Fine-needle Aspiration Cytology Of Thyroid Nodules Research Articles

Factors for second non-diagnostic ultrasound-guided fine-needle aspiration cytology in thyroid nodules

IntroductionResults in fine-needle aspiration cytology (FNAC) of thyroid nodules may be non-diagnostic (ND). In these cases, it is recommended to repeat the FNAC. The aim of our study was to evaluate the influence of demographic, clinical and ultrasound (US) characteristics in the recurrence of an ND result in thyroid nodule FNAC. MethodsA retrospective study of ND thyroid nodule FNAC was performed for the period 2017–2020. Demographic and clinical data (age, gender, cervical radiotherapy, presence of Hashimoto's thyroiditis, and TSH value) and US characteristics (nodule size, echogenicity, composition and microcalcifications) were collected at first ND FNAC. ResultsOut of 230 nodules with first ND FNAC (83% women; mean age 60.2±14.1 years), 195 (84.8%) underwent a second FNAC: 121 benign, 63 non-diagnostic, 9 indeterminate and 2 malignant. Nine (3.9%) underwent surgery, only 1 of which showed malignant histology and 26 (11.3%) remained under US monitoring. Demographically, patients with second ND FNAC were older (63.4±14 vs. 59±14 years; P=0.032). Females had lower risk of second ND FNAC (OR, 0.4, 0.2–0.9; P=0.016); risk of second ND FNAC was higher in patients treated with anticoagulant/antiplatelet drugs (OR, 2.2, 1.1–4.7; P=0.03). Previous cervical radiotherapy, family history of thyroid cancer, Hashimoto's thyroiditis and TSH value did not influence the risk of second ND FNAC. On US, nodule echogenicity differed significantly between the ND and diagnostic FNAC, with greater risk of an ND result in hypoechogenic nodules. Microcalcification increased the risk of ND FNAC (OR 2.2, 1.1–4.5; P=0.03). Nodule composition and size did not significantly differ according to ND or diagnostic second FNAC. ConclusionMale gender, advanced age, anticoagulant/antiplatelet drug therapy, hypoechogenic nodules and microcalcified nodules are likely factors for second ND FNAC. Nodules with two ND FNACs were rarely malignant, and a more conservative approach in these cases is not unsafe.

Association of Fine-Needle Aspiration of Thyroid Nodules With Final Histopathology in Diagnosing Thyroid Malignancy: A Single Institute Retrospective Study.

Background Fine needle aspiration cytology (FNAC)is the gold standard for detecting thyroid nodules. It is a cost-efficient approach that affords prompt and accurate evaluation. It is crucial in deciding to treat patients with suspected malignancy of thyroid nodules that might have thyroid surgery. According to findings in cytology, patients may be observed when the cytology is benign, and surgery can be performed if the cytology is malignant, which leads to a reduction in the incidence of unneeded surgery. Aim The current study aims to assess the concordance between FNAC of thyroid nodules with final histopathology and identify the different types of detected thyroid lesions. Methodology A retrospective record-based study reviewed the medical files of all patients presenting to the Armed Forces Hospital, Southern region, with suspected thyroid nodules from April 2018 to January 2020. Data were extracted using pre-structured data extraction sheet to avoid inconsistency. Data extracted included patients' demographic data, swelling laterality, size, ultrasound, and histopathological findings. Results The baseline characteristics of studied samplesin the present study:Forty-seven samples had a mean age of 44.27 (SD=±13.5) years, and 85.1% were female gender. The study showed that 12.5% of benign samples were lymphocytic in histopathology, 25% suspicious for follicular neoplasm samples were benign multi-nodular goiter in histopathology, and all 100% of samples suspicious for malignancy were malignant in final histopathology. Conclusions The current study showed that the malignancy rate of the examined nodules was not uncommon in FNAC and histopathology. Where papillary carcinoma was the most detected malignancy, the diagnosis of malignancy using FNAC is a cost-efficient approach that affords prompt and accurate evaluation. Once diagnosed, these cases should be subjected to surgery.

ODP457 A Single-center Retrospective Study of Thyroid Nodules 4 cm or Larger

Abstract Background There is conflicting data and no clear consensus regarding the management of thyroid nodules 4 cm or larger. Diagnostic accuracy of fine needle aspiration (FNA) cytology of these nodules has been variable. Few studies have reported higher false negative rates suggesting surgery as reasonable option whereas other studies reported low false negative rates with no significant difference between small and large nodules. The goal of our study was to evaluate the reliability of FNA cytology in excluding malignancy in thyroid nodules 4 cm or larger in our patient population and to investigate the association between malignancy and any patient specific risk factors or ultrasound features. Methods We conducted a retrospective review of 380 patients with thyroid nodules who underwent thyroid surgery between 2014 and 2021 at our institution. Patient demographics such as age, gender and ethnicity, number and size of thyroid nodules, TSH level, FNA cytology, type of surgery and final surgical pathology results were recorded for patients with nodules 4 cm or larger and nodules between 2-4 cm. False negative rate of FNA cytology was compared between these two groups. Accessible ultrasound images for nodules 4 cm or larger were reviewed. Patient specific and nodule characteristics were compared between malignant and benign nodules. Fisher exact tests and multivariate logistic regression were used for data analysis. Results A total of 81 patients with thyroid nodules 4 cm or larger were studied, of which 22 patients (27.1%) had thyroid cancer. Mean age in patients with malignant nodules was 48.1 +/- 18.3 years versus 51.7 +/- 14.5 years in patients with benign nodules. The adjusted odds of malignancy for males was 20 times (95% CI: 3.3-125; p=0. 001) the odds for females. The adjusted odds of malignancy for nodules with both peripheral and internal vascularity on doppler ultrasound was 9.9 times (95% CI: 1.36-71.70; p=0. 024) that of nodules with only peripheral vascularity. Other nodule characteristics like composition, echogenicity, margins, halo, echogenic foci and taller than wide shape were not significantly different between malignant and benign nodules. False negative rate of FNA cytology for nodules 4 cm or larger was 8.7% (4/46 patients) as compared to 10% (4/40 patients) for nodules between 2-4 cm. This was not statistically significant (p=1. 0). Conclusion In our study, the false negative rate of FNA cytology in thyroid nodules 4 cm or larger was similar to that of nodules between 2-4 cm. This indicates that patients with thyroid nodules 4 cm or larger and benign cytology can be managed conservatively with appropriate clinical follow up. Male gender and nodules with peripheral and internal vascularity on doppler ultrasound were associated with thyroid malignancy in our review. Presentation: No date and time listed

Precision of ultrasonography and fine needle aspiration cytology in the evaluation of thyroid nodules in correlation with histopathology

Background and Objectives: The incidence of palpable thyroid nodules is approximately 4%–7% in the population. Most thyroid nodules are benign in nature but malignancy should be ruled out, which is quite less frequent. In such cases, a reliable diagnostic modality to evaluate and differentiate the malignant thyroid nodules is required. This retrospective study was conducted with the objective to evaluate the accuracy of Fine Needle Aspiration Cytology (FNAC) and Ultrasonography (USG) for diagnosis of euthyroid nodules & to differentiate malignant thyroid nodules from the benign nodules in comparison to histopathological diagnosis. Materials and Methodology: It’s a retrospective study that included 132 patients who underwent USG and FNAC of thyroid nodules. Only patients with available histopathology were included in the study. The results of USG, FNAC were evaluated and correlated with histopathology report considered as the final diagnosis. Results: Out of 132 patients, USG showed benign lesions in 107(81.06%) patients, out of which histopathology showed benign lesions in 103 (96.26%) patients and malignant lesions in 4 (3.74%) patients. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false-positive rate, false-negative rate and accuracy of USG of thyroid lesions were 78.95%, 91.15%, 60%, 96.26%, 8.85%, 21.05%, 89.39% respectively.

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Thyroid Nodules in Thammasat University Hospital

Background: Fine needle aspiration (FNA) cytology is a key investigation of thyroid nodules. There are several reports of FNA accuracy, which ranges from 75.0% to 94.8%, while false negative rates are 5.8% to 21.5%. In Thailand, there is no available data of FNA accuracy according to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The present study reported single-institute data of FNA accuracy, that could be used in thyroid nodule management. Objective: To determine the diagnostic accuracy of FNA cytology results of thyroid nodules collected in Thammasat University (TU) Hospital. Materials and Methods: The present study was a retrospective study collected cytologic results of all thyroid nodules that subsequently had definitive histopathologic diagnoses. The data were gathered from clinics at TU Hospital that performed thyroid nodule FNA between May 2011 and November 2014. The FNA cytology results were classified according to TBSRTC. Each cytopathologic result was compared with its postoperative tissue histopathology. The malignancy rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: The present study included 197 thyroid nodule FNA cytology results. The sensitivity and specificity were 77.8% and 65.4%, respectively. The calculated PPV was found to be 47.7%, and the NPV was 87.9%. The accuracy of these results was 69.0%. The malignancy rate of the unsatisfactory group was 6.25%, benign group 8.05%, atypia of undetermined significance or follicular lesion of unknown significance 22.22%, follicular neoplasm/suspicious for follicular neoplasm 14.20%, suspicious for malignancy 73.68%, and malignant 100%. Conclusion: The FNA cytology in TU Hospital has comparable sensitivity to the other studies. Interestingly, the malignancy rate in the follicular neoplasm category is lower than that of the other institutes because of a high false positive rate in this category. This causes lower specificity and accuracy, which may cause a higher rate of unnecessary operations. Keywords: FNA; Thyroid nodule; Diagnostic accuracy

Correlation of TIRADS and Bethesda Scoring Systems with Final Histopathology of Thyroid Nodules - An Institutional Experience.

Fine needle aspiration cytology (FNAC) reduces the number of unnecessary thyroid surgeries for patients with benign nodules and appropriately triages patients with thyroid cancer to appropriate treatment. This was a observational study done on cases presenting with clinical suspicion of thyroid malignancy which underwent ultrasonography followed by FNAC of thyroid nodule. Ultrasonographic characterization of nodules was based on Thyroid Imaging Reporting and Data System (TIRADS) and cytology reporting was based on Bethesda system. All recruited patients underwent thyroidectomy. Pre-operative cytology and ultrasonography features were compared with final histopathology report. In our study, Bethesda system of cytology reporting for thyroid nodules had a better sensitivity, specificity and diagnostic accuracy than TIRADS system of ultrasound reporting. Bethesda system in FNAC had a larger area under the ROC curve (0.91) as compared to ultrasound TIRADS (0.70). Malignancy rate of TIRADS 5 nodules was 97.1% with significant p value (0.022). 100% of Bethesda VI lesions were malignant according to final histopathology report. Ultrasound TIRADS could pre-operatively predict malignancy in 63.6% of indeterminate thyroid nodules which were malignant according to post-operative histopathology. The overall concordance of ultrasound TIRADS, Bethesda system and histopathology was 69.8%. Higher TIRADS and Bethesda scoring among thyroid nodules was associated with increased risk of malignancy. US TIRADS is a good predictor of malignancy in indeterminate thyroid nodules.

Analytical and clinical validation of pairwise microRNA expression analysis to identify medullary thyroid cancer in thyroid fine-needle aspiration samples.

BackgroundMedullary thyroid carcinoma (MTC) is an aggressive malignancy originating from the parafollicular C cells. Preoperatively, thyroid nodule fine‐needle aspiration cytology (FNAC) and pathogenic gene mutations are definitive in approximately one‐half of cases. MicroRNAs (miRNAs) are endogenous, noncoding, single‐stranded RNAs that regulate gene expression, a characteristic that confers the potential for identifying malignancy. In the current study, the authors hypothesized that differential pairwise (diff‐pair) analysis of miRNA expression levels would reliably identify MTC in FNA samples.MethodsThe relative abundance of 10 different miRNAs in total nucleic acids was obtained from ThyraMIR test results. Diff‐pair analysis was performed by subtracting the critical threshold value of one miRNA from the critical threshold values of other miRNAs. Next‐generation sequencing with the ThyGeNEXT panel identified oncogenic gene alterations. The discovery cohort consisted of 30 formalin‐fixed, paraffin‐embedded benign and malignant thyroid neoplasms, including 4 cases of MTC. After analytical validation, clinical validation was performed using 3 distinct cohorts (total of 7557 specimens).ResultsIn the discovery cohort, 9 diff‐pairs were identified as having significant power using the Kruskal‐Wallis test (P < .0001) to distinguish MTC samples from non‐MTC samples. The assay correctly classified all MTC and non‐MTC samples in the analytical validation study and in the 3 clinical validation cohorts. The overall test accuracy was 100% (95% confidence interval, 99%‐100%). In indeterminate FNAC samples, the sensitivity of the diff‐pair analysis was greater than that of the MTC‐specific mutation analysis (100% vs 25%; P = .03).ConclusionsPairwise miRNA expression analysis of ThyraMIR results were found to accurately predict MTC in thyroid FNA samples, including those with indeterminate FNAC findings.

Diagnostic Accuracy of Fine needle Aspiration Cytology of Thyroid Nodules at two tertiary Hospitals in Zambia: a cross-sectional study

Introduction: Thyroid nodules are one of the common surgical presentations in Africa and are of great concern because of their potential to be malignant. Zambia is not excluded from these common surgical conditions. However, there are no pre-operative cellular or intra-operative tissue diagnoses of the thyroid nodules done before thyroidectomy making it difficult to plan for an optimal and definitive management. Fine needle aspiration cytology (FNAC) is known to play a pivotal role in the screening and management of thyroid swellings. This study serves to assess the diagnostic accuracy of FNAC on thyroid nodules in patients at two tertiary hospitals in Zambia in order to establish a basis for introducing its use in the management of thyroid nodules at the institutions. Objectives: To evaluate the accuracy of FNAC, as compared to histopathology, in the diagnosis of thyroid nodules at University Teaching Hospital (UTH) and Ndola Central Hospital (NCH) in Zambia. Methods: This was a prospective cross-sectional study conducted in UTH and NCH surgery department from June 2014 to March 2015. Seventy-three patients, who presented with palpable thyroid nodules and underwent thyroidectomy, were enrolled in the study. The FNAC diagnosis of the patients was compared to the histopathology finding following thyroidectomy. Results: Females made up the majority of the patients (n=67, 91.8%). The ages of the patients ranged from 18 to 78 years. The mean age was 44.3 years and the peak age of incidence was in the fourth decade. All patients were clinically euthyroid at the time of enrolment. The FNAC findings included 23 cases reported as unsatisfactory (31.5%); 29 cases benign (39.7%); 2 cases atypical (2.7%); 6 cases suspicious (8.2%); and 13 cases malignant (17.8%). Histopathology findings were available from all 73 tissue samples of participants, of which 55 (75.3%) and 18 (24.7%) were reported as benign and malignant respectively. Of the 18 malignant cases identified by histology, the most common cancer was follicular carcinoma (n=9, 50%), followed by papillary carcinoma (n=6, 33.3%) and undifferentiated carcinoma (n=3, 16.7%). FNAC, in this study, had sensitivity, specificity, negative and positive predictive values, and accuracy of 83.33%, 89.09%, 94.23 and 71.42%, and 87.67% respectively. Conclusion: In this study, FNAC of thyroid nodules had a high sensitivity, specificity, predictive values and accuracy, and can therefore be recommended to be adopted as a pre-operative tool for screening of thyroid nodules.

Is thyroid nodule location associated with malignancy risk?

PurposeNodules located in the upper pole of the thyroid may carry a greater risk for malignancy than those in the lower pole. We conducted a study to analyze the risk of malignancy of nodules depending on location.MethodsThe records of patients undergoing thyroid-nodule fine-needle aspiration cytology (FNAC) at an academic thyroid cancer unit were prospectively collected. The nodules were considered benign in cases of a benign histology or cytology report, and malignant in cases of malignant histology. Pathological findings were analyzed based on the anatomical location of the nodules, which were also scored according to five ultrasonographic classification systems.ResultsBetween November 1, 2015 and May 30, 2018, 832 nodules underwent FNAC, of which 557 had a definitive diagnosis. The prevalence of malignancy was not significantly different in the isthmus, right, or left lobe. Among the 227 nodules that had a precise longitudinal location noted (from 219 patients [155 females], aged 56.2±14.0 years), malignancy was more frequent in the middle lobe (13.2%; odds ratio [OR], 9.74; 95% confidence interval [CI], 1.95 to 48.59). This figure was confirmed in multivariate analyses that took into account nodule composition and the Thyroid Imaging, Reporting, and Data System (TIRADS) classification. Using the American College of Radiologists TIRADS, the upper pole location also demonstrated a slightly significant association with malignancy (OR, 6.92; 95% CI, 1.02 to 46.90; P=0.047).ConclusionThe risk of thyroid malignancy was found to be significantly higher for mid-lobar nodules. This observation was confirmed when suspicious ultrasonographic features were included in a multivariate model, suggesting that the longitudinal location in the lobe may be a risk factor independently of ultrasonographic appearance.

False-negative BRAF V600E mutation results on fine-needle aspiration cytology of papillary thyroid carcinoma

BackgroundThe BRAF V600E mutation is highly specific for papillary thyroid carcinoma (PTC). A test for this mutation can increase the diagnostic accuracy of fine-needle aspiration cytology (FNAC), but a considerably high false-negative rate for the BRAF V600E mutation on FNAC has been reported. In this study, we investigated the risk factors associated with false-negative BRAF V600E mutation results on FNAC.MethodsBRAF V600E mutation results of 221 PTC nodules between December 2011 and June 2013 were retrospectively reviewed. BRAF V600E mutation results on both preoperative FNAC and postoperative formalin-fixed, paraffin-embedded (FFPE) samples were compared. We investigated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of BRAF V600E mutation results on FNAC. And, we identified the risk factors associated with false-negative results.ResultsOf 221 PTC nodules, 150 (67.9%) on FNAC and 185 (83.7%) on FFPE samples were BRAF V600E mutation positive. The sensitivity, specificity, PPV, and NPV for BRAF V600E mutation testing with FNAC were 80.5, 97.2, 99.3, and 49.3%, respectively. Thirty-six (16.3%) BRAF V600E mutation-negative nodules on FNAC were mutation positive on FFPE sample analysis. Risk factors for these false-negative results were age, indeterminate FNAC results (nondiagnostic, atypia of undetermined significance (AUS), and findings suspicious for PTC), and PTC subtype.ConclusionFalse-negative rate of BRAF mutation testing with FNAC for thyroid nodules is increased in cases of old age, indeterminate FNAC pathology results, and certain PTC subtypes. Therapeutic surgery can be considered for these cases. A well-designed prospective study with informed consent of patients will be essential for more informative results.

Low Malignancy Rates in Fine-Needle Aspiration Cytologies in a Primary Care Setting in Germany.

Reported results for thyroid nodule fine-needle aspiration (FNA) cytology mainly originate from tertiary centers. However, thyroid nodule FNA cytology is mainly performed in primary care settings for which the distribution of FNA Bethesda categories and their respective malignancy rates are largely unknown. Therefore, this study investigated FNA cytology malignancy rates of a large primary care setting to determine to what extent current evidence-based strategies for the malignancy risk stratification of thyroid nodules are applied and applicable in such primary care settings. In a primary care setting, 9460 FNAs of thyroid nodules were retrospectively analyzed from 8380 patients evaluated by one cytologist (I.R.) during a period of two years. The 8380 FNA cytologies were performed by 64 physicians in different private practices throughout Germany in primary care settings. The cytopathologic results were classified according to the Bethesda System as non-diagnostic in 19%, cyst/cystic nodule in 21%, benign (including thyroiditis) in 48%, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 6%, follicular neoplasms/suspicious for follicular neoplasm (FN/SFN) in 4%, suspicious for malignancy (SFM) in 1%, and malignant in 1%. The proportion of patients proceeding to surgery or with a follow-up of at least one year and the observed risks of malignancy were 22%/8% for AUS/FLUS, 69%/17% for FN/SFN, 78%/86% for SFM, and 71%/98% for malignant. For 112 cytologically suspicious and malignant FNAs, there were 102 true positives and 10 false positives, considering histology as gold standard. At variance with other data mostly originating from tertiary centers, these data demonstrate low percentages for malignant, SFM, FN/SFN, and AUS/FLUS, and high percentages for cysts/cystic nodules in this primary care setting in Germany. The risks of malignancy for malignant, SFM, AUS/FLUS, and FN/SFN FNA cytologies are according to Bethesda recommendations.

“The Diagnostic Accuracy of Thyroid Nodule Fine-Needle Aspiration Cytology Following Thyroid Surgery: a Case–Control Study”

Thyroid surgery may cause regional scarring and some degree of fibrotic process which may extend into the perithyroidal soft tissues. This may result in problems when collecting thyroid fine-needle aspiration biopsy (FNAB) samples and evaluating the cellular abnormalities. This study aimed to determine if a history of thyroid surgery is a risk factor for nondiagnostic (ND) FNAB results. Patients with ≥1 discrete nodular lesion of the thyroid who underwent FNAB were included. The patients with a history of thyroid surgery constituted group 1, and the others constituted group 2. The factors which may influence FNAB results, including age, gender, presence of Hashimoto's thyroiditis, and ultrasound characteristics, were also evaluated. Group 1 included 123 patients with 200 nodules, and group 2 included 132 patients with 200 nodules. The two groups were similar with respect to demographic characteristics of the patients and ultrasonographic features of the nodules including diameter, content (cystic or solid), echogenicity, margin, and calcifications (P > 0.05). In all, 176 (44 %) of the participants had ND FNAB results. The median time interval between thyroid surgery and FNAB was 15 years [range, 1-45 years; interquartile range (IQR) 13 years]. Significantly more nodules in group 1 had ND FNAB results than in group 2 [98 (49 %) vs 78 (39 %), respectively, P = 0.028]. Multivariate analysis revealed that history of thyroid surgery was independently associated with ND FNAB [odds ratio (OR) 1.55, 95 % confidence interval (CI) 1-2.33, P = 0.033]. A history of thyroid surgery increases the risk of initial ND FNAB.

Frequency and Intensity of Pain Related to Thyroid Nodule Fine-Needle Aspiration Cytology

Quality of life is an important issue in endocrine tumors because of the high prevalence of benign tumors and the indolent course of most malignant tumors. To evaluate the frequency and the intensity of pain and anxiety in patients undergoing thyroid nodule fine-needle aspiration cytology (FNAC) and to identify factors associated with pain. Single center prospective study in the setting of a one-stop outpatient diagnostic clinic for thyroid nodules. Pain was evaluated using a 100-mm visual analogue scale (VAS) immediately following (VAS1) and 30 minutes after (VAS2) FNAC and was considered significant if ≥ 30. Anxiety symptoms were assessed prior to FNAC using a self-report measure questionnaire: the state form of Spielberger State-Trait Anxiety Inventory (STAI, form Y-A). FNAC was performed with a 25-gauge needle and a moderate aspiration and two passes for each nodule. Two hundred eighteen consecutive patients (163 females, 55 males; mean age 53 years, range 12-84 years) undergoing FNAC of one to three nodules were included. VAS1 was ≥ 30 in 24% of the patients and VAS(2) was ≥ 30 in 13% of the patients. Independent significant factors correlated to a VAS1 of ≥ 30 were age under 25 years and the number of nodules being biopsied. Independent significant factors correlated to a VAS2 of ≥ 30 were VAS1 ≥ 30 and female sex. No correlation was found between pain and nodule size or nodule depth, nor the duration of application of the eutectic mixture of local anesthetics (EMLA) patch prior to FNAC. The mean STAI score for anxiety was 37 ± 12. The average STAI score was significantly higher in women (39) than in men (33; p = 0.01). There was no significant correlation between STAI score and age under 25 years, previous FNAC, number of nodules biopsied, or acetaminophen administration, but the STAI score was significantly correlated to VAS1 and VAS2. FNAC-related pain is frequent and correlates with the number of nodules biopsied, age under 25 years, female sex, and anxiety.

Intrinsic factors affecting adequacy of thyroid nodule fine‐needle aspiration cytology

To evaluate intrinsic nodule features predictive of an inadequate report in fine-needle aspiration cytology (FNAC). Single-centre cross-sectional study. Between May 2005 and April 2011, 3279 ultrasonography-assisted FNACs were carried out and features of nodules recorded prospectively. Univariate logistic regression analyses were performed to estimate the association between nondiagnostic cytology and variables such as age, gender, single nodule, maximum nodule diameter and estimated volume. Inadequate or nondiagnostic samples were reported in 1195 FNACs. All diameters were found to be predictors of nondiagnostic cytology; estimated nodule volume, on the other hand, was not. Nodules with a diameter <10 mm were more frequently nondiagnostic (OR 1.65, 95% CI 1.40-1.94, P < 0.001). Neither micro- nor macrocalcification increased the risk of inadequacy. On the contrary, mixed lesions were more frequently diagnostic (OR 0.68, 95% CI 0.85-0.80, P < 0.001). Solid nodule aspiration was performed more easily on isoechogenic nodules (OR 0.64, 95% CI 0.54-0.77, P < 0.001); the same procedure was more cumbersome on hypoechogenic lesions (OR 1.87, 95% CI 1.62-2.16, P < 0.001). Increased vascularization did not cause a significant increase in the nondiagnostic results. Blurred margins increased the inadequacy rate (OR 1.45, 95% CI 1.24-1.69, P < 0.001), while presence of a hypoechogenic halo decreased it (OR 0.67, 95% CI 0.54-0.82, P < 0.001). Some ultrasonographic features suggestive of malignancy may be predictive of inadequate cytology. Patients must be notified that the FNA report may be nondiagnostic and that this represents a limitation of the technique related to the structure of lesions.

150. Indeterminate FNAC in thyroid nodules – How certain do we want to be?

Background: it is estimated that a palpable thyroid nodule, which has a prevalence of 5%, is a follicular neoplasm in 15-20% of cases. All patients with a solitary thyroid nodule should have fine-needle aspiration cytology (FNAC) as the initial screening test but, unlikely, up to 30% patients with nodular thyroid disease will receive a FNAC report diagnostic for follicular lesion, or suspicious. Thence, most patients with follicular lesions will require surgical management.

Investigating the value of fine needle aspiration cytology in thyroid cancer

Background:Current guidance recommends the use of fine needle aspiration cytology (FNAC) as an essential investigation in patients presenting with a thyroid lump. Current literature suggests that the sensitivity of FNAC in thyroid nodules ranges between 80-90%. However, only very few studies have looked specifically at the sensitivity of FNAC in solely thyroid cancer patients.Aims:The aim of our study was to investigate the value of FNAC as a first-line investigation in patients with thyroid cancer. We aimed specifically to assess the sensitivity of FNAC within this group.Materials and Methods:Patients diagnosed with thyroid cancer between 2000-08 were identified from a local histopathology database. Sixty-seven case notes were retrieved, retrospectively reviewed and analyzed. Analysis included results of FNAC, ultrasound scanning and final histopathological diagnosis.Results:Analysis of the 56 patients who underwent FNAC revealed that a cytological grading of thy3 or greater was only given to 31 cases (55.3%).Conclusion:In this study, FNAC findings of thy3 or greater were reported only in 55.3% of proven thyroid cancer cases. This study highlights the greater diagnostic difficulties of thyroid cancer compared to other thyroid nodules. Our findings suggest that clinicians must interpret the results of this initial investigation with caution and consider the routine use of ultrasound scanning to help guide FNAC.

Does Fine-Needle Aspiration Cytology Optimize the Surgical Management of Thyroid Disorders in Endemic Goiter Region?

The aim of this study was to determine the diagnostic value of fine-needle aspiration cytology (FNAC) before thyroidectomy in an endemic goiter region. One hundred patients with preoperative FNAC of thyroid nodules who underwent thyroidectomy were recruited. FNAC were classified into five groups. 0, no thyroid cells; 1, normal thyroid cells; 2, degenerative thyroid cells without evidence of malignacy; 3, follicular or oncocytary neoplasia; and 4, malignant thyroid cells. FNAC was compared with postoperative histopathological diagnoses. Only 76% of the FNAC allowed an adequate cytological examination. In 15 patients (15%), carcinomas were found in the postoperative histopathological diagnosis (including four follicular carcinomas). In the 48 patients of FNAC groups 3 and 4, nine carcinomas (18.7%) were found (including four follicular carcinomas). In the 28 patients of groups 1 and 2, there was only one papillary carcinoma (3.5%). In the 24 patients of group 0, there were two papillary, two follicular, and one anaplastic carcinomas (total of 20.8%). The sensitivity, specificity, and likelihood ratio (LR) of the FNAC for benign nodules were 90%, 40.9%, 0.24, respectively. The LR for malignant nodules was 13.2, and that for follicular neoplasia was 0.55. Despite the high prevalence of carcinoma in an endemic goiter region, FNAC disappointed its diagnostic expectation. The lower specificity of FNAC may be caused by a higher prevalence of thyroid nodules in an endemic goiter region or by the absence of a specialized cytopathologist.

Thyroid fine needle cytology complicated by recurrent laryngeal nerve palsy and unnecessary radical surgery

Fine needle aspiration cytology (FNAC) is an important tool in the investigation of thyroid nodules and has few reported complications. We present the first report of recurrent laryngeal nerve palsy arising as a complication of thyroid nodule FNAC. This complication led to inaccurate diagnosis and unnecessarily radical surgery, with consequent increased morbidity.

The meaning and predictivity of Hürthle cells in fine needle aspiration cytology for thyroid nodular disease

Aims. The significance of Hürthle cells in thyroid nodule fine needle aspiration cytology (FNAC) samples remains uncertain. This study aims to clarify the meaning and the predictivity of this kind of cells. Methods. One hundred and ten patients with Hürthle cells in FNAC of thyroid nodules were reviewed. Histopathology was correlated with cytological findings. Results. The density of Hürthle cells in FNACs ranged from 20 to 100%. Eighty-nine patients had benign nodular disease (Hürthle cell or follicular adenoma), and 21 patients had malignant tumours. The presence of more than 50% Hürthle cells in FNAC correlated with benign or malignant Hürthle cell neoplasm. Hürthle cell carcinomas displayed more than 90% Hürthle cells in FNAC. Conclusions. Surgery is indicated for all nodular lesions with more than 50% Hürthle cells in FNAC.

Clinicopathologic Analysis of Fine Needle Aspiration Cytology of the Thyroid

To evaluate the accuracy of fine needle aspiration (FNA) of thyroid lesions at our institution and to ascertain its usefulness in determining the therapeutic approach. The authors reviewed the results of 1,613 cases of FNA cytology of thyroid nodules performed from 1999 to 2001 at the Department of Pathology, Chonnam National University Hospital. Cytologic diagnoses were compared with histologic diagnoses in 207 cases that included both FNA and thyroid surgery. The sensitivity for the detection of neoplasms (carcinoma and follicular adenoma) was 78.4% and the specificity 98.2%. A false positive diagnosis was made in 1 case (1.8%) and false negative ones in 28 cases (21.5%). The diagnostic accuracy was 84.4%, with a positive predictive value of 99.0% and negative predictive value of 66.3%. The predictive value of a cytologic diagnosis was 100% in papillary carcinoma. FNA is a useful test in determining the therapeutic approach of thyroid lesions.