodules with indeterminate elastography by increasing the detection rate of thyroid malignancy.

Diagnostic Accuracy of Fine Needle Aspiration for Solitary and Multiple Thyroid Nodules in a Tertiary Care Center

Background: Thyroid nodules are common in clinical practice. They are usually benign, but malignancy must be ruled out. Fine needle aspiration (FNA) biopsy of the thyroid is a rapid and cost-effective procedure in the initial evaluation of a thyroid nodule, but its results may be inaccurate in 10% to 30% of cases. This prospective observational study was conducted to determine the prevalence of thyroid cancer, its related findings, and the diagnostic accuracy of preoperative FNA in a tertiary care center. Methods: We prospectively studied the medical records of 345 subjects, who underwent thyroid resection in the university hospital setting over a 4-year period. Age, gender, FNA and pathologic reports, and whether the lesion was multinodular or a solitary nodule were determined. Results: The sensitivity and specificity of FNA were 64.96% and 62.76%, respectively. The positive predictive value of the test for the diagnosis of malignant nodules was 59.30% and its negative predictive value was 68.20%. In 63.5% of the patients, the preoperative FNA matched the surgical histopathology results. The presence of multinodular goiter was an important risk factor for thyroid malignancy. Fifty-two subjects had papillary microcarcinoma and the rate of aggressive behavior was considerable in this group. Conclusions: Although fine needle aspiration biopsy is the most important step in the workup of the thyroid nodules, it may miss a significant number of malignant lesions. Therefore, there is a mandatory need to evolve other clinical and laboratory adjuncts, which assists the clinicians with the interpretation of FNA more accurately.

Size and Ultrasound Features Affecting Results of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules.

Our goal was to assess the diagnostic efficacy of ultrasound (US)-guided fine-needle aspiration (FNA) of thyroid nodules according to size and US features. A retrospective correlation was made with 1745 whole thyroidectomy and hemithyroidectomy specimens with preoperative US-guided FNA results. All cases were divided into 5 groups according to nodule size (≤5, 5.1-10, 10.1-15, 15.1-20, and >20 mm). For target nodules, static images and cine clips of conventional US and color Doppler were obtained. Ultrasound images were reviewed and evaluated by two radiologists with at least 5 years US working experience without knowing the results of pathology, and then agreement was achieved. The Bethesda category I rate was higher in nodules larger than 15 mm (P < .05). The diagnostic accuracy was best in nodules of 5 to 10 mm in diameter. The sensitivity, accuracy, PPV, and LR for negative US-guided FNA results were better in nodules with a size range of 5 to 15 mm. The specificity, negative predictive value (NPV), and LR for positive results and the Youden index rose with increasing nodule size. Seventeen false-positive and 60 false-negative results were found in this study. The false-negative rate rose with increasing nodule size. However, the false-positive rate was highest in the group containing the smallest nodules. Nodules with circumscribed margins and those that were nonsolid and nonhypoechoic and had no microcalcifications correlated with Bethesda I FNA results. Nodules with circumscribed margins and those that were nonsolid, heterogeneous, and nonhypoechoic and had increased vascularity correlated with false-negative FNA results. Borders correlated with Bethesda I false-negative and false-positive FNA results. Tiny nodules (≤5 mm) with obscure borders tended to yield false-positive FNA results. Large nodules (>20 mm) with several US features tended to yield false-negative FNA results.

Fine-needle Aspiration of Thyroid Nodules: Is it Worth Repeating?

The fine-needle aspiration has a significant role in assessing the malignancy risk of thyroid nodules. There is uncertainty regarding the value of repeat fine-needle aspiration in benign nodules. This study aims to evaluate the concordance of results in consecutive fine-needle aspiration and to study the relevance of repetition in benign results. Retrospective study of the 4800 thyroid nodules fine-needle aspiration held in Instituto de Patologia e Imunologia Molecular da Universidade do Porto between January 1, 2014 and May 2, 2016. Of the initial sample, we selected the repeated fine-needle aspiration on the same nodule. The first fine-needle aspiration result of the 309 nodules underwent revaluation was non-diagnostic in 103 (33.3%), benign in 120 (38.8%) and atypia/follicular lesion of undetermined significance in 86 (27.8%). The agreement between the first and second fine-needle aspiration was significantly higher in cases with an initial benign result (benign: 85.8%, non-diagnostic: 27.2% and atypia/follicular lesion of undetermined significance: 17.4%, p < 0.005). The fine-needle aspiration repeating motifs in initially benign nodules (n = 78) were repetition suggestion in 58, nodule growth in 17 and suspicious ultrasonographic features in 3. The fine-needle aspiration repetition in nodules with initial non-diagnostic and atypia/follicular lesion of undetermined significance result changed the initial diagnosis in a significant proportion of patients, modifying their therapeutic approach. The high concordance of results in initially benign nodules makes fine-needle aspiration repetition not cost-effective in most cases. The fine-needle aspiration should be repeated when the initial cytology result is non-diagnostic or atypia/follicular lesion of undetermined significance.

The Use of the Bethesda System for Reporting Thyroid Cytopathology in Korea: A Nationwide Multicenter Survey by the Korean Society of Endocrine Pathologists.

BackgroundThe Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has standardized the reporting of thyroid cytology specimens. The objective of the current study was to evaluate the nationwide usage of TBSRTC and assess the malignancy rates in each category of TBSRTC in Korea. MethodsQuestionnaire surveys were used for data collection on the fine needle aspiration (FNA) of thyroid nodules at 74 institutes in 2012. The incidences and follow-up malignancy rates of each category diagnosed from January to December, 2011, in each institute were also collected and analyzed. ResultsSixty out of 74 institutes answering the surveys reported the results of thyroid FNA in accordance with TBSRTC. The average malignancy rates for resected cases in 15 institutes were as follows: nondiagnostic, 45.6%; benign, 16.5%; atypical of undetermined significance, 68.8%; suspicious for follicular neoplasm (SFN), 30.2%; suspicious for malignancy, 97.5%; malignancy, 99.7%. ConclusionsMore than 80% of Korean institutes were using TBSRTC as of 2012. All malignancy rates other than the SFN and malignancy categories were higher than those reported by other countries. Therefore, the guidelines for treating patients with thyroid nodules in Korea should be revisited based on the malignancy rates reported in this study.