For Fine Needle Aspiration Cytology Research Articles

Meaning of ACR-TIRADS recommendation in favor of follow-up rather than FNAC in thyroid nodules.

Thyroid Imaging Reporting and Data Systems (TIRADSs) have been largely diffused for their high accuracy in risk stratification of thyroid nodules (TNs) and their selection for fine-needle aspiration cytology (FNAC). The most popular TIRADSs are ACR-, EU-, and K-TIRADS, with some discrepancies each other. One major difference is that ACR-TIRADS includes a recommendation in favor of follow-up in TNs having a major diameter insufficient to indicate FNAC. The present study aimed to explore prevalence and significance of this recommendation. EU- and K-TIRADS were used as comparator. A retrospective series of thyroidectomies was searched according to a pre-defined protocol. The study period was 2019-2023. Preoperative ultrasound images were reviewed by radiologists blinded of clinical data. Matching of TIRADS and histology was performed later. Histology was the gold standard. The study series included 39 TNs classified as category 3, 4, or 5 and assessed for follow-up according to ACR-TIRADS. The overall cancer frequency was 25.6%, being 13% in category 3, 20% in category 4, and 83.3% in category 5. The category assessment according to ACR-, EU-, and K-TIRADS was not significantly different. EU-TIRADS indicated FNAC in 10 TNs of which two cancers and eight benign lesions. K-TIRADS recommended FNAC in 32 TNs of which seven cancers and 25 benign lesions. TNs assessed for follow-up according to ACR-TIRADS are cancer in one-fourth of cases. EU- and, especially, K-TIRADS allow us to select for FNAC cancers, with the burden of non-negligible frequency of unnecessary FNACs.

Correlation of ultrasound features in the TIRADS scoring system with cytological findings in the FNAC of thyroid nodules and their association with the metabolic status

BackgroundThyroid nodules were widely encountered in the population, and the selection of thyroid nodules for fine needle aspiration cytology (FNAC) remains confusing. It is essential to investigate the risk factors associated with thyroid nodules.Aim of workThis study aimed to evaluate the accuracy of the American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) scoring system in distinguishing malignant thyroid nodules from benign ones and its association with cytological examination of the FNAC of the thyroid nodules. Additionally, we seek to investigate any potential association between thyroid nodules and some metabolic derangements.Patients and methodsThe study included 111 Egyptian patients with euthyroid nodules whom were subjected to history taking, clinical examination, and laboratory investigations including thyroid profile, fasting blood sugar (FBS), glycosylated hemoglobin A1c (HbA1c), and lipid profile. Thyroid ultrasound and FNAC were done for all patients. Categorization of each nodule was done according to the TIRADS. Cytopathological diagnosis was done by Bethesda system cytology classification.ResultsThere were 19 malignant and 92 benign nodules. There was a statistically significant difference between benign and malignant nodules regarding TIRADS classification, taller-than-wide shape, solidity, border, presence of peripheral calcifications, or punctuate echogenic foci (p < 0.05). Taller-than-wide shape had the highest specificity followed by irregular margin (94.6% and 92.6%, respectively). Sensitivity, specificity, PPV, and NPV for ACR-TIRADS versus cytopathology were 73.7%, 57.6%, 26.4%, and 91.4% respectively with overall accuracy of 60.4%. The high sensitivity and NPV of the US-based TIRADS classification system have excellent utility for correctly classifying nodules as positive for malignant disease. As regards risks for thyroid nodules, results showed that most of the study population were obese [Body Mass Index (BMI) = 31.6 ± 6.3, Waist circumference (WC) = 107.4 ± 13.9]. TSH and hypercholesterolemia did not show a significant association with thyroid malignancy.ConclusionACR-TIRADS classification is of high significant value in classifying nodules as positive for malignant disease and for predicting the absence of malignant disease, reducing unnecessary nodule FNAC. Hypercholesterolemia and TSH value were not significantly associated with malignant thyroid nodules.

Accuracy and diagnostic performance of the Bethesda system for reporting thyroid cytopathology in a tertiary endocrine surgical referral center in Belgium.

The Bethesda System for Reporting Thyroid Cytopathology is a commonly used classification for fine needle aspiration (FNA) cytology of suspicious thyroid nodules. The risk of malignancy (ROM) for each category has recently been analyzed in three international databases. This paper compares the diagnostic performance of the Bethesda classification in a high-volume referral center in Belgium. All consecutive thyroid procedures were registered in a prospective database from January 2010 till August 2022. Patient and surgical characteristics, preoperative Bethesda categories, and postoperative pathology results were analyzed. Out of 2219 consecutive thyroid procedures, 1226 patients underwent preoperative FNA. Papillary thyroid cancer was the most prevalent malignancy (N=119, 70.4%), followed by follicular (N=17, 10.1%) and medullary thyroid cancer (N=15, 8.9%). Micropapillary thyroid cancer was incidentally found in 46 (3.8%) patients. Bethesda categories I, II, III, IV, V, and VI, respectively, represented 250 (20.4%; ROM 4.4%), 546 (44.5%; ROM 3.8%), 96 (7.8%; ROM 20.8%), 231 (18.8%; ROM 15.2%), 62 (5.1%; ROM 72.6%), and 41 (3.3%; ROM 90.2%) patients. Overall ROM was 13.8%. An negative predictive value (NPV) of 96.2% was found. Overall specificity was 64.2% with a positive predictive value (PPV) of 31.9%. Diagnostic accuracy was 67.8%. Compared to international databases (CESQIP, EUROCRINE, and UKRETS), ROM in this study appeared lower for Bethesda category IV (15.2 vs. 26.7% and p=0.612). Despite being validated in numerous studies, ROM based on preoperative FNA cytology classified according to the Bethesda classification may vary among surgical centers and countries as this study reveals a higher NPV and lower PPV.

Concordance of the ACR TI-RADS Classification With Bethesda Scoring and Histopathology Risk Stratification of Thyroid Nodules

Although most thyroid nodules are benign, 10% to 15% of them harbor cancer. Thyroid ultrasonography is useful for risk stratification of nodules, and American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) classification provides recommendations for fine-needle aspiration cytology (FNAC) based on objective ultrasonographic features of these nodules. To validate the concordance of ACR TI-RADS classification with Bethesda classification and histopathology. This retrospective cohort study was performed to evaluate the concordance of ACR TI-RADS classification with Bethesda classification and histopathology and was conducted in Singapore General Hospital Outpatient Otolaryngology clinic in March 2021 to May 2021. Data analysis was performed in May 2021. Results were deemed concordant when ACR TI-RADS recommendations aligned with Bethesda scores. Conversely, results were classified as nonconcordant with Bethesda scores and/or histopathology results when nodules that were recommended for FNAC yielded benign results or nodules that were not recommended for FNAC yielded malignant results. A total of 446 patients (370 women [83%]; mean [range] age, 60 [24-89] years) who underwent ultrasonography of the thyroid and ultrasonography-guided thyroid FNACs were identified. A total of 492 of 630 nodules (78.1%) were benign on FNAC (Bethesda II). Score 3 ACR TI-RADS nodules yielded the highest negative predictive values: 94.6% (95% CI, 92.9%-95.9%; P < .001) compared with Bethesda scoring and 100.0% (95% CI, 15.8%-100.0%; P = .003) compared with histopathology. Score 4 or 5 ACR TI-RADS nodules yielded positive predictive values of 2.8% and 16.2%, respectively, compared with Bethesda scoring and 6.1% and 66.7%, respectively, compared with histopathology. Small (<1.5 cm) ACR TI-RADS nodules of scores of 4 and 5 that were not recommended for FNAC yielded a malignant risk of 5.7% and 25.0% on Bethesda 5 and 6, respectively. On surgical excision, 5 of 46 (10.9%) ACR TI-RADS 4 nodules and 15 of 21 (71.4%) of ACR TI-RADS 5 nodules were confirmed to be malignant. Among nodules initially not recommended for FNAC, histopathology-proven cancer was found in 4 of 13 (30.7%) and 3 of 6 (50.0%) of nodules, respectively. These findings suggest that ACR TI-RADS score 3 nodules have a low risk of cancer and should be considered for FNAC only if nodules are 2.5 cm or larger. Patients with small (<1.5 cm) ACR TI-RADS 4 and 5 nodules should be appropriately counseled for FNAC to exclude cancer.

Value of TI-RADS and elastography strain ratio in predicting malignant thyroid nodules: experience from a single center in Egypt

IntroductionThyroid nodules are highly prevalent in the general population; therefore, it is crucial to discriminate benign from malignant nodules. A practical thyroid imaging reporting and data system (TI-RADS) for thyroid nodules and ultrasound elastography are valuable tools not only for characterization of nodules but also for the selection of tumors for fine-needle aspiration cytology (FNAC).ObjectiveThis study aimed to evaluate the diagnostic accuracy of US evaluation in the prediction of malignant thyroid nodules and evaluate the role of the elastography score, strain ratio (SR), and the TI-RADS scoring system as non-invasive tools in differentiation between malignant and benign thyroid nodules.Material and methodsA total of 1269 patients were evaluated between February 2017 and April 2020 by a single expert thyroid ultrasound operator. The final diagnosis was achieved from cytological and/or histological evaluation and follow-up for at least 1 year.ResultsThere were 1088 females and 181 males with a mean age of 44 ± 10 SD. The final diagnosis was 1197 benign nodules and 72 malignant nodules. Most malignant nodules were scored elastography score 4 (83.3%) and TI-RADS category 5 (86.11%). We found that nodules with antero-posterior to transverse (A-P/T) diameter > 1, have 21 times more risk to be malignant than those with A-P/T diameter < 1, patients with solitary thyroid nodules have 4.5 times to develop malignancy compared to those with multinodular goiter (MNG), nodules with absent halo have 4 times more risk of malignancy. Furthermore, microcalcifications in thyroid nodules increase the risk of malignancy 9 times compared to those without calcifications. SR was found to be an excellent discriminator to differentiate between benign and malignant nodules with P < 0.001. Also, we found that for every unit increase in SR, the risk of malignancy increased by 20%. We reported that the accuracy of ultrasonography in the detection of malignant thyroid nodules had a sensitivity of 89%, specificity of 98%, 70% PPV, and 99.3% NPV, with an overall accuracy of 97.2%.ConclusionThe application of ultrasonographic non-invasive criteria for thyroid nodules in clinical practice might significantly reduce the number of unnecessary FNAC. Elastography, SR, and TI-RADS classification could be good predictors for malignant thyroid nodules.

A STUDY OF SPECTRUM OF NEOPLASTIC AND NON-NEOPLASTIC LESIONS OF SALIVARY GLAND AND THEIR CYTOLOGICAL CORRELATION WITH HISTOPATHOLOGY

Objective: This current study analyzed the diagnostic accuracy of cytology of various salivary gland lesions and correlated with histopathological findings. Method: A study of 45 samples for fine-needle aspiration cytology (FNAC) were obtained from patients who were posted to the department of pathology. Aspirate from all salivary gland lesions and corresponding histopathological (HPE) specimens were included. Results: Cytologic (FNAC) diagnosis reveals non-neoplastic, benign, and malignant lesions in 23% (12), 68% (31), and 4% (2) of 45 samples, respectively. While histopathological (HPE) diagnosis revealed non-neoplastic, benign, and malignant lesions in 20% (9), 62% (28), and 18% (8) of cases, respectively. The most common lesion in cytology and histology was discovered to be pleomorphic adenoma, which has a high sensitivity and specificity and can thus be used to screen all salivary gland tumors for a better therapeutic approach. The higher sensitivity, specificity, and diagnostic accuracy of FNAC confirms its important role in conjunction with radiological and clinical findings to provide the best initial assessment. There is a statistically significant relationship between the consistency, location, and cellularity of the lesion in benign and malignant tumours. Study concluded that on FNAC, 48% were benign in nature and 24% were malignant in nature. The sensitivity of FNAC was 86.5%, specificity was 100%, positive predictive value was 100%, negative predictive value was 86%, and diagnostic accuracy was 92.5%. Conclusion: The study confirms the utility of FNAC as a safe and cost-effective method of distinguishing benign and malignant salivary gland lesions. FNAC had a sensitivity of 86.5%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 86%, and a diagnostic accuracy of 92.75%. FNAC and histopathology complemented each other to provide infallible diagnoses that are critical in planning future management.

High resolution ultrasonography of thyroid nodules: can ultrasonographic assessment obviate the need for invasive aspiration cytology in ultrasonographically benign lesions?

The use of high-resolution ultrasound (HRUS) thyroid imaging has resulted in a significant revolution in the treatment of thyroid nodules. The enigma of thyroid nodules has been a blind spot for radiologists for a long period. Reporting a thyroid nodule as benign or malignant is quite difficult and many times not accurate. The American Collage of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) 2017 classification has solved this problem to a large extent. However, the classification needed pathological confirmation for it to be highly accurate. We compared our HRUS-based TIRADS labeling of thyroid nodules with thyroid cytopathology using revised Bethesda classification system. Patients detected with thyroid nodules by HRUS were categorized using ACR-TIRADS and further were taken for fine needle aspiration cytology (FNAC) in our department. The pathological results were compared with the initial TIRADS category of the nodule and the effectiveness of the TIRADS classification in categorizing nodules into benign and malignant was assessed using various statistical variables. The initial USG and the FNAC were performed by a single radiologist with over 10 years of experience. A total of 201 patients underwent HRUS followed by FNAC after obtaining written consent in our department. The thyroid nodules labeled as true benign on ACR-TIRADS (TIRADS 2) were all true benign on Bethesda cytopathology (less than Bethesda III), confirming the high accuracy of HRUS. The diagnostic accuracy of HRUS in cases of ACR-TIRADS 3 nodules was approximately 90.6% with an error rate of 9.4%. Nodules labeled as ACR-TIRADS 4 and 5 had error rates of 47% and 10% in labeling nodules as malignant. The ultrasound-based ACR-TIRADS system can accurately predict the likelihood of specific nodules being benign. There is a strong concordance between Bethesda cytology and ACR-TIRADS classification, particularly for benign nodules. In resource-constrained system like ours, patients with TIRADS 2 and 3 nodules can be safely followed obviating the need for an invasive procedure like FNAC.

A Study of AgNOR Scores on FNAC of Breast Lumps and Its Correlation with Histopathological Grading

Background: Breast cancer is one of the leading cancers in women both in developed and developing countries. Nucleolar Organizer Regions (NORs) are loops of DNA related to protein synthesis and ribosomal activity. Argyrophilic Nucleolar Organizer Region (AgNOR) counts act as a reliable cell proliferative marker as they aid in identifying cell proliferation activity and aggressiveness of a lesion, and thereby helps in differentiating benign and malignant breast lesions.&#x0D; Aim: To evaluate the role of AgNOR count in differentiating benign and malignant breast lumps.&#x0D; Methods: All breast lump specimens collected for Fine Needle Aspiration Cytology (FNAC) and histopathology, for a period of one year, were included in the study. A total of 69 specimens were included. All FNAC and histopathology slides were stained with AgNOR stain, and the score was recorded.&#x0D; Result: A total of 69 cases were studied, both non-neoplastic and neoplastic breast lesions. All FNAC cases correlated histologically. Out of the 69 cases, 38 were malignant. The mean AgNOR counts in non-neoplastic, benign and malignant breast lesions were found to be 2.19, 2.88 and 5.94 respectively (p&lt;0.05). Other parameters such as proliferative AgNOR index, AgNOR size variation, AgNOR distribution within the nucleus and the Subjective AgNOR Pattern Assessment (SAPA) scores also showed statistically significant difference between benign and malignant lesions.&#x0D; Conclusion: AgNOR scores showed good correlation in differentiating benign and malignant breast lesions, they can be used as a reliable tool to aid in the diagnosis.

Accuracy of ultrasound guided fine needle aspiration cytology in head and neck lesions

Background: Palpable superficial mass (es) is a major complain making patients attending any surgical and otolarygeal clinic. Most of these lesions are related to thyroid, cervical lymph nodes or salivary glands Triple assessment technique using clinical examination, ultrasound and cytology are usually sufficient in reaching the final diagnosis especially in specialized surgical centers. Aims: The objective of this study was to assess how accurate ultrasound in guessing the diagnosis of the lesion and how accurate as a guide for fine needle aspiration cytology (FNAC). Methods: A prospective study included 50 patients who were presented with self-detected head or neck lump and attending the specialized surgical clinic in the Medical City Complex, Baghdad during the period from November 2019 to October 2020. Their age ranged from 10-63 years. Patients were underwent ultrasound examination after clinical examination and then subjected to ultrasound guided FNAC. Results: Twenty patients presented with palpable lump were included in this study. Their ages ranged between 10 to 63 years (mean age 37.8 years). Regarding the distribution of the anatomical locations the majority of the lesions were lymph nodes (7/20) six of them are cervical and one of them was inguinal, the 2nd common location was the parotid gland seen in four out of twenty, The provisional diagnosis provided by ultrasound for lococregional pathology was benign in majority of Lymph node group (5/7) and malignant in two, three out of four parotid lesions are benign and all thyroid cases are also benign, The FNAC results in correlation with ultrasound findings are in concordance regarding the lymph nodes and parotid aspirates in 100% while thyroid aspirate was in concordance in 100% after two passes due to bloody aspirate, the aspirate from the breast is 50% in line and no concordance seen in 50 %, the aspirate is compatible regarding the hip mediastinum and sternomastoid while is not conclusive in lung aspirate. The accuracy of ultrasound in guiding the needle for targeting the lesion is 100%, and overall accuracy of ultrasound in reaching the final diagnosis is 85% with 100 % sensitivity. Conclusion: Ultrasound guided FNAC represents a reliable interventional radiology modality for targeting the needle to any superficial or ultrasound reachable deep seated head and neck lesion and considered a recommended method for assessment of underlying cause responsible for palpable head and neck mass this is due to reliable focusing the mass lesion, avoiding nearby vital organ or vessel and direct real time visualization of the needle within the lesion and by that sampling cells by flickering the needle within the lesion.

Role of the American College Of Radiology –Thyroid Imaging Reporting and Data System (ACR TI-RADS) in Differentiating Benign and Malignant Thyroid Nodules

Introduction: Thyroid nodule is commonly detected while performing an ultrasound of the neck. American College of Radiology, Thyroid imaging reporting and data system (ACR-TIRADS) is a classification used to characterize thyroid nodules based on ultrasound findings. The objective of this study is to evaluate the role of ACR-TIRADS classification in differentiating benign and malignant thyroid nodules.&#x0D; Methods: This is a prospective study conducted at Manipal Teaching Hospital. A total of 70 patients presenting to our radiology department for fine needle aspiration cytology (FNAC) of thyroid nodule were enrolled in the study. Thyroid nodules were grouped as 1- 5 according to the ACR-TIRADS. The ACR-TIRADS findings were correlated with FNAC and or biopsy findings as available. Subsequently; sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ACR-TIRADS in differentiating benign from malignant nodules were assessed.&#x0D; Results: Mean age of patients in our study was 52.16 years (18-89 years). Male patients were 11 (15.7 %) and female were 59 (84.30 %). According to Ultrasonography; 1.4% of thyroid nodules were labelled as ACR-TIRADS 1; 21.4% as ACR-TIRADS 2; 32.85% as ACR- TIRADS 3; 28.6 % as ACR-TIRADS 4 and 15.7 % as ACR-TIRADS 5. ROC curve analysis showed AUC of 0.78 (95% CI). ACR-TRIADS had sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy of 87.5%, 68.5 %, 45.16 %, 94.87 %, 72.86 % respectively.&#x0D; Conclusion: ACR- TIRADS has high sensitivity and accuracy in differentiating benign and malignant thyroid nodules.

CYTODIAGNOSIS OF TUBERCULOSIS USING CONVENTIONAL ZIEHL-NEELSON STAINING METHOD AND MODIFIED BLEACH METHOD ON LYMPH NODE ASPIRATES ALONG WITH CLINICAL CORRELATION IN TERTIARY CARE CENTRE.

Tuberculosis (TB) is a common public health problem and second leading cause of communicable disease world wide. Tuberculosis is one of the top ten causes of death and the leading cause from a single infectious agent (above HIV/AIDS). India accounting for almost one fth (21%) of global incidence. Lymphadenopathy accounts for the most common form of Extra-Pulmonary Tuberculosis (EPTB) 3. A prospective study was carried on 100 cases of suspected tubercular lymphadenopathy patients over a period of 18 months at Gajra Raja Medical College and JAH Group of Hospitals, Gwalior from Jan 2020 to Jun 2021. All cases of clinically suspected tubercular lymphadenopathy reporting for Fine Needle Aspiration Cytology (FNAC) examination in Department of Pathology, Gajra Raja Medical College and Jay Arogya Group of Hospitals (J.A.H.), Gwalior, Madhya Pradesh (M.P.) with proper marking for affected lymph nodes and documentation. Aim was to evaluate the efcacy of bleach method with cytological diagnosis and the conventional method. Patients with tubercular lymphadenitis were evaluated. The acid-fast positivity by routine staining was compared with modied bleach method of AFB staining. Among 100 patients, 23(23%) were positive for AFB on conventional ZN method and the smear positivity was increased to 33 (33%) by bleach method. The bleach method is simple and inexpensive. It clearly improves microscopic detection of AFB.

Fine-needle aspiration cytology repetition in thyroid nodules with non-diagnostic findings or atypia of undetermined significance/follicular lesions of undetermined significance: Does time matters?

IntroductionAfter a nondiagnostic (ND) result or findings of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), the current recommendation is for fine-needle aspiration cytology (FNAC) of the thyroid nodule to be repeated after at least 3 months. The aim of this study was to evaluate whether the interval between FNACs has any influence on the final cytological diagnosis. MethodsThis was a retrospective study including all patients who underwent FNAC for the first time between January 2016 and December 2019 with ND or AUS/FLUS cytological results and then underwent a second FNAC procedure. Demographic, clinical, ultrasound and cytological data were retrieved. 1,497 nodules were evaluated; 535 had a first FNAC result of ND or AUS/FLUS, and 246 of these were re-evaluated with a second FNAC. The cases were grouped according to the timing of the repeat FNAC in two different analyses: < vs. ≥ 3 months and < vs. ≥ 6 months after initial FNAC. ResultsTwo hundred forty-six repeat FNACs were performed in 186 patients (76% female, median age 59.5 years). Twenty-two of these procedures (8.9%) were performed within 3 months, and 115 (46.2%) within 6 months of the first FNAC. Second FNAC findings were ND in 121 (49.2%) cases, benign in 103 (41.9%), AUS/FLUS in 8 (3.3%), follicular neoplasm/suspicious follicular neoplasm in 9 (3.7%), suspicious malignancy in 4 (1.6%) and malignancy in 1 (0.4%). Early repetition of FNAC did not significantly influence the final cytological result (< 3 vs. ≥ 3 months, P=0.51; and <6 vs. ≥ 6 months, P=0.20). ConclusionThis study suggests that the interval in repeat FNAC procedures is not relevant to overall diagnostic performance.

DEFINING EPIDEMIOLOGY OF EPIDERMOID CYST: A RETROSPECTIVE CASE STUDY AT RIMS RANCHI

Background: An epidermoid cyst is a benign cyst derived from the infundibulum or upper portion of a hair follicle, encapsulated in a thin layer of epidermis-like epithelium. They are common ,painless lump can occur anywhere in body and usually do not require treatment,unless a person wants to have them removed due to cosmetic reasons,or if the cysts is infected. Material and method:It is a retrospective record based study,performed in department of Pathology RIMS, Ranchi.Study population included all cases those who came for fine needle aspiration cytology (FNAC) for the swelling over different areas on body, with some common clinical presentations of pain, mild pain or no pain and gradually increasing in size from January 2020-July 2021.Result:A total of 105 cases recorded with FNAC diagnosis of epidermoid cyst of which 62% were male, majority were adults of age group 21-30 years(33.33%) and most common site is submandibular region 19% followed by face 16% and periauricular region 13%.Conclusion: Epidermoid cyst are common in adult males and more frequent on upper trunk.

Diagnostic value of thyroid imaging reporting and data system in thyroid nodules

Background: The improved detection of TNs (TNs) with US has resulted in an increase in the number of thyroid fine needle aspiration biopsy (FNAB). Appropriate criteria are necessary to avoid an increase of rather unnecessary benign cytologic results in TNs. Thyroid imaging reporting and data system (TIRADS) was first used by Horvath et al in 2009. This was to standardize the reporting of results of thyroid (ultrasonography) US that can be understood by clinicians and also stratify the risk of malignancy of a lesion based on the US features of the lesion.Methods: Cases with uninodular or multinodular goiter had been included. Evaluation of cases had been done using ultrasound of the neck. TNs were classified into categories according to thyroid imaging reporting and data system of the American colleague of radiologists (ACR-TIRADS).Cases were ordered for fine needle aspiration cytology (FNAC). Operable cases were only included in the study and postoperative histopathology was revised.Results: The study included 46 patients. The different TIRADS categories were confronted with the results of cytology and histopathology. Combining TIRADS 2 and 3 as probably benign categories and TIRADS 4 and 5 as probably malignant categories, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were respectively 100%, 84.38%, 73.68% and 100%. The accuracy of ACR-TIRADS was 89.13%.Conclusions: ACR-TIRADS helps in stratifying nodular thyroid disease based on the risk of malignancy. It could lead to a significant decrease of the number of unnecessary FNABs.

Changes in thyroid fine needle aspiration practice during the COVID-19 pandemic.

PurposeTo investigate the diagnostic accuracy of a different sample preparation protocol for fine needle aspiration cytology (FNAC) of thyroid nodules established during the COVID‐19 pandemic.MethodsFrom April 2020, conventional smears during FNAC were ceased according to World Health Organization recommendations due to the increased infection risk for operators, and a new protocol using only liquid‐based cytology (LBC) was adopted. FNACs performed between April and July 2020 (COVID‐19 group) were retrospectively compared with those from December 2019 through March 2020 (Pre‐COVID‐19 group). The distribution of diagnoses based on SIAPEC‐IAP categories and the concordance between cytological and histological results were compared using the chi‐squared test.ResultsCategories based on FNAC for 90 and 82 thyroid nodules in the Pre‐COVID‐19 and COVID‐19 groups showed no significant difference in distribution (P = .081), with the following respective cases (and percentages): TIR1, 7 (8%) and 8 (10%); TIR1C, 0 (0%) and 6 (7%); TIR2, 59 (66%) and55 (67%); TIR3A, 8 (9%) and 5 (6%); TIR3B, 1 (1%) and 2 (3%); TIR4, 5 (6%) and 1 (1%); and TIR5, 10 (12%) and 5 (7%). Among patients with potentially malignant lesions, surgery was performed for 12/16 (75%) nodules in the Pre‐COVID‐19 and 7/8 (88%) nodules in the COVID‐19 groups, with no significant differences between cytological and histological diagnoses (P = .931).ConclusionThe new LBC‐only protocol provided similar diagnostic accuracy in comparison with conventional smears, and can be effectively applied during a viral pandemic improving operator safety.

Patients with chronic autoimmune thyroiditis are not at higher risk for developing clinically overt thyroid cancer: a 10-year follow-up study.

The association between chronic autoimmune thyroiditis (CAT) and differentiated thyroid cancer (DTC) remains controversial. The incidence of DTC increases when screening procedures are implemented, as typically occurs in CAT patients being routinely submitted to thyroid ultrasound (US). The aim of this study was to longitudinally evaluate the long-term development of DTC in patients with CAT. A retrospective longitudinal cohort study was designed. For the study, 510 patients with chronic autoimmune thyroiditis (CAT) with a 10-year follow-up were enrolled. Patients were divided in two groups according to the presence (CAT+ NOD+; n = 115) or absence (CAT+ NOD-; n = 395) of co-existent nodules at diagnosis. The main outcome measures were appearance of new thyroid-nodules and development of DTC during follow-up. During a 10-year median follow-up period, new thyroid-nodules were detected in 34/115 (29.5%) patients in the CAT+ NOD+ group and in 41/395 (10.3%) in the CAT+ NOD- group (P < 0.001). Logistic regression analysis showed that thyroid-volume at diagnosis and belonging to the CAT+ NOD+ group significantly predicted the appearance of a new thyroid nodule during follow-up, independently of baseline age and sex. Among the 75 patients experiencing the appearance of a new nodule, 27 (39%) met the criteria for fine-needle-aspiration-cytology (FNAC). A benign cytological diagnosis was rendered in all cases. In our series of CAT patients, the appearance of new thyroid-nodules was frequent, but none of them were found to be malignant. The presence of CAT appears to be associated with a negligible risk of developing clinically overt DTC.

Role of elastography strain ratio and TIRADS score in predicting malignant thyroid nodule.

Ultrasonography (US) is the most accurate and cost-effective imaging method in diagnosis of thyroid nodules. A practical thyroid imaging reporting and data system (TIRADS) for thyroid nodules has been proposed to classify nodules of the thyroid gland to solve the problem of nodule selection for fine needle aspiration cytology (FNAC). Real-time elastography and strain ratio (SR) is a method used to assess the stiffness and predict the malignancy of thyroid nodules. The objective of this study was to assess the role of elastography and SR and the TIRADS scoring system in discriminating malignant from benign thyroid nodules. From 2015 to 2018 at Cairo University Hospital, a series of 409 patients with thyroid nodules was referred to undergo thyroid ultrasound. Categorization of each nodule according to the TIRADS ranged from 1 to 5. The qualitative elastography score and semiquantitative SR of the nodules were evaluated. Final diagnosis was done by either post-thyroidectomy histopathological examination or US-guided FNAC. Our study included 409 patients with thyroid nodules. Their mean age was 39 ± 10 SD; 36 were males and 373 were females. There were 22 malignant nodules and 387 benign nodules. There were statistical differences between benign and malignant nodules regarding TIRADS classification, SR, anteroposterior/transverse ratio, degree of echogenicity, border, presence of calcification, and absence of halo sign (P < 0.001). The elastic properties of thyroid nodules proved to be a good discriminator between malignant and benign nodules (P- < 0.001) at a cut off value of > 2.32 with 95.2% sensitivity and 86.5% specificity. For every unit increase in SR, the risk of malignancy increased by nearly 2 times. Patients with irregular borders had nearly 17 times increased risk of malignancy than those with regular borders. Elastography and SR proved to be of high significant value in discriminating benign from malignant nodules, so we recommend adding it to the TIRADS classification.

Performance of the ACR TI-RADS and EU TI-RADS scoring systems in the diagnostic work-up of thyroid nodules in a real-life series using histology as reference standard.

The ultrasonographic scores EU TI-RADS and ACR TI-RADS were introduced to give the clinicians indications for fine needle aspiration cytology (FNAC). The predictive role of these scores was never evaluated and compared in a surgical series of patients. The aim of this study was to evaluate the ex post diagnostic accuracy of EU TI-RADS and ACR TI-RADS in a real-life series of thyroidectomized patients and to evaluate the 'missing' thyroid cancer following the operational indications of these scores. Retrospective monocentric cohort study. In total, 255 patients (harboring 304 nodules) undergoing thyroidectomy for benign and malignant thyroid conditions were enrolled. The prevalence of thyroid malignancy for each class of ACR TI-RADS and EU TI-RADS, their diagnostic accuracy, the number of 'unnecessary' FNAC and the number of 'missed' cancers were evaluated. ACR TI-RADS and EU TI-RADS score had similar and satisfactory accuracy values for predicting thyroid malignancy (AUC: 0.835 for ACR TI-RADS vs 0.827 for EU TI-RADS). The ACR TI-RADS and EU TI-RADS categories (suspicious vs non-suspicious), age, sex and presence of a single nodule significantly and independently predicted the presence of malignancy in a logistic regression model. An ex post analysis according to the indications for FNAC for each score indicated that 31 and 16 cases of cancer would have been missed by ACR TI-RADS and EU TI-RADS scores, respectively. ACR TI-RADS and EU TI-RADS display a good performance in predicting thyroid cancer when histology is taken as reference standard, but additional clinical judgement is required to decide the indication for FNAC.

MON-LB86 The Sensitivity and Specificity of Various Thyroid Nodule Ultrasound Characteristics and the Diagnostic Accuracy of the ATA Guidelines and ACR TI-RADS for Predicting Thyroid Cancer at an Urban Endocrinology Clinic

Introduction: Several current guidelines assess sonographic features to guide management of thyroid nodules. The ACR uses an additive point system to assign the level of risk to various sonographic features, whereas the ATA groups sonographic features together to determine the level of risk. The purpose of this study is to compare the performance of the ATA guidelines and ACR TI-RADS at an urban endocrinology clinic in risk stratifying thyroid nodules by their specific sonographic features. Methods: This retrospective, chart-review study includes adult patients who met sonographic criteria for fine needle aspiration (FNA) biopsy based on ATA or ACR TI-RADS at an outpatient endocrinology practice in San Francisco, CA between December 2011 and August 2019. Patients with a prior history of thyroid malignancy (anaplastic and medullary thyroid carcinoma or thyroid lymphoma) were excluded. The reference standard for the diagnosis of malignancy was surgical pathology or FNA cytology Bethesda category V or VI when surgical pathology was unavailable. Analysis of guideline performances and specific sonographic features included: sensitivities (Sn), specificities (Sp), positive predictive values (PPV), negative predictive values (NPV), and area-under-the-curve (AUC) using Fisher’s exact test. Results: Two hundred seventy-five nodules among 195 adults (86.2% were women) were included in the analysis. Twelve nodules were malignant, with an associated malignancy rate of 4.4%. TI-RADS had higher accuracy based on AUC of 0.710 compared to 0.623 using ATA guidelines. TI-RADS also had a higher PPV of 21.4% among nodules with 9 points, versus 5.8% among nodules in the ATA “high suspicion” category. Ultrasound characteristics with the highest Sp, relative PPV and NPV were: microcalcifications (84.5%, 4.3%, 96.0%, respectively), taller-than-wide (81.7%, 7.1%, 96.7%), irregular margins (77.7%, 6.0%, 96.5%); the characteristic with the highest Sn was hypoechogenicity (83.3%), however this had relatively low Sp (25.4%) and PPV (4.5%). Conclusions: TI-RADS performed better with higher overall accuracy and PPV when applied to nodules classified as having the highest malignancy risk. Taller-than-wide shape, irregular margins, and microcalcifications were the characteristics most useful for malignancy risk stratification. Limitations of this study include: interobserver bias, small sample size, referred patient population (which may differ from other institutions), and inability in some cases to confirm malignant FNA cytology with surgical pathology.

Thyroid Dysfunction and Cytological Patterns among Patients Requested for Thyroid Function Test in an Endemic Goiter Area of Gondar, North West Ethiopia.

Background Thyroid dysfunction is the most common endocrine disorder in clinical practice, and about half of the population with thyroid dysfunction remains undiagnosed. There is a fairly wide spectrum of thyroid dysfunction, which can be identified by patterns of thyroid function test results. The prevalence of thyroid dysfunction among the population varies in different studies. Methods A cross-sectional study was conducted from February 8th to April 8th, 2017, among patients who requested for the thyroid function test in an endemic goiter area at the Gondar Hospital, University of Gondar. A pretested structured questionnaire was used to collect the data. Three milliliters of blood samples was collected in a plain test tube and centrifuged for serum separation. The thyroid function test was done by using the MINI-VIDAS automation following the manufacturer manual (Setema PLC, Italy). Data were entered and analyzed using SPSS version 20. Descriptive statistics were used for data presentation, and P value < 0.05 was considered significant. Result Of the total 384 study participants, 346 (90.1%) were females and the study participants' mean age was 38 ± 13.9 years. The overall thyroid dysfunction prevalence was 26.3% (101): 1.6% was identified as subclinical hypothyroidism, 0.5% hypothyroidism, 9.6% subclinical hyperthyroidism, and 14.6% hyperthyroidism, and 23.4% had goiter. Furthermore, for cytological pattern analysis, 144 study participants who fulfilled indications for fine-needle aspiration cytology (FNAC) in thyroid nodules were included. Of the total, 3 (2.1%) had thyroid carcinoma, 46 (32%) had cystic degenerated follicular cells, and 82 (57%) had nodular thyroid goiter. In addition, a clinical presentation of a total of 144 study participants, showed lymphadenites in 7 participants (4.8%), hypertension in 9 (6.2%), and cardiac failure in 12 (8.3%). Conclusion The prevalence of thyroid dysfunction was high. The majority of thyroid dysfunction cases were newly diagnosed and more common in females. In addition, the most common disorders were subclinical hyperthyroidism and hyperthyroidism. Follicular cell with cyst degeneration and thyroid nodular goiter were the predominant FNAC findings. For early diagnosis and appropriate intervention in goiter endemic areas, the thyroid function test should be closely monitored.