Fine-needle Aspiration Biopsy Results Research Articles

Abstract PO5-02-12: Comparison of survival outcomes according to axillary ultrasonography findings and cytology results in early-stage breast cancer patients

Abstract Purpose: Axillary lymph node dissection and sentinel lymph node biopsy are associated with increased risk of post-surgical complications including lymphedema and recent trials have raised questions about the therapeutic benefit of axillary operation in early-stage breast cancer patients. While treatment options for lymph nodes with negative findings on axillary ultrasonography (AUS) or positive findings on fine needle aspiration biopsy (FNAB) are evident, data regarding lymph nodes that are suspicious on AUS but negative by FNAB are limited. Thus, we aimed to compare clinicopathological characteristics of AUS positive and FNAB negative patients with those of AUS negative or FNAB positive patients. Materials and Methods: Medical records of patients who underwent breast cancer surgery between January 2010 and December 2017 were reviewed. Patients were grouped into the following three groups: (a) negative findings on AUS, (b) suspicious findings on AUS but negative on FNAB, (c) and FNAB positive. A total of 4,506 patients were included for analysis, with 3,771 patients with no suspicious lymph nodes on AUS, 557 patients who had suspicious AUS findings but were negative on FNAB, and 178 patients with positive findings on both AUS and FNAB. Primary endpoints were disease free survival (DFS) and recurrence free survival (RFS), and secondary endpoint was overall survival (OS). Results: At a median follow-up period of 92 months, DFS and RFS was significantly higher in the AUS negative group compared to the other two groups (10-year-DFS: 91.6% vs 87.5% vs 75.7%, 10-year-RFS: 95.0% vs 89.9% vs 77.1%, p < 0.001). In terms of OS, AUS negative group and the AUS positive and FNAB negative group did not show statistically significant survival difference (10-year-OS: 94.5% vs 92.8%, p = 0.061), while the FNAB positive group showed significantly lower survival rates (10-year-OS: 81.8%, p < 0.001). Multivariable analysis revealed that not AUS positive and FANB negative but positive FNAB was significantly associated with poor RFS. Moreover, hormone receptor (HR) positive and HER2 negative subtype showed poor DFS and RFS in subgroup analysis. Conclusion: Early breast cancer patients with suspicious findings on AUS but negative FNAB results had similar OS but inferior DFS and RFS compared to those with negative features on AUS, especially in HR(+)HER2(-) subtype. While further prospective trials are warranted to determine whether additional treatment is necessary, close surveillance is recommended for this subgroup of patients. Figure1. Overall survial and Disease free survival according to axillay US and FNAB status Table1. patients' characteristics Table2. prognostic factors for overall survival and disease free survival related to axillary US and FNAB status Citation Format: Suk Jun Lee. Comparison of survival outcomes according to axillary ultrasonography findings and cytology results in early-stage breast cancer patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-02-12.

Malignancy rates in thyroid nodules classified as benign according to the nodule size threshold of 4 cm

SUMMARY Aim: The false negative rate of fine needle aspiration biopsy (FNAB) in large thyroid nodules ranges from 7.7% to 53%. The treatment of nodules that are 4 cm or larger is controversial because of the potential for false-negative FNAB results. In order to make treatment recommendations for nodules ≥4 cm in size, we compared the results of preoperative FNAB with thyroid surgery specimens. Materials and Methods: We evaluated patients who underwent thyroid surgery and had preoperative FNAB between 2017 and 2022. Patients were divided into two groups based on nodule size (

Clinical and morphological features and unsolved issues in diagnosis of aggressive forms of papillary thyroid carcinoma

Differentiated thyroid cancer (DTC) is a disease with a favorable clinical course and high survival rate compared to other epithelial tumors. The majority of DTC (up to 85 %) is represented by various subtypes of papillary thyroid cancer (PTC). Aggressive forms of PTC characterized by early lymphogenous and hematogenous metastasis, low avidity to radioiodine therapy (RIT), low relapse-free survival rates and high mortality rate compared to other types of PTC occur among them. Preoperative diagnosis of PTC is based on the results of ultrasound (US) examination and fine-needle aspiration biopsy (FNA) with cytological examination of the aspirate. At the same time, the capabilities of cytological examination in determining the histological type of PTC are limited and it does not allow to predict its aggressiveness and plan adequate treatment. Molecular genetic tests of the tumor cytological and morphological material are effective in prognosis of aggressiveness of PTC due to the determination of specific mutations in the BRAF, TERT, RAS genes and the quantitative expression of oncogenic and tumor suppressive microRNAs. Some of these indicators are already used in the morphological classification of tumors of the endocrine system.
 At the same time, there are contradictory data concerning the connection of the molecular genetic portrait of PTC, the clinical manifestations of its aggressiveness (extrathyroidal invasion, early metastasis, and radioiodine resistance) and its pathomorphological structure. We tried to summarize and analyze the literature data regarding the diagnosis of aggressive variants of PTC.

Comparison of transoral endoscopic thyroidectomy vestibular approach and open conventional thyroidectomy regardıng inflammatory responses, pain, and patient satisfaction: a prospective study.

The application of transoral endoscopic thyroidectomy vestibular approach (TOETVA) is becoming widespread throughout the world. We primarily aimed to evaluate the severity of surgical trauma in TOETVA and conventional open thyroidectomy (COT) regarding the inflammatory response including the comparison of surgical stress markers [interleukin-6 (IL-6), C-reactive protein (CRP), white blood cell (WBC)]. This non-randomized prospective study enrolled two groups with 20 patients each: COT group and TOETVA group. Patients aged 18-65 years with benign thyroid disease; with fine needle aspiration biopsy results of Bethesda III, IV or Bethesda V, VI (<1 cm nodule); thyroid volume <50 cm3; nodule diameter <4 cm; female gender without a previous neck, chin, and/or oral surgery; without vocal cord paralysis preoperatively; and patients in euthyroid state were enrolled to the study. Preoperative, postoperative second hour, first day, and second day CRP, WBC, and IL-6 levels were evaluated. Pain intensity was evaluated with the visual analog scale (VAS) score on the 2nd and 12th hour, 1st and 2nd days postoperatively. All the patients were female and mean age was significantly higher in the COT group. The operative time was significantly longer in the TOETVA group. No significant difference was found between the two groups regarding IL-6 levels. In the TOETVA group, postoperative second hour WBC value (p = 0.044) and first (p = 0.002) and second day (p = 0.005) CRP values were significantly higher. In the TOETVA group, the lower lip and lower chin VAS scores were significantly higher at 2nd and 12th hour, on the first and second days. The anterior neck VAS score was significantly higher in the TOETVA group at the second hour (p = 0.025). General and cosmetic satisfactions were similar at the 15th and 30th days in both groups. The longer operative time and higher postoperative CRP level and VAS score in the chin and lower lip in the TOETVA group suggested that the method is not a minimally invasive technique compared to COT. However, the presence of similar total complication rates and early postoperative general and esthetic satisfaction that improves over time in both groups suggests that the clinical effect of increased magnitude of systemic inflammatory response in TOETVA might be temporary and acceptable.

Preoperative Role of Superb Microvascular Imaging and Shear-Wave Elastography for Prediction of Axillary Lymph Node Metastasis in Patients With Breast Cancer.

This study aims to evaluate the role of shearwave elastography (SWE) and superb microvascular imaging (SMI) for preoperative prediction of axillary lymph node metastasis (ALNM) in patients with breast cancer. In a cohort of 214 women with breast cancer, B-Mode ultrasonography (US), SMIvascular-index (SMIvi), and SWE (E-mean, E-ratio) values were recorded before tru-cut biopsy. Axillary fine-needle aspiration biopsy (FNAB) and sentinel lymph node sampling results were collected. Imaging findings and histopathological data were statistically compared. Receiver operating characteristic curve analysis was used to evaluate diagnostic performance. Reverse stepwise logistical regression analysis was conducted. Although ALNM was negative in 111 cases, it was positive in 103 patients. Axillary lymph node metastasis (+) group had larger size (P < 0.001), higher vascularization (SMIvi: 8.0 ± 6.0 versus 5.0 ± 4.3, P < 0.001), and higher elasticity value (E-mean: 129 ± 31 kPa versus 117.3 ± 40 kPa, P = 0.014). Axillary lymph node metastasis was observed statistically more frequently in Her-2 positive cases (P = 0.005). There was no significant difference between other B-mode US findings (P > 0.05), SMI Adler (P = 0.878), and E-ratio (P = 0.212). The most appropriate cutoff value for the prediction of ALNM was 23.5 mm for size, 3.8 for SMIvi, and 138.5 kPa for E-mean. The most sensitive (77%) method was the SMIvi measurement, while the most specific (86%) finding was Her-2 positivity. The combined model (being Her-2 positive, >23.5 cm, and >3.8 SMIvi) increased the specificity (78%), PPV (71%), and accuracy (68%). Although the increased size is a previously studied parameter in predicting the risk of ALNM, Her-2 and data obtained by SWE, and SMI can be used to assist conventional US.

SAT528 Evaluation of Fine Needle Aspiration Biopsy Results in Patients with History of Thyroid Surgery for Benign Thyroid Disease

Abstract Disclosure: A.S. Can: None. J. Naran: None. Objective: We aimed to compare our thyroid fine needle aspiration (FNA) biopsy results in patients with history of thyroid surgery for benign thyroid disease and in patients without history of thyroid surgery. Material and Method: FNAs were performed between January 2016 and December 2020. The demographic data and outcomes were reviewed retrospectively. The results were presented per nodule, not per patient. FNA was performed on two groups: Group 1: nodules with history of thyroid surgery for benign thyroid disease, and Group 2: nodules without history of thyroid surgery. FNA results were categorized as malignant, benign, indeterminate, and unsatisfactory. FNAs were performed under ultrasound guidance. Results: 711 thyroid nodules underwent ultrasound guided FNA. 18 FNAs were performed on nodules diagnosed in patients who had history of thyroid surgery for benign thyroid disease (Group 1). Average age and standard deviation (SD) of Group 1 were 63±10 years. Average maximum size of nodules in Group 1 was 20±12 mm and average volume was 5.4±13.0 mL. Group 1 nodules had surgery on average 18±10 years ago. Thirteen nodules had hemithyroidectomy, three subtotal thyroidectomy and two nodule removal only. 693 FNAs were performed on nodules diagnosed in patients without history of thyroid surgery (Group 2). Average age and SD of Group 2 patients were 58±14 years. Average maximum size of nodules in Group 2 was 21±11 mm and average volume was 4.7±9.7 mL. FNA results in Group 1 versus Group 2 nodules were as follows: malignant 0% versus 3% (n=0 versus n=22), benign 72% versus 68% (n=13 versus n=470), indeterminate 6% versus 10% (n=1 versus n=70), unsatisfactory 22% versus 19 % (n=4 versus n=131), Chi-Square= 1.08, degrees of freedom= 3, p= 0.78. There was no statistical difference between groups in biopsy results. The chi-square statistic may not be reliable because two of the expected frequencies were less than 5. Conclusions: We did not observe any malignancy in patients with thyroid nodules who had history of thyroid surgery for benign thyroid disease. FNA performed similarly well whether there was history of thyroid surgery for benign thyroid disease or not. Further studies on larger group of patients with history of thyroid surgery for benign disease can be considered to confirm our findings. Presentation Date: Saturday, June 17, 2023

SAT575 Can We Miss Diagnosis Of Tall Cell Variant Papillary Thyroid Carcinoma?

Abstract Disclosure: J. Huynh: None. A. Makawi: None. G. Elshimy: None. Introduction Large thyroid nodules have a high rate of evolving into malignancy. Fine needle aspiration biopsy (FNAB) is a key diagnostic tool with a caveat of a high false-negative rate for cancer detection ranging from 0.7 to 13%. Key to maximizing the odds of a successful FNAB are the utilization of ultrasound (US) guidance, visualization of the needle tip, preprocedural consideration of the size of the target nodule, and expertise of the cytopathologist. Case presentation 40-year-old African American female who presented to endocrinology clinic given concern for a large left-side thyroid nodule with tracheal deviation seen on a CT scan of the chest. The US revealed a large left hypoechoic, spongiform nodule &amp;gt;5cm with grade 2 vascularity with no calcification measuring 5.1 x 4.3 cm. The thyroid labs were within normal range and she denied any compressive symptoms. FNAB of the nodule showed benign colloid. Given the large size of the nodule, we recommended surgical resection but the patient declined and preferred conservative management. Five months later, she started to experience dysphagia with positional neck pain and shortness of breath. Due to the progression of the compressive signs, the patient opted for left thyroidectomy which revealed multifocal papillary thyroid carcinoma (PTC) tall cell variant (TCV) with the largest foci of 1.7 cm with extrathyroidal extension and vascular invasion. She then underwent completion thyroidectomy followed by postoperative radioactive iodine ablation later on as the second surgery pathology was also consistent with PTC with metastasis to the lymph nodes. She was treated with levothyroxine with the goal to suppress TSH. Postoperatively, the patient is being monitored with biochemical testing and imaging for recurrence given the aggressive nature of her disease. Discussion There is a positive correlation between nodule size and false negative results (FNR). FNR for malignancy is known to be higher in nodules larger than 4cm. Patients with large thyroid nodules causing compressive signs should undergo resection regardless of the FNAB result. This patient had a benign FNAB initially which was misleading as the pathology of thyroidectomy was consistent with TCV PTC, a more aggressive variant. TCV PTC usually presents in larger nodules and with a higher rate of extrathyroidal extension and metastasis compared to classic. The prognosis is poorer with TCV, even without an extranodal extension. This patient received appropriate treatment with total thyroidectomy, THR therapy, sequential imaging, and biochemical testing for recurrence. A key takeaway here is that FNABs may not always reflect accurate histology of the whole lesion with larger nodules having a higher tendency for inadequate sampling. Key to successful biopsy and reducing FNAB false-negative results is an experienced radiologist, a cytopathologist familiar with these tumors, and US guidance. Presentation: Saturday, June 17, 2023

Evaluation of Thyroid Nodules in Patients With Fine-Needle Aspiration Biopsy.

The incidence of thyroid nodules has increased in the last 50 years due to the widespread use of imaging methods and incidental detection of small thyroid nodules. Thyroid fine-needle aspiration biopsy (FNAB) is the most accurate, reliable, and cost-effective test to evaluate thyroid nodules. In this research, we aimed to elucidate thyroid fine-needle aspiration cytology (FNAC) to understand how suspicious cases predict malignancy. Within this research's scope, 411 patients over 16 years old who were evaluated in IzmirKatipCelebi University, Ataturk Training and Research Hospital Internal Medicine (Izmir, Turkey) outpatient clinic for thyroid nodules between2018 and 2022and underwent thyroid FNAC followed by thyroid surgery were analyzed retrospectively. The age, gender, thyroid FNAC, operation type, and histopathology of all the patients were reviewed. Individuals with a history of head and neck cancer were excluded from the analysis. No statistically significant relationship between the pathology results and demographic characteristics was found. A statistically significant correlation existed between the pathology and FNAB results (p<0.05). Although 84.5% of the patients were diagnosed as benign, 14.7% as suspicious, and 0.8% as malignant in FNAC, all of these cases were diagnosed as benign in final histopathology results. Similarly, 21.9% of the patients were diagnosed asbenign, 58.8% as suspicious, and 19.4% as malignant in FNAC and all of these cases were diagnosed as malignant in final histopathology results. A correlation was determined between the two measurements (Cohen's kappa(κ)=0.557; p<0.001). The test's sensitivity was 47%, and the specificity was 99.1%. According to the FNAC results, the rate of being diagnosed with malignancy (positive predictive value (PPV)) was 93.9%, and the rate of being diagnosed as benign (negative predictive value (NPV)) was 85.8% for the individuals initially diagnosed as benign. Although FNAB remains the most important diagnostic tool to identify benigncases with a high accuracy rate, the operation decision is not clear in suspicious atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) cytology findings. In conclusion, this study highlights the importance of FNA results andhelps in surgical decision-making by emphasizing that the possibility of malignancy in the post-operative final histopathology report is higher, especially in the presence of suspicious FNAC results.

Predictors and a prediction model for positive fine needle aspiration biopsy in C-TIRADS 4 thyroid nodules.

To screen out the predictors and establish a prediction model of positive fine needle aspiration biopsy (FNAB) in the Chinese Guidelines for Malignant Risk Stratification of Thyroid Nodule Ultrasound (C-TIRADS) 4 thyroid nodules, and this nomogram can help clinicians evaluate the risk of positive FNAB and determine if FNAB is necessary. We retrospectively analyzed data from 547 patients who had C-TIRADS 4 thyroid nodules and underwent fine-needle aspiration biopsy (FNAB) at the Second Affiliated Hospital of Chongqing Medical University between November 30, 2021 and September 5, 2022. Patients who met our inclusion criteria were divided into two groups based on positive or negative FNAB results. We compared their ultrasound (US) features, BRAF V600E status, thyroid function, and other general characteristics using univariate and multivariate logistic regression analyses to identify independent predictors. These predictors were then used to construct a nomogram. The calibration plot, area under the curve (AUC), and decision curve analysis were employed to evaluate the calibration, discrimination, and clinical utility of the prediction model. Out of 547 patients, 39.3% (215/547) had a positive result on fine-needle aspiration biopsy (FNAB), while 60.7% (332/547) had a negative result. Univariate logistic regression analysis revealed no significant differences in TPOAb, TgAb, TSH, Tg, nodule location, sex, or solid status between the two groups (P>0.05). However, age, nodule size, internal or surrounding blood flow signal, microcalcifications, aspect ratio, morphology, and low echo showed significant differences (P<0.05). Multivariate logistic regression analysis was conducted to explore the correlation between potential independent predictors. The results showed that only age (OR=0.444, 95% Cl=0.296~0.666, P<0.001), low echo (OR=3.549, 95% Cl=2.319~5.432, P<0.001), microcalcifications (OR=2.531, 95% Cl=1.661~3.856, P<0.001), aspect ratio (OR=3.032, 95% Cl=1.819~5.052, P<0.001), and morphology (OR=2.437, 95% Cl=1.586~3.745, P<0.001) were independent predictors for a positive FNAB. These variables were used to construct a prediction nomogram. An ROC curve analysis was performed to assess the accuracy of the nomogram, and AUC=0.793, which indicated good discrimination and decision curve analysis demonstrated clinical significance within a threshold range of 14% to 91%. In conclusion, 5 independent predictors of positive FNAB, including age (≤45 years old), low echo (yes), microcalcifications (yes), aspect ratio (>1) and morphology (irregular), were identified. A nomogram was established based on the above 5 predictors, and the nomogram can be used as a complementary basis to help clinicians make decisions on FNAB of C-TI-RADS 4 thyroid nodules.

Should encountering atypia of undetermined significance / follicular lesion of undetermined significance after thyroid biopsy lead to the operation?

Objectives: Nodular goiter is the most common disease of the thyroid gland. Thyroid nodules are malignant in 3-5% cases. To determine the incidence of malignancy in patients defined as atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) as a result of fine needle aspiration biopsy (FNAB) and evaluate the clinical, biochemical and sonographic features as possible predictors of malignancy. Methods: Patients who had undergone at least one FNAB and diagnosed as AUS/FLUS from January 2011 to December 2015 were included in the study. Age, gender, benign disease, thyroid stimulating hormone (TSH) level, size, localization, number, time of FNAB, ultrasonography (USG) characteristics, follow-up data on repeated FNAB results and, if surgical excision was performed, final pathological results were analyzed. Results: A total of 5181 thyroid nodules were biopsied in 4089 patients, and the biopsy specimen taken from 611 nodules was diagnosed histopathologically as AUS/FLUS (11.79%). After FNAB, 167 of 611 patients diagnosed with AUS/FLUS were operated. While 65.9% (n = 110) of 167 patients who underwent surgery were made a benign diagnosis; malign diagnosis was made to 34.1% (n = 57). Conclusions: The rate of malignancy in surgically confirmed nodules was 34.1% in this study, which is higher than the Bethesda classification. Due to the high malignancy rate which determined in cytologically diagnosed AUS/FLUS, we think that the repeat decision of the FNAB should be reconsidered and the surgical plan after the first FNAB should be considered more seriously.

Factors affecting the false negativity of fine-needle aspiration biopsy in thyroid nodules with indeterminate cytology

Purpose: False negative results of fine needle aspiration biopsies (FNAB) remain one of the most important problems in the management of thyroid nodules. The aim of this study was to evaluate the factors affecting the false negative results of FNAB, especially in thyroid nodules with indeterminate cytology.&#x0D; Materials and Methods: Patients with thyroid nodules who underwent FNAB and subsequent thyroidectomy between January 2017 and January 2020 were included in the study. FNAB was performed on suspicious nodules according to the TIRADS classification. Nodules with "atypia/follicular lesion of undetermined significance (AUS/FLUS)", "non-diagnostic (ND)" cytology or "follicular neoplasm/suspicious for follicular neoplasm (FN/SFN)" according to FNAB were defined as "indeterminate cytology (IC)". Nodules were analyzed in two groups. Nodules with false negative FNAB were included in Group-1, while nodules with true positive and true negative FNAB were included in Group-2. Demographic and clinical data, pathologic results and genetic profiles of the patients were statistically compared for all patients and IC group separately.&#x0D; Results: The results of FNAB and final pathology were discordant in 94 patients (Group-1) and concordant in 233 patients (Group-2). In the IC subgroup, 56 of 95 patients were in IC/Group-1 and 39 patients were in IC/Group-2. The accuracy of FNAB was statistically significantly higher in the presence of extrathyroidal extension (71.4% vs. 30.8%), perineural/lymphovascular invasion (60.0% vs. 29.6%), classical variants (68.5% vs. 50.7%), non-encapsulated tumors (67.9% vs. 50.0%) and multicentricity (47.2% vs. 24.1%). In the IC group, the presence of thyroiditis (75.0% vs. 49.2%) and high serum Anti-TPO levels (60.0% vs. 30.7%) increased the rate of false negativity on FNAB. High serum Neutrophil to Lymphocyte Ratio (NLR) and small tumor size also increase the false negativity of FNAB, especially in IC group patients.&#x0D; Conclusion: The diagnostic accuracy of FNAB is increased in classical variant tumors and in tumors expected to be aggressive due to presence of extra-thyroidal extension, perineural/lymphovascular invasion, non-encapsulated tumors and multicentricity. It should be kept in mind that the false negative results of FNAB increase in the presence of thyroiditis, high level of serum anti-TPO and high level of NLR.

Comparison of thyroid fine needle aspiration biopsy and ultrasonography results.

Thyroid nodules are one of the most common health problems in the community. Although most of the nodules are benign, Fine needle aspiration biopsy (FNAB) is requested due to malignancy concerns. In this research, the aim was to make a comparison of the results of thyroid ultrasonography (USG) and FNAB for thyroid nodules. This study was conducted retrospectively on the data of 532 patients. Detail Edu ultrasonographic assessment was conducted before the FNAB procedure and FNAB was performed by an endocrinology specialist. FNAB results and Thyroid USG features were compared, and thyroid FNAB results were graded using the classification of World Health Organization Bethesda-2017. The average age of the individuals included in the research was 49.99 ± 13.65 (min = 18-max = 97). According to the 2017 Bethesda classification, 74.6% of FNAB results were benign, 16% follicular lesion of undated mined significance or A type of undated mined significance, 0.9% were malignant, and 1.1% were suspicious for malignancy. When USG findings were compared according to FNAB results, it was found that malignant lesions were significantly higher in single nodules (non- cystic and non- mixed lesions). Lesions with a single nodule on USG were found to be 3.6 times more likely to be malignant (OR 95% CI: 1.172-11.352). The gold standard method for the diagnosis the presence of thyroid nodules is thyroid fine needle aspiration biopsy with ultrasound guidance. Taking samples from the correct nodule and component increases its value. The presence of a single nodule from the thyroid USG features was found to be an important predictor of malignancy according to the biopsy results.

Fine needle aspiration biopsy as a diagnostic method that guides the clinician and affects the treatment in parotid gland masses

ABSTRACT&#x0D; Objective: The aim of our study was to determine the specificity and sensitivity criteria of parotid fine needle aspiration biopsy in the diagnosis of parotid gland masses in our instution, and guide the physician by using FNAB before surgery.&#x0D; Study design: Retrospective chart review&#x0D; Methods: Retrospective analysis was conducted by comparing the fine needle aspiration biopsy results of 80 patients with complete data and postoperative histopathological diagnoses of 90 patients who underwent fine needle biopsy in our clinic between 2015 and 2022 and were subsequently operated. Correlation of preoperative FNB results to final surgical pathology was performed and measures of diagnostic accuracy computed.&#x0D; Results: Of all patients, 56.3% were male and 43.7 were female. The mean age was 48 (range 19-87). 56.2% of them were right-sided and 43.8% were left-sided. When the fine needle aspiration biopsies of the patients were examined, 47 were reported as benign (58.8%), 2 as malignant (2.5%), 21 as suspicious (26.3%), and 10 as insufficient (12.5%). Of 80 patients, 34 were diagnosed as pleomorphic adenoma, 14 as whartin tumor, and 7 as sialoadenitis.&#x0D; Conclusion: FNAB is one of the most important diagnostic tools in the diagnosis of parotid gland masses when applied knowing its advantages and given treatment without ignoring the deficiencies. It should be kept in mind that subtyping with FNAB in cases with malignant histopathological diagnosis will reduce the secondary surgical needs of the cases.

A-287 UTILITY OF CORRELATION BETWEEN TI-RADS AND BETHESDA CLASSIFICATION TO ESTIMATE RISK OF MALIGNANCY FOR CYTOLOGICALLY INDETERMINATE THYROID NODULES

Abstract Background Currently, we are directing therapeutic strategy based on the results of fine-needle aspiration biopsy defined by the Bethesda classification. The TI-RADS classification of ultrasound features can help surgeons to estimate the risk of malignancy (ROM). The aim of this study was to explore the correlation between the two classifications. Methods All patients who underwent a total or hemithyroidectomy from January 2021 to June 2022 in a high-volume endocrine surgery center were included in this study. The results of TI-RADS classification and Bethesda classification were collected, as well as the pathologic results. Multivariable logistic regression analysis was performed to determine whether malignancy correlated with the Bethesda diagnosis and TI-RADS score. Results During the study period, 1903 patients had thyroid surgery including 848 (44.6%) who had a final pathologically verified thyroid cancer. Bethesda group III was associated with a ROM of 25.4%; in association with a TI-RADS 5 the ROM increased to 48.6%. Bethesda IV was associated with a ROM of 33.5% but, when combined with TI-RADS 3 or 5, the ROM ranged between 33.3 and 44.8% respectively. Bethesda 5 group was associated with a ROM of 81.8% and in combination with TI-RADS 5 score the ROM increased to 90.2%. Our model used the TI-RADS score to stratify the ROM for each Bethesda diagnostic group. We found that the model was more accurate than using the Bethesda diagnosis alone especially for estimation of ROM for Bethesda III thyroid nodules classified as Bethesda III. Conclusion Use of TI-RADS scores for each Bethesda diagnostic group allow a more accurate assessment of ROM for indeterminate thyroid nodules.

Correlation of Thyroid Fine Needle Aspiration Biopsy With Histopathological Results.

Introduction Fine needle aspiration biopsy (FNAB) is an effective method used in the differential diagnosis of thyroid nodules. The Bethesda system has contributed to the determination of clinical approaches by bringing standardization to cytopathology reporting. However, the rate of cytological-histological incompatibility varies between 10% and 30%. Results differ according to clinics in the literature. These results create a need to reevaluate the efficacy and safety of fine needle aspiration biopsy. In this study, we aimed to evaluate the diagnostic accuracy of FNAB of thyroid nodules by correlating the cytopathology results of FNAB with the results of postoperative histopathology. Methods In this retrospective study, thyroid FNAB results and postoperative histopathology results of patients who underwent thyroidectomy operations in our clinic between January 2018 and December 2021 were compared. Accuracy, sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), false positive rate (FPR), and false negative rate (FNR) were calculated. Cases with nondiagnostic FNAB results were excluded from the calculations.FNAB results with a follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN) and suspicious for malignancy were included in the malignant group. Results A total of 304 patients were included in the study. The male/female ratio was 1:3.3. As a result of the study, malignancy was detected histopathologically in 47 (15.46%) patients. The commonest malignancy detected was papillary carcinoma. According to the Bethesda system, the results were evaluated in six categories. The incidence of malignancy in the Bethesda categories were 0%, 4%, 40%, 69.2%, 100%, and 100%, respectively. Accordingly, the specificity and sensitivity of FNAB for detecting malignancy were 98.7% and 66.6%, respectively. The accuracy was 93.5%. The false positive rate, false negative rate, positive predictive value, and negative predictive value were 1.20%, 33.3%, 91.4%, and 93.8%, respectively. Conclusion Thyroid FNAB is an effective method used with satisfactory reliability in the differential diagnosis of malignancies of thyroid nodules. Still, it has some limitations. This article demonstrates higher rates of malignancy in Bethesda categories III and IV. Therefore, clinical approaches are gaining importance in these categories.

Predictive factors for sufficient cytological result after first nondiagnostic thyroid fine-needle aspiration biopsy result

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Clinical, cytological and ultrasonographic features of incidental thyroid cancer in a hospital‐based study in vietnam

Thyroid nodules are common diseases of the endocrine system, with a 5% prevalence rate in the general population. This study aimed to identify prevalence, clinical, cytological and ultrasonographic features of incidental thyroid cancer and its associated factors in Vietnam. This cross-sectional descriptive study consisted of 208 patients with incidental thyroid nodules detected by ultrasound at the Endocrinology Department, Bach Mai Hospital, Hanoi, Vietnam between November 2019 and August 2020. Clinical information, sonography characteristics of thyroid nodules, results of fine-needle aspiration biopsy (FNAB), postoperative pathology and lymph node metastasis were collected. A multiple logistic regression model was used to estimate factors associated with thyroid cancer. A total of 272 thyroid nodules (from 208 participants) were included in this study. The mean age was 47.2± 12.0 (years). The rate of incidental thyroid cancer patients detected was 17.3%. Nodules <1 cm in size were significantly more prevalent for malignant nodules. The size of more than half of thyroid cancer nodules was 0.50-0.99 cm. Postoperative pathology of all nodules with Bethesda V and VI was papillary thyroid cancer which was consistent with cytological results. 33.3% of thyroid cancer patients have lymph node metastasis. The regression model showed that thyroid cancer was more likely to occur at a younger age (≤ 45 years vs. >45 years, OR 2.8; 95% CI: 1.3-6.1), taller-than-wide nodules (OR 6.8; 95% CI: 2.3-20.2) and hypo-echoic nodules (OR 5.2; 95% CI: 1.7-15.9). The study showed that the prevalence of incidental thyroid cancers was 17.3%, of which 100% was papillary carcinoma. People under the age of 45 and the presence of ultrasound characteristics, such as taller-than-wide and hypoechoic nodules increased risk for malignancy.

Risk assessment of cytologically indeterminate thyroid nodules with integrated molecular testing and repeat biopsy: a surgical decision-oriented tool

BackgroundThe preoperative diagnosis of cytologically indeterminate thyroid nodules (ITNs) is very challenging. In this study, we aim to provide an integrated risk assessment for thyroid nodules with indeterminate cytology to guide surgical decision-making, which includes results of blood tests, molecular tests, and repeat fine-needle aspiration biopsy (FNAB).MethodsThe study retrospectively included 265 ITNs between June 2019 and April 2022. According to our integrated risk assessment process that starts with blood testing, followed by supplementary DNA mutation detection on the first FNAB, and finally repeat FNAB, we divided the ITNs into high-risk and low-risk groups. Performance was evaluated with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under the receiver operating characteristic curve (AUC), and the consistency between the risk evaluation and histological results.ResultsOf the 265 ITNs, 87 were included in the risk assessment process. The risk assessment had a sensitivity of 84.1%, specificity of 83.3%, PPV of 95.1%, NPV of 57.7%, and AUC of 0.837. The nodules with consistent results between the risk groups and histological outcomes, which included malignant cases in the high-risk group and benign cases in the low-risk group, accounted for 83.9% of all risk-assessed nodules.ConclusionsThese data suggest that the integrated risk assessment might provide proper information for surgical decision-making in patients with ITNs.

Thyroid fine needle aspiration biopsy results before and during the COVID-19 pandemic: From a single centre perspective

Aim: One of the effects of the COVID-19 pandemic on the healthcare system has been the postponement of elective procedures. We aimed to investigate how the COVID-19 pandemic has affected our thyroid fine-needle aspiration biopsy (FNAB) results. Method: The distribution of cytology results during the 16.5 months of the pandemic was compared with the pre-pandemic period by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) diagnostic categories. Results: The number of FNABs performed during the pandemic period decreased by 27.3% compared to the pre-pandemic period in our center, in line with the recommendations (1197 to 327 diagnostic FNABs). Benign biopsy results decreased during the pandemic period compared to the pre-pandemic period (77.3% to 49.5%, p&lt;0.001), and indeterminate biopsy results (AUS/FLUS, FN/SFN, and SUS) increased from 19.5% to 45.9 %, p&lt;0.001. Malign biopsy rates did not differ between pre-pandemic and pandemic periods (3.3% to 4.6%, p=0.25). Conclusion: Although the number of FNAB decreased due to pandemic measures, we found a decrease in benign cytology and an increase in indeterminate for malignancy. The pandemic period allowed us to be more selective when deciding on a biopsy for FNABs. We recommend that the risk assessment of nodules be done carefully when making the biopsy decision in the next period. Although it is recommended not to delay FNAB for nodules at risk for malignancy, it should not be forgotten that the surgical decision should not be hasty in indeterminate results, and follow-up can be continued, or biopsy can be performed again under appropriate conditions.

Prevalence of thyroid cancer in hyperthyroidism: Identifying risk factors for malignancy

Objective: Contrary to the previously held belief that hyperthyroidism may be protective against the development of cancer, a growing number of studies suggest a link between hyperthyroidism and thyroid cancer. The purpose of this study is to investigate the incidence of malignancy in patients undergoing total thyroidectomy for hyperthyroidism with toxic adenoma (TA), toxic multinodular goiter (TMNG), and/or Graves' disease (GD), and to identify factors predictive of malignancy. Materials and Methods: This is a retrospective study of patients aged 18 years and older who underwent total thyroidectomy for toxic adenoma and toxic multinodular goiter associated with hyperthyroidism and Graves' disease. Thyroidectomies were performed by a single surgeon at a tertiary teaching hospital between January 2014 and December 2020. Our cohort was divided into two separate groups based on whether the pathology results were malignant or benign. Results: Between January 2014 and December 2020, 199 patients were included, 66.3% were female and the average age was 44.6 years. Hyperthyroidism cases included 52.7% toxic multinodular goiter (TMNG), 9.1% toxic adenoma (TA), and 38.2% Graves’ disease (GD). The cohort revealed a 32.6% thyroid cancer incidence in hyperthyroid patients. The leading malignancy was papillary carcinoma. Hyperthyroidism causes significantly predicted malignancy; TMNG had a 42.8% malignancy rate, compared to 22.4% for GD and 16.3% for TA (p=0.005). Fine needle aspiration biopsy (FNAB) findings were significant for malignancy prediction (p=0.001), with 62.9% malignancy after non-diagnostic FNAB results. Conclusion: The study emphasizes the need for careful consideration of malignancy risk in hyperthyroidism cases. Factors such as FNAB results and the type of hyperthyroidism condition significantly influenced malignancy prediction. The results underscore the necessity for a thorough evaluation of hyperthyroid patients at risk of malignancy.