Preoperative Evaluation Of Thyroid Nodules Research Articles

Accuracy of ultrasound-guided fine-needle aspiration cytology in evaluation of thyroid nodules using different ultrasonographic and cytological features.

Fine-needle aspiration cytology (FNAC) is a reliable method for preoperative evaluation of thyroid nodules particularly if ultrasound-guided (USG-FNAC). The main purpose of this study is to evaluate the efficacy of USG-FNAC and its accuracy. We retrospectively studied 212 thyroidectomy cases with preoperative ultrasonography and FNAC data during the period 2015-2022 using TI-RADS for final ultrasound diagnosis and Bethesda system for cytological diagnosis. The studied cases were 200 females and 12 males. Thyroid cancer was more prevalent under 20 years old (78.5%). Papillary thyroid carcinoma comprises 84% of all cancer cases. Significant ultrasound features (p-value <0.05) favour malignancy were hypoechogenicity (66%), mixed echogenicity (84%), irregular border (61%), microcalcification (68%) and rim halo (63.6%). Malignancy was found in 21% of TI-RADS-2, 65% of TI-RADS-4 and 100% of TI-RADS-5. There is a significant difference between different categories of Bethesda system. All cases in Cat-VI were malignant (100%). Malignancy was also found in 81% of Cat-V, 20% of Cat-IV, 33% of Cat-III, 16% of Cat-II and 43% of Cat-I. Cytological features consistent with malignancy were as follows: grooving (94%), nuclear irregularities (89%), nuclear pseudoinclusion (89%) and little colloid (82%). In our study, USG-FNAC sensitivity was 83%, specificity 85%, PPV 85%, NPV 83% and accuracy 84%. Ultrasound features in favour of malignancy in thyroid nodules are hypoechoic or complex echogenicity, irregular border, punctuate calcification and presence of rim halo. Cytological features in favour of malignancy are grooving, nuclear irregularities, nuclear pseudoinclusion and little or absent colloid.

Comparative analysis of accuracy between fine-needle aspiration biopsy and postoperative histopathology for detecting large thyroid nodules: A retrospective observational study.

To avoid unnecessary surgeries, ultrasound-guided fine-needle aspiration biopsy (FNAB) is an effective and reliable procedure for the preoperative evaluation of thyroid nodules. However, there have been only a limited number of studies exploring the ability of preoperative FNAB to distinguish malignancy compared to postoperative histopathology in thyroid nodules larger than 4 cm. The aim of this study was to investigate the diagnostic accuracy of FNAB compared to postoperative histopathology in distinguishing malignancy in thyroid nodules larger than 4 cm. A single-center retrospective observational study was conducted at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, between January 2014 and December 2018. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. A total of 83 patients were included in the study. The results showed that preoperative FNAB may have the ability to distinguish malignancy compared to postoperative histopathology. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 42.85%, 98.38%, 90.00%, 83.56%, and 84.33%, respectively. These data suggested that ultrasound-guided preoperative FNAB is a reliable diagnostic tool in the preoperative evaluation of thyroid nodules larger than 4 cm, but it has limited capability in distinguishing malignancies. In conclusion, although FNAB may be useful in reducing unnecessary surgeries, histopathology remains the preferred method for confirming malignancy in thyroid nodules.

Diagnostic accuracy of fine needle aspiration biopsy versus postoperative histopathology for diagnosing thyroid malignancy.

Ultrasound-guided fine needle aspiration biopsy (FNAB) is currently widely used for the initial screening of patients with thyroid nodules enabling prevention of unnecessary surgery. The purpose of this study was to retrospectively analyse the diagnostic accuracy of thyroid FNAB compared with postoperative histopathology of a large cohort from Azerbaijan. We evaluated the FNAB results of 738 patients who underwent thyroid surgery at the National Centre of Oncology in Azerbaijan. The measures of diagnostic accuracy were calculated for the ultrasound-guided preoperative FNAB results (based on the six diagnostic categories of the Bethesda classification) compared with postoperative histopathologic results (benign or malignant) for correspondent areas. Considering both DC V and DC VI categories (387 cases) as 'cytologic-positive' and DC II category (72 cases) as 'cytologic-negative', we found 14 false-positive and 10 false-negative results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 97.4%, 86.1%, 96.4%, 81.6% and 94.8%, respectively. Conversely, when considering only the DC VI category as 'cytologic-positive', the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNA were 93.2%, 100%, 100%, 81.6% and 97.1%, respectively. The results of our cohort demonstrated high levels of diagnostic accuracy, supporting FNAB's role as a reliable diagnostic tool in the preoperative evaluation of thyroid nodules. The sensitivity, specificity, NPV, PPV and accuracy of thyroid FNAB in our institution were comparable with those of other institutions.

ASO Author Reflections: Quantitative Shape Analysis of Thyroid Nodules: A Small But Important Step Towards Software-Based Preoperative Evaluation of Thyroid Nodules.

ASO Author Reflections: Quantitative Shape Analysis of Thyroid Nodules: A Small But Important Step Towards Software-Based Preoperative Evaluation of Thyroid Nodules.

Pre-Operative Cytological Evaluation of Thyroid Nodules According to the 2017 Bethesda System

Objective: This study aims to present the experience of the implementation of the Bethesda system for reporting thyroid cytopathology in Alpha Prolipsis Medical Laboratories, a private medical laboratory located in Athens, Greece. Methods: 617 FNAs, performed since 2017, were included in the study. Reports were issued according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Aspirates were prepared with both conventional and liquid based cytology methods and were evaluated by two board certified cytopathologists. Diagnostic reproducibility and accuracy were evaluated. In 106 of these cases the cytological diagnosis was histologically confirmed. Results: Out of the 533 cases cytologically diagnosed as benign, 7 false negative results were obtained by FNA, whereas out of the 37 cytological diagnoses of probably or definitively malignant tumors one case was found histologically to be follicular adenoma. In this trial, the diagnostic accuracy of FNA was 96.7%, the specificity 94% and the sensitivity 87%. Conclusions: Our results show that FNA is a valuable examination technique in the preoperative evaluation of thyroid nodules. The integration of the 2017 Bethesda System for Reporting Thyroid Cytopathology is effective with an overall accuracy around 92%.

Accuracy of ultrasonography-guided fine needle aspiration cytology and significance of non-diagnostic cytology in the preoperative detection of thyroid malignancy.

Thyroid fine-needle aspiration cytology (FNAC) is an established investigation for the preoperative evaluation of thyroid nodules and is often done under ultrasonography guidance. While its accuracy has been widely reported, there is little evidence in the literature on the approach to non-diagnostic cytology results. In our study, we aimed to determine the diagnostic performance of ultrasonography-guided thyroid FNAC for the preoperative diagnosis of thyroid cancer at our institution and evaluate the significance of a non-diagnostic thyroid FNAC. We retrospectively reviewed the thyroid ultrasonography studies and medical records of all patients who underwent both thyroid FNAC and subsequent thyroid surgery at our institution from 2011 to 2013. FNAC results were correlated with the final histological diagnosis from surgery and the ultrasonography studies were reviewed for suspicious sonographic features. FNAC predicted malignancy with sensitivity, specificity, positive predictive value, negative predictive value, false positive rate, false negative rate and total accuracy of 90.7%, 53.6%, 43.3%, 93.7%, 46.4%, 9.3% and 64.1%, respectively. We found that only one of 26 nodules with non-diagnostic FNAC results was proven malignant on a second FNAC and subsequent thyroidectomy. The accuracy of ultrasonography-guided FNAC at our institution was comparable to that reported in the literature. There appears to be very low probability of malignancy in sonographically benign nodules with initial non-diagnostic FNAC results.

The predictivity of thyroid fine-needle aspiration biopsy varies depending on the radiologist experience: A retrospective cohort study

Aim: To compare thyroid fine-needle aspiration biopsy with histopathological examination results. Material and Methods: Postoperative histopathological examination results of 361 patients, who were thyroidectomized between December 2010 and October 2017 in Ýnonu University Turgut Ozal Medical Center Department of General Surgery and whose preoperative FNAB registries we could reach were evaluated retrospectively. Biopsies made in external centers were included in preoperative FNAB results. FNAB results were examined according to Bethesda 2007 in 6 categories: unsatisfactory, benign, atypia of undetermined significance, follicular lesion-neoplasm or suspicious for a neoplasm, suspicious for malignancy and malignant. Histopathological results of patients with incidental malignancy were presumed benign. Results: Among the 361 patients that were included in the study, 274 were female (75.9%), 87 were male(24.1%). Mean age of the patients in the benign group was 49.1±12.5 years, and 48.6±13.5 years in the malignant group. It was found that FNAB’s sensitivity was 83.9 %, specificity was 92.4%, false positive rate was 16.1% and false negative rate was 7.6%. Conclusion: FNAB is reported as the gold standard for preoperative evaluation of thyroid nodules. In our study, however, it was seen that FNAB was not adequate alone to detect malignancy. This situation suggests the importance of collaboration between radiologist, cytopathologist and clinician.

Incidence and malignancy rates classified by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) – An 8-year tertiary center experience in Thailand

Incidence and Malignancy Rates Classified by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) – An 8-year Tertiary Center experience in Thailand. BackgroundFine-needle aspiration (FNA) of the thyroid is considered the best diagnostic tool for preoperative evaluation of thyroid nodules. The introduction of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in 2010 provided the opportunity to establish worldwide standard for reporting and terminology guidelines for diagnostic categories. It is recommended that every institution evaluates the risk of malignancy (ROM) in each category for quality improvement process. AimTo assess the effectiveness of TBSRTC method at our institution using cyto-histological correlation. MethodA retrospective 8-year (2010–2017) audit of thyroid FNA done by thyroid specialists at Theptarin hospital. The FNA results were classified according to TBSRTC. Histopathology reports for operated cases were used to correlate cytology and final histopathology. ResultsA total of 2735 thyroid FNA from 2115 patients (mean age 45.7 ± 13.1 years, female 89.8%) were examined. The rates of non-diagnostic, benign, atypia of undetermined significance (AUS), follicular neoplasm, suspected for malignancy, and malignant cases were 21.1%, 66.6%, 4.7%, 2.4%, 1.8%, and 3.3% respectively. There were 188 patients (9%) who underwent surgical resection with available histopathology. Malignancy rates in operated thyroid nodules were 20.0%, 4.2%, 9.4%, 23.5%, 57.1%, and 90.3% for categories 1 to 6, respectively. The sensitivity, specificity, negative predictive value, and positive predictive value were 96.6%, 88.5%, 95.8%, and 90.3, respectively. ConclusionsPreoperative diagnosis of thyroid nodules using TBSRTC in our hospital was comparable with other studies. The uniform diagnostic criteria of the Bethesda System help avoid misinterpretation while sharing local experience with international benchmarks.

Preoperative Evaluation of Thyroid Nodules: A Prospective Study Comparing the accuracy of Ultrasound (TI-RADS) Versus the FNAC Bethesda System in Relation to the Final Postoperative Histo-pathological Diagnosis

Preoperative Evaluation of Thyroid Nodules: A Prospective Study Comparing the accuracy of Ultrasound (TI-RADS) Versus the FNAC Bethesda System in Relation to the Final Postoperative Histo-pathological Diagnosis

Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules: Relation Between Radiology Thyrads Score and Bethesda Pathology Score System

Background: Although fine-needle aspiration biopsy (FNAB) is considered the standard for preoperative evaluation of thyroid nodules, the value of this has been questioned for different thyroid nodules size. Different pathology and radiological scoring may improve the accuracy of preoperative diagnosis of thyroid nudoles. The aim of this study was to evaluate the relation between radiology Thyrads score and Bethesda pathology score system size in two group size (? 10 mm and > 10 mm) of thyroid nodule in US-FNAB. Methods: There were 183 thyroid nodules between 3 mm to 35 mm who underwent US-FNAB from January 2015 to November 2016 in Shaheed Sadoughi hospital- Yazd. They were divided in to two groups (group A, 3 - 10 mm; group B, 11- 35 mm). The patients were studied according radiology Thyrads score and Bethesda pathology score system. The relation between radiology Thyrads score and Bethesda pathology score system according groups size was analyzed by SPSS21. Results: The mean age ( standard deviation) of patients was 44.5 ( 12.8 years). Most of them were female 138 (83.6%). The frequency of final pathology diagnoses were; 35(21.2%) non diagnostic, 107 (64.8%) benign, 13 (7.9%) malignant and 10 (6.1%) suspicious. no statically significance relation between thyrads score and nodule characteristics (solid/cyst (p-value: 0.555), calcification (P value: 0.558), lymph-adenopathy (P value: 0.521), ecogenicity (P value: 0.236), margin (P value:0.149)). The spearman correlation between radiology thyroids score and Bethesda pathology score system was statistically significant. (Correlation coefficient: 0.202, P value: 0.004). Conclusions: There was a statistically significance correlation between Thyrads score and pathologic Bethesda scoring system. Decision making basis on the radiologic Thyrads score can improve the radiological diagnosis precision in nodular goiter patients.

MALDI-MSI Analysis of Cytological Smears: The Study of Thyroid Cancer.

Fine needle aspiration (FNA) biopsies are the current gold-standard for the preoperative evaluation of thyroid nodules. However, a significant number of them (15-30%) are unable to be affirmatively diagnosed and are given an "indeterminate for malignancy" final report, meaning that the malignant nature of the thyroid nodule remains unknown and the recommended therapeutic approach is total thyroidectomy. Furthermore, cytomorphological evaluation of biopsies taken post-surgery indicates that approximately 80% of nodules within this group of patients are in fact benign, and the total thyroidectomy unwarranted. Therefore, the identification of new possible diagnostic targets that can assist in the preoperative diagnosis of thyroid tumors and reduce the number of unnecessary thyroidectomies is imperative.Matrix-Assisted Laser Desorption/Ionization (MALDI)-Mass Spectrometry Imaging (MSI) has the ability to provide very precise and localized information regarding protein expression in cytological specimens. This enables the detection of cell subpopulations based on their different protein profiles, even within regions that are indistinguishable at the microscopic level, and the feasibility of this approach to investigate FNA specimens has already been highlighted in a number of studies. Here, an overview about the sample preparation procedure for the MALDI-MSI analysis of ex vivo FNA biopsies is provided, highlighting how molecular imaging can be combined with traditional histology to generate protein signatures of the different thyroid lesions, and, ultimately, build classification models that can be potentially used to classify benign and malignant thyroid nodules from a molecular standpoint.

Application of the Bethesda Classification for Thyroid Fine-Needle Aspiration: Institutional Experience and Meta-analysis.

-Fine-needle aspiration (FNA) biopsies have been an important component in the preoperative evaluation of thyroid nodules. Until the introduction of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in 2008, individual institutions had developed their own diagnostic categories. The BSRTC proposed 6 categories in an attempt to standardize reporting of thyroid FNA. -To present a 15-year experience of thyroid FNA at one institution, including data before and after introduction of the BSRTC. The risk of malignancy is compared with the meta-analysis of high-quality published data. -Data sources were PubMed, a manual search of references, and institutional data. -The diagnostic categories developed at our institution were similar to those proposed by the BSRTC, with best fit into the 6 categories easily accomplished and reported in the final 2 years of the study. Significant differences were noted in the frequencies of cases in diagnostic categories Benign (II; P = .003), Suspicious for follicular neoplasm/Follicular neoplasm (IV; P < .001), and Malignant (VI; P = .003) after the introduction of the BSRTC. Eighteen published articles met the criteria for inclusion in the meta-analysis. The risk of malignancy in each category in our institution was similar to that determined in the meta-analysis, except for Insufficient for diagnosis (I; 20% versus 9%-14%). Meta-analysis showed an overlapping 95% CI of risk of malignancy between Atypia of undetermined significance/Follicular lesion of undetermined significance (III; 11%-23%) and Suspicious for follicular neoplasm/Follicular neoplasm (IV; 20%-29%), suggesting similar risks of malignancy. The use of newer molecular tests for these indeterminate cases may further refine risk assessment.

Role of 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Evaluation of Cytologically Indeterminate Thyroid Nodules.

Background:Thyroid nodules with indeterminate fine-needle aspiration biopsy (FNAB) results remain a diagnostic dilemma, because 70 - 85% of these nodules have been found to be benign after thyroid surgery.Objectives:The purpose of this study was to evaluate the usefulness of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the preoperative diagnosis of cytologically indeterminate nodules.Patients and Methods:Forty-six patients were included in this study. These individuals had undergone FDG PET/CTs for the preoperative evaluation of thyroid nodules with indeterminate FNAB results. The results of the preoperative PET/CT scans were compared with the postoperative pathological results and statistically analyzed.Results:Of the 46 patients included in our study, the histopathology of the surgical specimens revealed thyroid cancer in 17 individuals (37%, 17/46). The PET/CT scan showed a positive result in 27 patients. Of these, 16 patients (59.3%) were found to have thyroid carcinomas. In addition, the PET/CT scan was considered to be negative in 19 patients, 18 (94.7%) of whom had benign lesions. For the detection of malignant lesions, the values for the sensitivity and specificity, and the positive predictive and negative predictive values were 94%, 62%, 59%, and 95%, respectively.Conclusion:The FDG PET/CT showed a high sensitivity and a high negative predictive value for identifying malignancies in thyroid nodules with indeterminate FNAB results. Therefore, the FDG PET/CT may be a helpful tool in the clinical management of these nodules. When an FDG positive lesion is detected, further examination is recommended.

Role of gene expression profiling in defining indeterminate thyroid nodules in addition to BRAF analysis.

Fine-needle aspiration (FNA) is routinely used in the preoperative evaluation of thyroid nodules. However, 15% to 30% of aspirations yield indeterminate cytologic findings. Because the assessment of BRAF mutations seems to improve the diagnostic accuracy, this study evaluated BRAF mutations with Sanger sequencing and real-time methods in 650 consecutive thyroid aspirates. In addition, the expression of a large number of genes involved in basement membrane remodeling, extracellular matrix proteolysis, and cell adhesion was studied in both benign and malignant nodules to identify new diagnostic tools. In this prospective series, despite the use of a very sensitive BRAF mutational testing method, the frequency of a BRAF alteration being identified in indeterminate FNA samples was 3 of 68. Expression analysis revealed several genes that were differentially expressed between benign and malignant nodules (transforming growth factor, cadherin 1, collagen α1, catenin α1, integrin α3, and fibronectin 1 [FN1]), between follicular adenomas and follicular variant of papillary thyroid carcinoma (FN1, laminin γ1, integrin β2, connective tissue growth factor, catenin δ1, and integrin αV), and between BRAF-wild-type and BRAF-mutated papillary thyroid carcinomas (TIMP metallopeptidase inhibitor 1; catenin α1; secreted phosphoprotein 1; FN1; ADAM metallopeptidase with thrombospondin type 1 motif, 1; and selectin L). These data were partially confirmed with real-time polymerase chain reaction analysis and immunohistochemistry. When the cost/benefit ratio of the procedures was taken into account, BRAF mutational testing failed to increase diagnostic accuracy in cytologically indeterminate nodules. However, the additional analysis of the expression of specific molecular markers could have possible utility as a diagnostic tool, although further evidence based on a large series of samples is needed before definitive conclusions can be drawn. Cancer Cytopathol 2016;124:340-9. © 2015 American Cancer Society.

Cytologic diagnostic approach to poorly differentiated thyroid carcinoma: a single-institution study.

Fine-needle aspiration cytology (FNAC) is a well-established technique for the preoperative evaluation of thyroid nodules because it is minimally invasive, cost-effective, quick, efficient, and safe. Various articles have discussed differences in the cytomorphology of different types of thyroid cancer. However, review articles on the cytologic diagnosis of poorly differentiated thyroid carcinoma (PDTC) are scarce as PDTC are rare tumors. Although the histologic diagnostic criteria are well standardized, the cytologic diagnostic criteria are not yet standardized. This prompted us to study the cytomorphological features of PDTC and assess features of distinction from differentiated thyroid carcinoma (DTC) and medullary thyroid carcinoma (MTC). This was a retrospective study of thyroid FNAC smears from 44 PDTC cases retrieved from the database of a single tertiary cancer institute (2009-2013). Papanicolaou and Giemsa smears were evaluated for 21 cytomorphologic features. Immunocytochemistry was available for 6 cases only. The frequencies of cytomorphologic features in the 44 cases were as follows: hypercellularity, 84.1%; insular pattern, 79.5%; small cell size, 93.2%; high nuclear-cytoplasmic ratio, 93.2%; granular chromatin pattern, 95.45%; nuclear overlapping, 88.64%; mild pleomorphism, 86.36%; grooves/inclusions, 22.7%; binucleation/multinucleation, 9.1%; abrupt nucleomegaly, 34.1%; apoptosis, 45%; mitosis, 25%; necrosis, 34.1%; and colloid, 22.7%. A high index of suspicion is necessary for an upfront diagnosis of PDTC on FNAC. Although PDTC, DTC, and MTC have overlapping features, there are distinguishing features also. The cytologic diagnostic criteria for PDTC need to be standardized by collaborative efforts among tertiary cancer centers. A prompt diagnosis is the key feature for planning multimodality treatment.

BRAF mutation analysis in thyroid nodules with indeterminate cytology: our experience on surgical management of patients with thyroid nodules from an area of borderline iodine deficiency.

Fine-needle aspiration (FNA) with cytologic evaluation is the most reliable tool for malignancy prediction in thyroid nodules, but cytologic diagnosis remains indeterminate for 12-18 % of nodules. BRAF V600E mutation has been reported to show a high specificity for malignant thyroid nodules and the use of this marker to refine indeterminate FNA cytology results may be a useful diagnostic adjunctive tool in the pre-operative evaluation of thyroid nodules. The aim of this study was to estimate the prevalence of BRAF exon 15 mutation (V600E) and its clinical value as a diagnostic tool in a series of thyroid nodules with indeterminate cytology from an area of borderline iodine deficiency. One hundred and fifty-three thyroid samples obtained by FNA of thyroid nodules from 151 patients were subjected to the analysis of BRAF V600E mutation by direct sequencing. In the study 54 nodules with indeterminate cytology, 56 benign and 43 malignant thyroid nodules were included. V600E BRAF gene mutation was demonstrated in 19/43 malignant nodules, in 0/56 benign nodules and in only 1/54 indeterminate nodules that, after histology, turned out to be at a papillary thyroid carcinoma. The application of BRAF exon 15 analysis showed limitations when applied to discriminate thyroid nodules with indeterminate cytology if wild-type BRAF is found, and there is no role for avoiding diagnostic thyroid surgery.

Diagnostic value of B‐RAFV600E in difficult‐to‐diagnose thyroid nodules using fine‐needle aspiration: Systematic review and meta‐analysis

Fine-needle aspiration (FNA) is routinely used in the preoperative evaluation of thyroid nodules. However, approximately 5-20% of thyroid nodules are considered indeterminate or suspicious cases that do not meet clinical standards. The B-RAF(V600E) mutation has been reported in FNA specimens. We conducted a systematic review to evaluate the diagnostic value of testing for B-RAF(V600E) in thyroid nodules that are difficult to diagnose by FNA. A systematic literature search was performed from January 1, 2002 to June 30, 2012. Articles were obtained by searching two electronic databases (MEDLINE and EMBASE), hand searching selected journals, and contacting authors. Article quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Sensitivity, specificity, and other measures of accuracy were pooled using random effects models. Summary receiver operating characteristic (SROC) curves were used to summarize overall diagnostic accuracy. A total of 16 studies incorporating 1131 patients were included in a meta-analysis on diagnostic accuracy of B-RAF(V600E) tests. Pooled sensitivity was 0.60 (95% confidence interval [CI]: 0.556-0.634), pooled specificity was 0.99 (95% CI 0.976-0.997), and the area under the curve of the SROC curve was 0.8376. Q index value was 0.7696. Our data suggest a potentially useful adjunct to evaluating thyroid nodules that are difficult to diagnose. The B-RAF(V600E) test has a high positive predictive value and could help clinicians formulate a more individualized treatment schedule. When supplemented with other noninvasive test methods, the B-RAF(V600E) test could be a powerful adjunct with extensive clinical applications.

Impact of Flow Cytometry in Thyroid Cytopathology

Background: Fine-needle aspiration (FNA) is a useful diagnostic tool for preoperative evaluation of thyroid nodules. However, cytomorphology alone has poor accuracy for the diagnosis of lymphoproliferative disorders involving the thyroid. This study reviews our experience with flow cytometry on thyroid FNA and correlation with surgical follow-up at The Johns Hopkins Hospital. Methods: The 11,118 thyroid FNAs performed over a 20-year period were reviewed for clinical flow cytometry data (n = 62) or a subsequent diagnosis of lymphoma in the thyroid without flow cytometry data (n = 2). Result: Sixty-four cases (0.6%) were included out of 11,118 thyroid FNAs collected over a 20-year period. Lymphoma was diagnosed 13 times. In 8 cases, both cytomorphology and flow cytometry arrived at the correct diagnosis. Cytomorphology alone made the correct diagnosis twice in the absence of flow cytometric results; flow cytometry made the diagnosis once in the absence of suspicious morphology. Neither flow cytometry nor cytomorphology made the correct diagnosis in 2 sparsely cellular cases. Conclusion: The combination of cytomorphology and flow cytometry is a useful diagnostic modality for the work-up of lymphocyte-rich thyroid nodules that show atypical lymphocyte populations.

Changes in TNM stage, reoperation and 131‐I ablation rate during the use of newer methods for the preoperative diagnosis of differentiated thyroid carcinoma

To define and discuss the changes of important risk factors and TNM staging over the last 40 years in patients operated on for differentiated thyroid carcinoma (DTC), resulting from the introduction of newer sensitive diagnostic procedures in the preoperative evaluation of thyroid nodules. We reviewed the medical records of 1251 patients with postoperative diagnosis of DTC who had undergone initial diagnosis, before surgery, at our unit, between 1971 and 2010. According to the period of diagnosis, the patients were divided into four groups (I, II, III, IV) corresponding to the four decades. The mean age at diagnosis was unchanged over time for both papillary (PTC) and follicular thyroid cancer (FTC). A decrease in the proportion of FTC (group I vs group IV P < 0·01) and a concomitant increase in PTC/FTC ratio was observed particularly in group IV. The significant decrease in the proportion of tumour size of PTC (group I vs group IV, P < 0·01), the increase in the proportion of microcarcinomas, from 22·4% in group I to 53·0% in group IV, P < 0·001, and the decrease in the number of cases with features of aggressiveness have changed the TNM stage towards stages I and II. The overall frequency of patients at high risk was significantly decreased, from 8·0% in group I to 1·8% in group IV. The number of patients who underwent reoperation for the completion of tumour resection and/or radioiodine therapy significantly decreased over time. The evaluation of thyroid nodules using the newer diagnostic methods was useful in identifying DTC early. Consequently, the reoperation and thyroid remnant ablation rates were reduced.

The Diagnostic Accuracy of Ultrasound-Guided Fine-Needle Aspiration Biopsy and the Sonographic Differences Between Benign and Malignant Thyroid Nodules 3 cm or Larger

Although fine-needle aspiration biopsy (FNAB) is considered the standard for preoperative evaluation of thyroid nodules, the value of this has been questioned for large thyroid nodules. Here, we evaluated the diagnostic accuracy of ultrasound-guided FNAB (US-FNAB) for thyroid nodules that were 3 cm or larger as well as the sonographic differences between benign and malignant nodules in this size group. There were 661 thyroid masses equal to or larger than 3 cm who underwent US-FNAB from February 2002 to December 2006 and were included in this study. The cytology and surgical pathology readings in these patients were reviewed along with the ultrasonography features, the last from the retrospective review by one radiologist. Histopathology was used to calculate accuracy parameters for the US-FNAB cytology readings. In addition, the likely diagnoses for patients with a benign cytology reading were ascertained. Thyroid surgery was performed for 206 of the 661 nodules in the same number of patients (31.2%). All subjects who had inadequate, indeterminate, or suspicious for malignancy cytology readings had thyroid surgery. All of the patients who did not have thyroid surgery were considered likely to have benign disease because of their initial cytology reading and follow-up, and finally, 587 (88.8%) were benign and 74 (11.2%) were malignant. When considering malignant, suspicious for malignancy, and indeterminate cytology readings as positive and benign cytology as negative, the sensitivity was 96.7%, specificity 85.9%, positive predictive value 76.6%, negative predictive value 98.2%, and accuracy 89.4%. Ultrasonography features of malignancy were more prevalent in thyroid nodules that were malignant compared with those that were benign or considered likely to be benign (70.3% vs. 1.2%, p < 0.001), and ultrasonography features of a benign nodule were more prevalent in thyroid nodules that were benign or considered likely to be benign than those that were malignant (94.9% vs. 29.7%, p < 0.001). In this study, US-FNAB appeared to be a relatively accurate method to evaluate thyroid nodules larger than 3 cm, with false-negative rates of about 2%. Much larger series would be required to determine its utility in this setting.