Thyroid Fine-needle Aspiration Biopsy Research Articles

Thyroid fine needle aspiration biopsy: The effect of radiological features of nodules on cytological adequacy

Aim: Thyroid fine needle aspiration biopsy (FNAB) is an inexpensive and microinvasive procedure used in the diagnosis of thyroid nodules. However, cytology may be insufficient in up to 40% of biopsies. This study aimed to assess the effect of radiological features of thyroid nodules on cytological adequacy. Methods: The patients who underwent thyroid FNAB between 2016 and 2019 in our clinic were reviewed in this retrospective cohort study. Diagnostic adequacy rate and radiological features of nodules (size, cystic component, calcification content, echogenicity, margin feature) were noted and their relationship was investigated. Results: A total of 525 patients (77% female, 23% male; mean age 53.3 years; age range 14-87) had FNAB for 595 nodules. Mean diameter of the nodules was 20.1 mm (min: 4mm; max: 60 mm). Of the all biopsies, 25% were inadequate for diagnosis. Adequacy was significantly low in nodules containing macrocalcification (P=0.036). There was no significant relationship between adequacy and echogenicity, margin feature, solid structure or size of the nodules (P>0.05 for each). Conclusion: Some radiological features may be predictive of inadequate sampling. Nevertheless, varied extrinsic factors affect cytopathological adequacy besides radiological features. Additional techniques may be required in these nodules.

Quality of Life Following Molecular Marker Testing for Indeterminate Thyroid Nodules

Thyroid cancer has a disproportionately negative effect on the quality of life (QOL) compared to malignancies with a worse prognosis. The QOL of patients with indeterminate thyroid nodules has not been previously evaluated. We aimed to assess the impact of molecular test results on the QOL of patients with indeterminate thyroid nodules. A short version of the Thyroid-Related Patient-Reported Outcome (ThyPro-39) was used to assess the QOL of patients who underwent thyroid fine needle aspiration (FNA) biopsy throughout UCLA Health from May, 2016, to June, 2017. All patients with indeterminate biopsy results underwent molecular testing with either Afirma Gene Expression Classifier or ThyroSeq v2 at the time of the initial biopsy. The QOL associated with symptoms of goiter, anxiety, depression, and impaired daily life were analyzed. Of 825 consented patients, 366 completed the assessment (44.4% response rate). FNA results included 76% benign, 7% malignant, and 17% indeterminate. There were no differences in QOL between patients with a benign FNA and patients with an indeterminate result with benign molecular testing. In patients with an indeterminate FNA, symptoms of goiter (20.5 versus 10.4; P = .033) and depression (33.3 versus 21.0; P = .026) were worse for patients with suspicious versus benign molecular test results; however, no significant differences were observed in anxiety or impaired daily life. A benign molecular test result may provide reassurance for patients with indeterminate thyroid nodules that the risk of malignancy is low. Long-term follow-up is necessary to determine if benign molecular test results maintain improved QOL.

Long-Term Impact of Thyroid Biopsy Specialists on Efficiency and Quality of Thyroid Biopsy.

To assess consistency and long-term progress in thyroid biopsy performed by trained sonographers under supervision of a radiologist. Trained sonographers started performing thyroid biopsy at our institute in August 2011. The data for this study were extracted from a prospectively maintained database for ultrasound guided thyroid biopsy and included the number of thyroid fine needle aspiration biopsy procedures performed between August 2011 and 2016 and the final cytopathology report as per the Bethesda Classification. For the analysis, the study was divided into two time periods: initial postimplementation period (August 2011 to 2013) and late postimplementation period (2014-2016). In all, 5,538 thyroid biopsies were performed by trained sonographers in the period, 2,561 in the initial implementation period and 2,977 between 2014 and 2016. The unsatisfactory rates dropped from 21% to 10% in the two periods (P < .001), and the proportion of malignant nodules on cytopathology increased from 6% to 7% in the two periods (P= .010). Wait times for thyroid biopsies remained low during the period. Sonographers trained to perform ultrasound guided thyroid biopsies provide persistent improved patient care over a long-term period. This reinforces the role of physician extenders in targeted scopes of practice.

The run for a million continues: is there still space for traditional techniques beyond molecular testing for indeterminate thyroid nodule cytology?

Thyroid nodules are increasingly common in our daily lives and the duo “thyroid ultrasound (US) & fine needle aspiration biopsy (FNAB)” remains the gold standard for identifying or ruling out malignancy with high accuracy ( ). However, we know that out of these nodules, about 25% has an undefined cytology, being named “indeterminate samples” or, according to the Bethesda’s Classification System, categories III (atypia of undetermined significance – AUS/follicular lesion of undetermined significance – FLUS) and IV (follicular neoplasm – [...]

Evaluation of the Bethesda System and the ACR TIRADS in an Endemic Goiter Region

ABSTRACT Background Various factors can affect incidence of thyroid disorders and disease profiles may show abrupt changes in endemic goitrous areas. In this study, it was aimed to analyze the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in terms of risk of malignancy and general recommendations in an endemic goiter region (EGR). Methods In this retrospective study, a total of 500 patients who had thyroidectomy following thyroid fine needle aspiration biopsy were enrolled. For the assessment of thyroid cytology, BSRTC was used and for the evaluation of ultrasound features of thyroid nodules, ACR TIRADS lexicon was adopted. For the assessment of thyroid cytology, Bethesda classification was used and for the evaluation of ultrasound features of thyroid nodules, ACR TIRADS lexicon was adopted. Results In the EGR setting, benign category of BSRTC had a cancer risk of 6.2% which was two times more than the 2017 BSRTC revision reported. Nodules 10–14.9 mm in diameter had nearly 4 times higher malignancy risk than nodules >15 mm. In this group of patients, the risk of malignancy for TIRADS level 1, 2, 3, 4 and 5 was 1.16%, 2.94%, 7%, 45.64% and 94.44%, respectively. The malignancy rates for Bethesda system category I, II, III, IV, V and VI were as follows: 14.43%, 6.2%, 19.05%, 36.73%, 75.68% and 100%. Conclusions There are slight differences between the common set of standards and this study results regarding risk of malignancy. This brings up the question whether there is need for revision for the use of categories and the appropriate management in endemic goiter regions.

Diagnostic Value of Molecular Testing in Sonographically Suspicious Thyroid Nodules.

Objective Molecular testing can refine the diagnosis for the 20% of thyroid fine-needle aspiration biopsies that have indeterminate cytology. We assessed the diagnostic accuracy of molecular testing based on ultrasound risk classification.MethodsThis retrospective cohort study analyzed all thyroid nodules with indeterminate cytology at an academic US medical center (2012-2016). All indeterminate nodules underwent reflexive molecular testing with the Afirma Gene Expression Classifier (GEC). Radiologists performed blinded reviews to categorize each nodule according to the American Thyroid Association (ATA) ultrasound classification and the American College of Radiology Thyroid Imaging, Reporting and Data System. GEC results and diagnostic performance were compared across ultrasound risk categories.ResultsOf 297 nodules, histopathology confirmed malignancy in 65 (22%). Nodules by ATA classification were 8% high suspicion, 44% intermediate, and 48% low/very low suspicion. A suspicious GEC result was more likely in ATA high-suspicion nodules (81%) than in nodules of all other ATA categories (57%; P = .04). The positive predictive value (PPV) of GEC remained consistent across ultrasound categories (ATA high suspicion, 64% vs all other ATA categories, 48%; P = .39). The ATA high-suspicion category had higher specificity than a suspicious GEC result (93% vs 51%; P < .01). A suspicious GEC result did not increase specificity for the ATA high-suspicion category.ConclusionThe PPV of molecular testing remained consistent across ultrasound risk categories. However, a suspicious GEC result was very likely in ATA high-suspicion nodules and did not improve specificity in this sonographic category.

Whirling technique for thyroid fine needle aspiration biopsy: a preliminary study of effectiveness and safety.

PurposeThis study was aimed to compare thyroid fine needle aspiration biopsy (FNAB) techniques (conventional vs. whirling) in terms of cell harvesting ability ex vivo, the unsatisfactory rate and complication rate in vivo, and multi-operator performance in a phantom study.MethodsIn the ex vivo study, cell counts per background at ×100 magnification were compared between both techniques. In the in vivo study, 70 patients who underwent whirling FNAB from July 2019 to November 2019 were retrospectively compared to 140 matched patients who underwent conventional FNAB from January 2018 to November 2019 regarding the unsatisfactory rate and complication rate. As a subgroup analysis, thyroid nodules in difficult biopsy situations (nodule diameter <10 mm and location within 3 mm from major anatomical structures) were compared. In the phantom study, eight operators with varying experience recorded levels of dexterity and needle tip visualization, and their preferences for both techniques.ResultsIn the ex vivo study, cell counts were comparable between both techniques in all thyroid nodule mimickers (80.0% vs. 87.5%, P=0.178). In the in vivo study, the unsatisfactory rate was comparable between the two groups (15.7% vs. 12.9%, P=0.859). In the subgroup analysis, the whirling technique demonstrated a lower unsatisfactory rate (5.9% vs. 24.2%, P=0.045) and a lower complication rate (0% vs. 6.1%, P=0.553). In the phantom study, the whirling technique demonstrated better dexterity and needle tip visualization and was preferred by all operators.ConclusionThis newly proposed whirling technique for thyroid FNAB may be effective and safe, especially in difficult biopsy situations.

MON-468 Hypoechoic Nodule Is Not Always the Bad Guy: Lessons Learned from a Patient with Subacute Painful Thyroiditis

Introduction: The diagnosis of subacute painful thyroiditis (SAT) is primarily based on clinical manifestations (thyroid tenderness and diffuse goiter). Suppressed TSH, elevated erythrocyte sedimentation rate (ESR) and low thyroid uptake help confirm the diagnosis. Thyroid ultrasonography and fine-needle aspiration biopsy (FNAB) are rarely necessitated. SAT produces a typical sonographic findings of ill-defined heterogeneously hypoechoic areas, which is difficult to differentiate from thyroid carcinoma. We herein report a patient with SAT who was initially diagnosed as malignancy. Case Presentation: A 36-year-old female had pain and swelling at the left thyroid gland for 3 weeks. A left thyroid nodule was diagnosed by her primary care physician. Ultrasonography revealed a poorly defined hypoechoic nodule measuring 2.5x1.1x1.5 cm at the mid pole of the left thyroid gland, for which biopsy was recommended. The nodule showed peripheral vascularity and no calcification. No suspicious cervical lymphadenopathy was detected. Histologic analysis from core biopsy found findings consistency with follicular neoplasm. Thyroid function tests were within normal range. She was treated with ibuprofen as management of thyroid pain and referred for surgery. However, the repeated ultrasonography was performed by endocrinologist in the next 2 weeks and found an interval reduction in size of hypoechoic lesion. FNAB was performed due to the risk of infiltrative malignancies. Cytologic analysis was compatible with SAT. ESR was slightly elevated. Surgery was cancelled and she was treated with ibuprofen. Two weeks later, she reported that the left thyroid pain and swelling had subsided. However, she developed thyroid pain associated with glandular tenderness and swelling of the right thyroid. On sonographic examination, the right lobe, which was previously normal was now similarly affected. Thyroid function showed thyrotoxicosis. The patient was given a further course of beta-blocker, ibuprofen and prednisolone for 2 weeks and recovered well. On follow-up at 2 months, the patient developed biochemical hypothyroidism and received levothyroxine replacement. The lesions in the thyroid gland were not visualized in the 6-month follow-up sonography. Conclusion: The ultrasonographic features of the thyroid during the acute stage of SAT may mimic thyroid carcinoma. Awareness of the sonographic findings and interval changes of SAT lesions may helpful for proper diagnosis and treatment of SAT.

Thyroid Cancer Incidence Trends in the United States: Association with Changes in Professional Guideline Recommendations.

Background: Overdiagnosis is the leading factor contributing to the rapid increase in thyroid cancer incidence of the last decades. During this period, however, thyroid cancer incidence has not been increasing at a constant pace. We hypothesized that changes in the slope of the incidence trends curve, called joinpoints, could be associated with changes in clinical practice guideline recommendations. Methods: Data were obtained from the initial nine registries of the Surveillance, Epidemiology, and End Results (SEER) Program. Thyroid cancer incidence was analyzed from 1975 to 2016. Joinpoints in thyroid cancer incidence trends and clinical variables were correlated with significant changes in clinical practice recommendations. Results: Incidence rate trends of medullary and anaplastic thyroid cancer were constant during the study period. Among papillary thyroid cancers (PTCs), three main joinpoints were identified, mainly driven by changes in incidence trends of smaller cancers. First, acceleration followed by two deceleration periods in thyroid cancer incidence coincident in time with the release of American Thyroid Association guidelines in 1996, 2009, and 2015. In 1996, the use of thyroid ultrasound and fine needle aspiration biopsy for the evaluation of thyroid nodules was described; and in 2009 and 2015, higher size thresholds for the biopsy of thyroid nodules were set. For the follicular variant of PTC, a joinpoint was observed around 1988, when the histological diagnosis of this entity was revised in the World Health Organization classification; and another one in 2015 coinciding with the proposal to remove the term carcinoma from noninvasive follicular-pattern tumors with papillary-like nuclear features which contributed to drive down the overall thyroid cancer incidence. Follicular thyroid cancer incidence was affected as well by changes in the guidelines, but to a lesser extent, and it was fairly stable during the study period. Conclusions: This study suggests that thyroid cancer incidence trends have been shaped, in large part, but not completely, by changes in professional guideline recommendations.

Considerations for Thyroid Fine Needle Aspiration (FNA) Biopsies During the COVID-19 Pandemic

Considerations for Thyroid Fine Needle Aspiration (FNA) Biopsies During the COVID-19 Pandemic

Diagnostic accuracy of preoperative palpation- versus ultrasound-guided thyroid fine needle aspiration cytology: an observational study

ABSTRACT Background Thyroid fine needle aspiration (FNA) is the mainstay for diagnosis of malignancy, and is an integral part of current thyroid nodule assessment. The present study analyzes the diagnostic accuracy of palpation-directed versus ultrasound guided fine-needle aspiration in patients who underwent surgery for thyroid nodules. Methods A retrospective chart review of all consecutive patients who had FNA biopsy (palpation or ultrasound guided) of thyroid nodules and underwent thyroid gland surgery between 1998 and 2014 was conducted. The FNA findings of the palpation-guided and ultrasound-guided groups were compared for baseline characteristics. Moreover, the diagnostic accuracy of FNA findings and surgical histopathology results were analyzed. Results A total of 1174 patients were included in the study with a mean age of 46.3 ± 11.7 years and the majority were females (75.5%). Among the study population, 392 (33.4%) patients underwent US-guided FNA; 570 (48.6%) had palpation-guided FNA in clinic and no FNA was done in 212 (18%) cases. Patients underwent US-guided FNA were more likely to have suspicion of malignancy (p = 0.001), and had indeterminate findings (p = 0.001). On the other hand, palpation-guided FNA group had significantly higher frequency of benign cytology (p = 0.001). With respect to the suspicion for malignancy as well as malignancy, the US-guided group had a similar diagnostic accuracy in comparison to the palpation group. The proportion of malignancy finding on US-guided FNA (8.9%) was higher than the palpation-guided FNA (6.4%) that had been confirmed on postoperative histopathological examination (p = 0.95). Conclusion The present study demonstrates higher sensitivity of US-guided thyroid FNA biopsies over palpation-guided FNA for the suspicion of malignancy; however, the accuracy is comparable. Moreover, both groups showed more postoperative malignancy in the benign and unsatisfactory categories than predicted in the Bethesda system. Further prospective studies are needed to underpin a realistic correlation between FNA and final histopathology reports.

Diagnostic value of the candidate microRNAs in thyroid fine-needle aspiration biopsy (FNAB) samples.

Background Thyroid cancer (TC) is known to be the most common endocrine malignancy with an incidence rate which has increased by 2.3-fold over the past 30 years. Approximately, 30% of the thyroid fine-needle aspiration biopsy (FNAB) outcomes are indecisive. Moreover, researchers recognized multiple differentially expressed microRNAs (miRNAs) as candidate diagnostic markers for thyroid nodules. The purpose of this study was to identify thyroid tumor-associated miRNAs in FNAB with the capacity to be developed as unique biomarkers. Materials and methods According to the study design, a quantitative real time reverse transcription polymerase chain reaction (qRT-PCR) was applied to evaluate the expression levels of nine miRNAs (Let7, miR-34a, miR-146b, miR-221, miR-151, miR-155, miR-181b, miR-222 and miR-375) among 224 FNA samples as the training set. Results The findings of this study revealed that miR-181b and miR-146b are the best predictors to diagnose benign thyroid FNA samples from malignant samples. However, the remaining miRNAs were co-expressed and had no significant effect on the predictor model. On the other hand, sensitivity and specificity of miR-181b and miR-146b were reported at 83.0%-83.0% and 83.0%-66.0%, respectively. Conclusions According to the results of this study, miR-146b and miR-181b might be considered as adjunct markers contributing to thyroid FNAB in tumor types. In addition, miR-146b and miR-181b were recognized as biomarkers for discriminating benign thyroid nodules from malignant ones. It is suggested that further prospective clinical trials be conducted to evaluate the accuracy of such findings in a larger cohort and determine the clinical uses.

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and the risk of malignancy in The Bethesda System for the Reporting of Thyroid Cytopathology.

The Bethesda System for the Reporting of Thyroid Cytopathology (TBSRTC) is used to categorize and diagnose thyroid nodules by fine needle aspiration biopsy (FNAB). Each category in TBSRTC is associated with an estimated risk of malignancy (ROM). A subset of noninvasive encapsulated follicular variant of papillary thyroid carcinoma (niEFVPTC) was reclassified as a nonmalignant tumor: noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). We studied the impact of this reclassification on the reported ROM in TBSRTC. We searched our institutional files for thyroid FNAB with surgical follow-up. ROM for each TBSRTC category was calculated. Subsequently, cases of niEFVPTC were reviewed and reclassified as NIFTP, if appropriate. ROM for each category was then recalculated after the reclassification. Twenty-six NIFTP were identified; the corresponding FNABs were distributed among all six TBSRTC categories. The majority of NIFTP FNAB were in the AUS/FLUS and suspicious for malignancy (SUSP) categories, 12 (46.2%) and 8 (30.8%), respectively. While the ROM changed for all diagnostic categories, the greatest change in ROM after reclassification was seen in these two categories. Absolute ROM for AUS/FLUS decreased from 25.0% to 21.0% and SUSP, from 71.7% to 58.3%, changes that were statistically significant. The reclassification of niEFVPTC to NIFTP has significantly impacted the ROM in the TBSRTC at our institution. While there was a decrease in ROM for all categories, the greatest reduction to ROM was in the categories of AUS/FLUS and FN. These changes to the ROM should help guide surgical approach moving forward.

Application of a machine learning algorithm to predict malignancy in thyroid cytopathology.

The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) comprises 6 categories used for the diagnosis of thyroid fine-needle aspiration biopsy (FNAB). Each category has an associated risk of malignancy, which is important in the management of a thyroid nodule. More accurate predictions of malignancy may help to reduce unnecessary surgery. A machine learning algorithm (MLA) was developed to evaluate thyroid FNAB via whole slide images (WSIs) to predict malignancy. Files were searched for all thyroidectomy specimens with preceding FNAB over 8years. All cytologic and surgical pathology diagnoses were recorded and correlated for each nodule. One representative slide from each case was scanned to create a WSI. An MLA was designed to identify follicular cells and predict the malignancy of the final pathology. The test set comprised cases blindly reviewed by a cytopathologist who assigned a TBSRTC category. The area under the receiver operating characteristic curve was used to assess the MLA performance. Nine hundred eight FNABs met the criteria. The MLA predicted malignancy with a sensitivity and specificity of 92.0% and 90.5%, respectively. The areas under the curve for the prediction of malignancy by the cytopathologist and the MLA were 0.931 and 0.932, respectively. The performance of the MLA in predicting thyroid malignancy from FNAB WSIs is comparable to the performance of an expert cytopathologist. When the MLA and electronic medical record diagnoses are combined, the performance is superior to the performance of either alone. An MLA may be used as an adjunct to FNAB to assist in refining the indeterminate categories.

Use of the Thyroid Imaging Reporting and Data System (TIRADS) in clinical practice: an Italian survey.

To perform an online survey about the use of Thyroid Imaging Reporting and Data System (TIRADS) classification in Italy. An online questionnaire was administered to all members of the Italian Society of Medical and Interventional Radiology (Società Italiana di Radiologia Medica ed Interventistica, SIRM) and Italian Society of Ultrasound in Medicine and Biology (Società Italiana di Ultrasonologia in Medicina e Biologia, SIUMB). The survey consisted of 14 questions about demographics, knowledge, and the use of TIRADS classification, current job, expertize in thyroid ultrasound and fine needle aspiration biopsy, and work environment. Descriptive and nonparametric statistics were used, with P < 0.05 indicating statistical significance. A total of 1544 answers (9.8% out of 15,836) were received. The participants were 45 (36-59) years old [median (25th-75th percentiles)] and mostly (53.6%) familiar with TIRADS classification. Structured reporting (P < 0.001), expertize in thyroid ultrasound (P = 0.005) and fine needle aspiration biopsy (P < 0.001), and work in a multidisciplinary team (P < 0.001) were associated with the use of TIRADS classification. Physicians working in other fields than radiology were more prone to using TIRADS classification than radiologists and radiologists-in-training (P < 0.001). Most physicians adopt TIRADS classification when performing thyroid ultrasound. TIRADS classification provides recommendations for the management of thyroid nodules and its use has to be encouraged.

Tiroid İnce İğne Aspirasyon Biyopsisi Önemi Belirsiz Atipi Olan Hastalarda Dolaşımdaki MikroRNA 190 ve MikroRNA95-3P Diferansiye Tiroid Kanserini Öngörebilen Birer Biyobelirteç Midir?

INTRODUCTION: It is not always possible to make a definitive diagnosis preoperatively with thyroid fine needle aspiration biopsy. Decision making is quite complicated in cases with atypical cells of undetermined significance. MicroRNAs have been shown to be associated with the development of neoplasia. For this purpose, we aimed to investigate the circulating microRNA 190 and microRNA 95-3P levels as a biomarker to distinguish benign and malign cases with preoperative atypical cells of undetermined significance diagnosis. METHODS: Patients with preoperative atypical cells of undetermined significance.diagnosis were included in the study. 29 malign and 29 benign patients were included. Venous blood samples isolated using a specific miRNA kit. RESULTS: According to the postoperative pathology results statistically significant between circulating miRNA 190 and miRNA 95-3p between cases with thyroid cancer. differences were detected. DISCUSSION AND CONCLUSION: It can be asserted that miRNA 95 and miRNA 190 assessment can help to differentiate thyroid cancer from benign thyroid nodules and may be useful in avoiding unnecessary surgery in patients with atypical cells of undetermined significance results.

Cytopathology-histopathology correlation and the effect of nodule diameter on diagnostic performance in patients undergoing thyroid fine-needle aspiration biopsy.

Although thyroid fine-needle aspiration biopsy (FNAB) is established to have a good overall sensitivity and specificity, various outcomes have been reported on its performance in large nodules. The aim of the study was to evaluate the diagnostic performance of FNAB and the effect of the nodule diameter on its diagnostic performance. The outcomes of a total of 7319 patients who underwent FNAB over the course of 5 years were analyzed retrospectively and 648 patients who had undergone post-FNAB thyroidectomy or lobectomy were included in the study. FNAB results were classified according to the Bethesda system. After evaluating the compatibility between cytology and pathology results, all-nodules and diameter-based (<4 cm and ≥4 cm) sensitivity, specificity, false positivity, false negativity, and accuracy rates of FNAB were calculated. Sensitivity of FNAB was 85.4% for all nodules, 88.3% for nodules <4 cm, and 75.8% for nodules >4 cm (P < 0.001). Specificity was 58.4% for all nodules, 49.3% for nodules <4 cm, and 75.1% for nodules >4cm (P < 0.001). While false positivity was 41.6% for all nodules, it was 50.7% for nodules smaller than 4 cm and was 24.9% for nodules larger than 4 cm (P < 0.001). False negativity was 14.6% for all nodules and was 11.7% for nodules smaller than 4 cm and 24.2% for nodules larger than 4 cm (P < 0.001). Finally, among the entire set of nodules, the accuracy was 64.4%, which was 59.2% in nodules smaller than 4 cm, and 75.2% in nodules larger than 4 cm (P < 0.001). Despite a higher rate of false negativity, FNAB has higher specificity and accuracy in large nodules than those in the small nodules. Nodule diameter should not be used alone as a criterion to recommend thyroidectomy to the patient.

Pattern of autoimmune thyroiditis in Egyptian children and adolescence

Background: Autoimmune thyroiditis (AIT) is the most common thyroid disorder in the pediatric age range. Aim: The aim of the retrospective study is to analyze the demographic, clinical, ultrasonographical, hormonal, immunological, and histopathological characteristics of 362 children and adolescents with a diagnosis of AIT. Patients and Methods: Data relating to the patient demographic and clinical characteristics both on presentation and during follow-up were collected. We also analyzed the investigations performed; these included thyroid function tests, immunological, radiological, and fine-needle aspiration biopsy (FNAB) results. Results: Patients' age ranged from 8.2 to 16.5 years and a female: male ratio of 5.1:1. The common presenting features were goiter and short stature (138 [38.1%] and 68 [18.7%], respectively). At diagnosis, 83 (22.9%), 23 (6.3%), and 256 (67.0%) patients were euthyroid, subclinical hypothyroid, and overt hypothyroid, respectively. High-resolution thyroid ultrasound revealed higher rate of nodular pattern compared to clinical examination (17 vs. 13 for single nodule and 6 vs. 4 for multiple nodules). Fine-needle aspiration of the thyroid gland was performed in 12 patients; none of them was malignant. Patients were followed for a mean period of 38 months (range: 6–45 month). Only 3 (13%) patients with subclinical hypothyroidism progressed to overt hypothyroidism, and started on L thyroxine therapy, while the rest of the case had stationary course. Conclusions: Our study reported the highest rate (68.7%) of overt hypothyroidism compared with other studies. The study reported that AIT in children and adolescents has benign course. Thyroid ultrasound can identify clinically unapparent thyroid nodules and play an important role in the selection of cases for FNAB. Careful follow-up of thyroid function is important to determine the necessity and timing of L-thyroxine replacement therapy.

Evaluation of Thyroid Fine-Needle Aspiration Biopsies according to Cytological Methods and Comparison with Histopathological Diagnosis.

Objectives:In this study, we aim to compare the results of aspiration of thyroid nodules evaluated according to the Bethesda category (BC) with tissue diagnoses in the operation materials and to compare the sensitivity, specificity and accuracy rates according to cytology methods.Methods:The previous fine-needle aspiration biopsy (FNAB) of thyroid nodules of 879 cases diagnosed histopathologically between 2010 and 2017 was examined. The FNAB results determined according to the Bethesda system were matched with tissue diagnoses, sensitivity, specificity, and accuracy rates were investigated according to cytology methods.Results:Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV) and accuracy rates were found in all FNAB results (in units of %; Sensitivity; 84.7, Specificity; 81.1, PPV; 74.1, NPV; 89.2, Accuracy; 82.5). All of the cytological evaluation methods of thyroid FNABs were found to be reliable and effective (Generally, the results are 80% and above). Specificity and accuracy rates were close to the general average (82.5%) in all methods. However, in cases evaluated with liquid base cytology (LBC) method and in addition to LBC or conventional smear (CS), the sensitivity rates in cases where cell block (CB) were evaluated together were higher than cases in which LBC and CS were used alone (92.6% and 91.0%). When examined statistically, there was no significant difference concerning sensitivity, specificity and accuracy rates of cytological methods (p>0.05, respectively, p=0.576, 0.065, 0.643).Conclusion:In cytopathology, when evaluating thyroid aspirations, it is seen that the LBC method is used instead of CS. In our study, we recommend the use of the LBC method, which seems to have the highest sensitivity (taking into account its technical advantages), instead of CS. However, we think that both CS and LBC methods should be evaluated by supporting them with cell block sections.

Comparison of Thyroid Fine Needle Aspiration Biopsies and Histopathology Results

Amaç: Bu çalışma ile Kırıkkale Üniversitesi Tıp Fakültesi’nde tiroidektomi operasyonu uygulanmış hastalara ilişkin tiroid ince iğne aspirasyon biyopsisi (TİİAB) sonuçları ile histopatoloji rapor sonuçlarının karşılaştırılarak kesitsel bir incelemenin yapılması ve tiroid nodüllerindeki TİİAB etkinliğinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Kırıkkale Üniversitesi Tıp Fakültesi Hastanesi’nde Ocak 2016 - Haziran 2018 tarihleri ​​arasındaki 2.5 yıllık dönemde tiroidektomi uygulanmış 75 hastaya ait TİİAB verileri ve histopatoloji rapor sonuçları çalışmamızın materyalini oluşturdu. TİİAB sonuçları benign, önemi belirsiz atipi veya foliküler lezyon (AUS/FLUS), foliküler neoplazi veya foliküler neoplazi için şüpheli lezyon (FN/SFN), malignite yönünden kuşkulu (SuspM), malign ve tanı için yetersiz (NDS) olarak sınıflandırıldı. Bulgular: Tiroidektomi operasyonu uygulanan vakaların TİİAB sonuçları değerlendirilmiş ve bu vakalardan 26’sına (%34.7) benign, 3’üne (%4) AUS/FLUS, 6’sına (%8) FN/SFN, 18’ine (%24) SuspM, 7’sine (%9.3) malign ve 15’ine (%20) de NDS olarak tanı verildi. Sitoloji sonucu benign olarak değerlendirilen olguların 4’ü, AUS/FLUS olarak değerlendirilen olguların 2’si, SuspM olarak değerlendirilen olguların 15’i ve malign olarak değerlendirilen 7 olgunun ise tamamı doku tanısı bakımından maligndi. Çalışmamızda duyarlılık, özgüllük, pozitif prediktif değer ve negatif prediktif değer sırasıyla; %74.2, %91.7, %92 ve %73.3 olarak hesaplandı.Sonuç: Bulgular bir arada değerlendirildiğinde TİİAB tekniğinin tiroid nodüllerine yaklaşımda etkin ve kolay uygulanabilir bir yöntem olduğu sonucuna varılmıştır. Günümüzde TİİAB materyallerinin değerlendirmesinde büyük öneme sahip olduğu ve yaygın olarak kullanılmakta olan, "Tiroid Sitopatoloji Raporlaması için Bethesda Sistemi" ile TİİAB tanılarında standardizasyonunun sağlandığı düşünülmüştür.