Thyroid Fine-needle Aspiration Biopsy Research Articles

WITHDRAWN: New thyroid fine needle aspiration biopsy needle. Prospective, randomized, clinical study.

Erhan Aysan, Yeliz Ersoy, Zuhal Gucin, Merve Cengiz, Huseyin Akbulut, Sema Arici, Mahmut Muslumanoglu. New thyroid fine needle aspiration biopsy needle. Prospective, randomized, clinical study, Clinical Endocrinology, 15th July 2014. https://doi.org/10.1111/cen.12554 WITHDRAWAL: The above article, first published online on Wiley Online Library (wileyonlinelibrary.com) on 15th July 2014, has been withdrawn by agreement between the Editors in Chief, Prof Aled Rees and Prof Maralyn Druce and John Wiley and Sons Ltd. The withdrawal has been made because the authors did not respond to requests to finalise the article for publication.

8012 A Severe Thrombotic Event Following Blood Thinner Interruption for Thyroid Fine Needle Aspiration Biopsy: A Case Report

Abstract Disclosure: V.A. Mendpara: None. P.P. Rao: None. M.V. Kellis: None. M.D. Lundholm: None. Background: This case highlights the potential severe thrombotic consequences of blood thinner medication interruption for thyroid fine needle aspiration (FNA). Case Presentation: A 77-year-old woman came to the endocrinology clinic for follow-up on thyroid nodules. She was a former smoker with controlled type 2 diabetes, hypertension, hyperlipidemia, and atrial fibrillation with patent foramen ovale on apixaban. She had no family history of thyroid cancer and no radiation exposure. Thyroid nodules were found incidentally, and she denied compressive symptoms. She had annual surveillance for the past 4 years, and her latest thyroid US redemonstrated 4 solid, hypoechoic nodules. The largest nodule, previously biopsied and benign in 2020, remained stable on the right. The next largest nodule in the left mid-thyroid was now 1.1 x 0.8 x 0.9 cm—a 30% growth from the previous year—with new punctate echogenic foci consistent with the TIRADS 5 classification. This finding was shared with the patient, who favored investigating with an FNA. At the recommendation of her PCP and the performing provider, she held her apixaban for approximately 48 hours before the FNA procedure.The US-guided thyroid FNA biopsy was uneventful, and the results indicated a benign nodule. However, 4 hours post-procedure, the patient suddenly became unresponsive while in the middle of cooking dinner. She was taken to the ED and found to have an ischemic stroke by basilar embolism, attributed to her interruption in apixaban therapy. Tenectaplase led to initial improvement but had subsequent hemorrhagic transformations affecting the midbrain, thalamus, and pons. This marked the beginning of a complex 2-month hospitalization requiring tracheostomy and percutaneous endoscopic gastrostomy (PEG) placement, followed by nearly a year of physical, occupational, and speech rehabilitation. Despite these efforts, she has not been able to return to her pre-stroke level of function and independence. Discussion: There is no consensus on the safety of performing a thyroid fine needle aspiration (FNA) biopsy for patients on blood thinner medications. Providers who favor holding blood thinners before FNA cite concerns for post-procedural hematoma formation or increased risk of non-diagnostic results. However, there is less discussion about the risks of interrupting these medications. This case emphasizes the potential for severe consequences from interrupting medically-indicated blood thinner therapy. The temporary discontinuation of apixaban for a routine thyroid FNA led to a life-threatening thrombotic event in our patient’s case. This outcome highlights the importance of carefully weighing the risks and benefits of medication interruptions for vulnerable populations. Further study is needed to investigate the safety of thyroid FNA on uninterrupted blood thinner therapy. Presentation: 6/2/2024

Assessment of thyroid nodule risk stratification knowledge and utilization among Polish physicians: a pilot study.

Ultrasonography is the primary diagnostic tool for evaluating thyroid nodules. The Thyroid Imaging Reporting & Data System (TIRADS) aims to standardise assessment and reduce fine-needle aspiration biopsies through risk stratification. This pilot study examined knowledge and utilisation of TIRADS among Polish physicians, their perception of the usefulness of TIRADS application and the extent of knowledge of individual nodule features included. An internet-based questionnaire about TIRADS use in clinical practice was sent out to Polish Ultrasound Society members. Information on the responder's experience with thyroid ultrasound and knowledge and use of TIRADS was assessed and analysed. Out of 159 physicians, 66.6% did not use TIRADS despite 43.4% being aware of its existence. EU-TIRADS was the most commonly adopted classification (50.9%). Participants who adopted TIRADS were younger (p = 0.047) and more likely to be radiologists (p < 0.01). TIRADS use was more prevalent in university clinical hospitals (p = 0.02), among physicians doing thyroid ultrasound as their primary professional activity (p < 0.01), those performing > 100 thyroid ultrasound examinations per year (p < 0.01) and those involved with thyroid fine-needle aspiration biopsy (p < 0.01). The purposes of TIRADS adoption (p < 0.01) and included imaging features (p < 0.01) were more accurately recognized by TIRADS users. TIRADS utilization among Polish clinicians is limited, despite awareness of the classification's existence. Knowledge of TIRADS components and the purpose of its application among users is satisfactory. Further training and TIRADS adoption should be encouraged, especially in the light of the recent EU-TIRADS-PL guidelines recommended by the Polish Scientific Societies.

The evaluation of fine needle aspiration biopsy results in differentiating between benign and malignant thyroid nodules

Introduction: Thyroid fine-needle aspiration biopsy (FNAB) has begun playing an important role in the evaluation of thyroid nodules, in addition to physical examination and imaging techniques. The purpose of this study was to evaluate the results of patients who underwent thyroid FNAB together with their demographic data, imaging findings, and follow-up compliance. Methods: Patients who underwent thyroid FNAB procedures in our hospital’s interventional radiology unit between January 2022 and May 2024 were evaluated retrospectively. Data were retrieved from patient records. Cytological results were classified as malignant, atypia of undetermined significance, benign, and non-diagnostic material. Results: Two hundred twelve solid nodules were detected in the patients who underwent biopsy, and 59 mixed nodules with a cystic component. Non-diagnostic material was reported in 51 cases at cytological examination, benign cytology in 150, atypia of undetermined significance in 53, and malignant material in 17. The incidence of non-diagnostic results was significantly higher in hypoechoic nodules and low-volume nodules. Conclusions: Thyroid FNAB is a valuable diagnostic tool due to its ease of application and provision of useful information in benign-malignant differentiation. Once it becomes capable of application by primary physicians and local state hospitals in Türkiye it will reduce delayed diagnoses, unnecessary surgical procedures, and economic burdens on social security institutions.

Predictive Value of the Nomogram Model Based on Multimodal Ultrasound Features for Benign and Malignant Thyroid Nodules of C-TIRADS Category 4.

To explore the predictive value of the nomogram model based on multimodal ultrasound features for benign and malignant thyroid nodules of C-TIRADS category 4. A retrospective analysis was conducted on the general conditions and ultrasound features of patients who underwent thyroid ultrasound examination and fine needle aspiration biopsy (FNA) or thyroidectomy at the Affiliated Hospital of Zunyi Medical University from April 2020 to April 2023. Predictive signs for benign and malignant nodules of thyroid C-TIRADS category 4 were screened through LASSO regression and multivariate logistic regression analysis to construct a nomogram prediction model. The predictive efficiency and accuracy of the model were assessed through ROC curves and calibration curves. Seven independent risk factors in the predictive model for benign and malignant thyroid nodules of C-TIRADS category 4 were growth pattern, morphology, microcalcifications, SR, arterial phase enhancement intensity, initial perfusion time, and PE [%]. Based on these features, the area under the curve (AUC) of the constructed prediction model was 0.971 (p ＜ .001, 95% CI: 0.952-0.989), with a prediction accuracy of 93.1%. Internal validation showed that the nomogram calibration curve was consistent with reality, and the decision curve analysis indicated that the model has high clinical application value. The nomogram prediction model constructed based on the multimodal ultrasound features of thyroid nodules of C-TIRADS category 4 has high clinical application value.

Timing of the repeat thyroid fine-needle aspiration biopsy: does early repeat biopsy change the rate of nondiagnostic or atypia of undetermined significance cytology result?

To determine whether early repeat fine needle aspiration biopsy (FNA) has an effect on adequate or atypia of undetermined significance (AUS) cytology rates in thyroid nodules with inadequate or AUS result in the first FNA. Nodules of patients who underwent repeat biopsy due to insufficient or AUS cytology between 2019-2022 were included. Data of the patients and ultrasonographic, cytological and histopathological results of the nodules were recorded. Additionally, the time between the two biopsies was noted. The first was called "initial" and the second was called "rebiopsy". Five different paired groups were formed according to the time between two consecutive biopsies; before and after 1 month, 45 days, 2 months, 3 months, and 6 months. The groups were compared in terms of adequate and AUS cytological results. We evaluated 1129 patients with 2187 nodules undergoing FNAB. After excluding nodules with one FNA result and/or missing data, 966 nodules of 628 patients who underwent FNA at least twice were included. Initial cytology was nondiagnostic (ND) in 665 (30.4%) and AUS in 301 (13.8%) nodules. The mean age of the patients was 52.0 ± 11.9 years, and the female sex ratio was 78.8% (n = 495). There were no differences in adequate or AUS rebiopsy results according to the different time interval groups (p > 0.05 for all). AUS result was statistically insignificantly more frequent in nodules with initially AUS nodules when rebiopsy was performed before 1 month in comparison to after 1 month (53.8%, 27.1%; p = 0.054). Accuracy of rebiopsy was also similar in the time intervals groups (p > 0.05 for all). In patients with inadequate or AUS initial biopsy, the rate of adequate or AUS cytology results at rebiopsy did not vary with the timing of repeat biopsy indicating that there may be no need to wait 1 month for a repeat biopsy. In patients with suspicious nodules, biopsy might be repeated before 1 month.

Assessment of inflammatory parameters as predictive markers for malignancy in thyroid nodules: a study on the correlation with Bethesda classification.

The study aimed to assess the predictive significance of inflammatory parameters as potential markers for malignancy in individuals with thyroid nodules. Nine hundred and ninety-one patients with thyroid nodules who had undergone thyroid fine-needle aspiration biopsy were included and classified according to the Bethesda system. Neutrophil lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) values obtained from hemogram parameters were determined for each patient. The study examined the correlation between the Bethesda classification and NLR/SII levels. In addition, a comparison was made between the inflammatory parameters of the benign and malignant Bethesda groups. Five hundred and seventy-three patients were classified as Bethesda 2 (benign), 34 as Bethesda 6 (malignant). A correlation was observed between the Bethesda classification and NLR and SII levels (r: 0.230, p < 0.001; r: 0.207 p < 0.001, respectively). NLR and SII values were significantly higher in the malignant group (p < 0.001). The cutoff value for SII in predicting benign and malignant thyroid nodules was 489.86 × 103/mm3 with a sensitivity of 88.2% and a specificity of 63.7%. The cutoff value for NLR for the same prediction was 2.06 with a sensitivity of 82.4% and a specificity of 83.4%. The findings of this study indicate that SII and NLR may be valuable prognostic markers for predicting the malignancy of thyroid nodules.

Discriminating Interpatient Variabilities of RAS Gene Variants for Precision Detection of Thyroid Cancer.

Interpatient variabilities in genomic variants may reflect differences in tumor statuses among individuals. To delineate interpatient variabilities in RAS variants in thyroid tumors based on the fifth World Health Organization classification of thyroid neoplasms and assess their diagnostic significance in cancer detection among patients with thyroid nodules. This prospective diagnostic study analyzed surgically resected thyroid tumors obtained from February 2016 to April 2022 and residual thyroid fine-needle aspiration (FNA) biopsies obtained from January 2020 to March 2021, at Mount Sinai Hospital, Toronto, Ontario, Canada. Data were analyzed from June 20, 2022, to October 15, 2023. Quantitative detection of interpatient disparities of RAS variants (ie, NRAS, HRAS, and KRAS) was performed along with assessment of BRAF V600E and TERT promoter variants (C228T and C250T) by detecting their variant allele fractions (VAFs) using digital polymerase chain reaction assays. Interpatient differences in RAS, BRAF V600E, and TERT promoter variants were analyzed and compared with surgical histopathologic diagnoses. Malignancy rates, sensitivity, specificity, positive predictive values, and negative predictive values were calculated. A total of 438 surgically resected thyroid tumor tissues and 249 thyroid nodule FNA biopsies were obtained from 620 patients (470 [75.8%] female; mean [SD] age, 50.7 [15.9] years). Median (IQR) follow-up for patients who underwent FNA biopsy analysis and subsequent resection was 88 (50-156) days. Of 438 tumors, 89 (20.3%) were identified with the presence of RAS variants, including 51 (11.6%) with NRAS, 29 (6.6%) with HRAS, and 9 (2.1%) with KRAS. The interpatient differences in these variants were discriminated at VAF levels ranging from 0.15% to 51.53%. The mean (SD) VAF of RAS variants exhibited no significant differences among benign nodules (39.2% [11.2%]), noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTPs) (25.4% [14.3%]), and malignant neoplasms (33.4% [13.8%]) (P = .28), although their distribution was found in 41.7% of NIFTPs and 50.7% of invasive encapsulated follicular variant papillary thyroid carcinomas (P < .001). RAS variants alone, regardless of a low or high VAF, were significantly associated with neoplasms at low risk of tumor recurrence (60.7% of RAS variants vs 26.9% of samples negative for RAS variants; P < .001). Compared with the sensitivity of 54.2% (95% CI, 48.8%-59.4%) and specificity of 100% (95% CI, 94.8%-100%) for BRAF V600E and TERT promoter variant assays, the inclusion of RAS variants into BRAF and TERT promoter variant assays improved sensitivity to 70.5% (95% CI, 65.4%-75.2%), albeit with a reduction in specificity to 88.8% (95% CI, 79.8%-94.1%) in distinguishing malignant neoplasms from benign and NIFTP tumors. Furthermore, interpatient differences in 5 gene variants (NRAS, HRAS, KRAS, BRAF, and TERT) were discriminated in 54 of 126 indeterminate FNAs (42.9%) and 18 of 76 nondiagnostic FNAs (23.7%), and all tumors with follow-up surgical pathology confirmed malignancy. This diagnostic study delineated interpatient differences in RAS variants present in thyroid tumors with a variety of histopathological diagnoses. Discrimination of interpatient variabilities in RAS in combination with BRAF V600E and TERT promoter variants could facilitate cytology examinations in preoperative precision malignancy diagnosis among patients with thyroid nodules.

Performance of Thyroid Fine-Needle Aspiration Biopsy in a Low- and Middle-Income Country

Introduction: The 6 categories of the Bethesda System for Reporting Thyroid Cytology (TBSRTC) with associated risk of malignancy (ROM) provide evidence-based clinical management guidelines. This study aimed to determine the ROM and accuracy of FNAB in South Africa (SA). Methods: Thyroid specimens from 3 pathology laboratories registered between January 2015 and December 2019 were considered for inclusion. ROM was obtained per TBSRTC category by cytohistological correlation and dividing the total number of specimens with malignant histology by the total number of cases operated. Accuracy was calculated based on the Bethesda category and eventual malignant histology. Results: Seventeen thousand seven hundred and seventy-three histology and 4,791 cytology cases were identified. Of the 4,791 cytology cases, 931 (19%) underwent surgery. More than a third (333, 35.8%) of cases were confirmed as malignant following histological assessment, with the majority being benign (584, 62.7%). The ROM for the nondiagnostic and benign categories was 24.3% and 20.5%. The highest ROM was for category VI (91.5%), followed by categories V (69.5%), IV (51.9%), and III (38.8%). Thyroid FNAB had a sensitivity of 73%, specificity of 74%, and overall accuracy of 74%. Conclusion: Bethesda categories II and IV have a relatively higher ROM in SA compared to findings from other developed countries. The diagnostic accuracy of thyroid FNAB in SA and the high rate of nondiagnostic diagnoses (38%) require further investigation. A national thyroid registry could provide location-specific data to aid the implementation of appropriate local policies and national guidelines for practicing thyroid surgeons.

A case series of thyroid fine needle aspiration biopsies diagnosed as follicular neoplasm with oncocytic features.

Oncocytic lesions of the thyroid are a heterogeneous group encompassing nonneoplastic and neoplastic entities ranging from benign to malignant and have traditionally been classified as separate entities in thyroid pathology. To illustrate the diversity of these thyroid lesions, we describe three cases of fine needle aspiration biopsies (FNAB) diagnosed as Bethesda Category IV: Follicular neoplasm, oncocytic type, under the 2017 Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), with ThyroSeq v3 molecular testing and subsequent surgical excision.

Effect of Music Therapy on Pain During Thyroid Fine Needle Aspiration Biopsy; A Randomized Controlled Clinical Trial

IntroductionHigh-resolution ultrasonography devices have led to the increased detection of thyroid nodules and the need for fine-needle aspiration biopsy (FNAB). However, FNAB is an invasive procedure that can cause discomfort and pain. Music therapy has been used for centuries to alleviate pain, and our clinical trial was conducted to investigate its impact on pain scores during thyroid FNAB. Materials and methodsWe conducted a randomized, controlled clinical trial, including adult patients undergoing thyroid FNAB. We evaluated the nonpharmacological intervention of listening to music before and during thyroid FNAB. We used a slow, nonlyrical, flowing melody with a tempo of 60 to 80 beats per minute as a therapeutic intervention for managing anxiety and pain. It had low tones, minimal percussion, and a volume of around 60 dB. The Beck Anxiety Inventory and Visual Pain Scale were used. ResultsThe study included 529 patients assigned to either the music group (n = 258, 48.7%) or the control group (n = 271, 51.2%). The patients were categorized into subgroups based on either a single nodule (73.63%) or multiple nodules (24.18%). When all patients or single nodule and multiple data are examined separately, the intervention group showed statistically significantly lower pain scores than the control group. ConclusionOur study is among the first on this topic and the largest in the available literature to demonstrate that listening to music during FNAB significantly reduces pain and anxiety. Music therapy is an effective, safe, and noninvasive intervention that can improve patient care and reduce distress and pain.

A Preliminary Study Comparing the Performance of Thyroid Molecular Tests to a Deep Learning Algorithm in Predicting Malignancy in Indeterminate Thyroid Fine Needle Aspiration Biopsies.

A Preliminary Study Comparing the Performance of Thyroid Molecular Tests to a Deep Learning Algorithm in Predicting Malignancy in Indeterminate Thyroid Fine Needle Aspiration Biopsies.

P-82 Riedel's thyroiditis: three-year follow-up under steroid, rituximab and mycophenolate mofetil treatment

Abstract Introduction Riedel's thyroiditis (RT) is an uncommon thyroiditis characterized by fibrosis, macrophage, and eosinophil infiltration and is assumed to be the primary cause of autoimmunity in the pathogenesis. Invasion of the surrounding tissues, particularly the trachea, occurs. RT is also regarded as thyroid involvement in IgG4-related systemic illness. Because there is no conventional medical treatment protocol for RT, this paper aims to highlight the problems we had in diagnosing and our approach throughout therapy. Clinical Case In the last 1.5 years, a 44-year-old female patient on levothyroxine replacement diagnosed with hypothyroidism developed bilateral swelling in the eyes, double vision, drooping eyelids, shortness of breath, and feeling something lodged in the throat. A diffusely enlarged and stiff thyroid gland was palpated in her physical examination. Neck CT revealed a diffusely enlarged thyroid gland 7cm in diameter and constricted trachea. She did not have any constitutional symptoms. According to physical and radiologic exams, preliminary differential diagnoses were anaplastic thyroid carcinoma and IgG4-related thyroiditis. In laboratory tests, TSH: 4.5 mIU/L, st3-4: normal, Anti TPO: +++ TRAB: 0.15 U/L, ANA: Negative, IgG4: 0.52 g/L (0.03-2.01), ACE:21.39. Since the thyroid fine needle aspiration biopsy reported a hypocellular smear, a lacrimal gland biopsy was performed for systemic involvement of IgG4 related disorder's. Her dyspnea was becoming critical; therefore, she was administered 0.5 mg/kg steroid for two weeks before the scheduled bilateral total thyroidectomy, and a considerable decrease in dyspnea, swallowing sensations, and regression in compression findings were seen. Lacrimal biopsies demonstrated persistent inflammation with plasma cells and severe fibrosis, consistent with late-stage IgG4-related illness. Both thyroid lobes were enlarged in neck T1 and T2-weighted MRI images (right lobe was 34×25×68 mm, the left lobe was 35×26×69 mm), diffuse hypointensity was noted, contrast uptake decreased in the thyroid parenchyma following IVCM, and the data was determined to be compatible with RT. The thyroid gland grew markedly on PET-CT, narrowing the air column, with increased FDG absorption in a heterogeneous character (SUVmax: 4.9), and mild-moderate involvement in bilateral lacrimal and parotid glands.The decision was made to continue steroid treatment at 1 mg/kg for one month. Rituximab was given twice every six months while the steroid was lowered. Mycophenolate mofetil (MMF) (2×500 mg) was introduced as a maintenance immunosuppressive medication. The initial radiologic findings regressed in the control neck MRI and PET-CT in the first year. The MRI findings were also steady in the second and third years of MMF. Conclusion Immunosupression therapy with steroid, rituximab and MMF was effective in our RT patient for the long term without significant complications. Clinical and radiological responses similar to surgery can be obtained with immunosuppressive agents.Figure 1.PET-CT and MRI images at diagnosis and third year

THE IMPACT OF PATIENT ANXIETY AND PAIN PERCEPTION ON THE ADEQUACY OF THYROID FINE-NEEDLE ASPIRATION BIOPSY SAMPLES: A PROSPECTIVE STUDY.

Fine-needle aspiration biopsy (FNAB) is the most accurate diagnostic method to assess the malignancy risk of thyroid nodules. However, non-diagnostic results may delay diagnosis, cause unnecessary interventions, and distress patients. We aimed to determine whether a correlation exists between patients' situational anxiety, pain perception and non-diagnostic cytology results. The prospective study included patients who underwent thyroid FNAB at the Endocrinology Clinic of Sultan Abdulhamid Training and Research Hospital between 11/2022 and 02/2023. The State-Trait Anxiety Inventory (STAI) questionnaire and visual analogue scale (VAS) assessed situational anxiety and pain in patients undergoing biopsy procedures. We evaluated whether the STAI-S and VAS score is related to non-diagnostic results. Of the 119 patients included in the study, 98 were female, and 21 were male. 25 (21%) nodules were non-diagnostic. The patients' mean STAI-S score before the biopsy was 47.31±12.37, and the mean VAS score after the thyroid biopsy was 2.57±1.51. A statistically significant relation was found between the patient's STAI-S score and VAS score and the cytology result of non-diagnostic (p= 0.001 and p=0.008). In univariate logistic regression, high pre-procedural anxiety (OR:3.09, 95% CI:1.07-8.94, P =0.037) and VAS score (OR:1.57, 95% CI: 1.17-2.10, P =0.002) were associated with non-diagnostic cytology. In multivariate logistic regression analysis, VAS score (OR: 1.59, 95% CI: 1.07-2.34, p=0.019) was still an independent factor related to specimen adequacy. Anxiety level and pain perception during FNAB may be considered risk factors for non-diagnostic cytology. Thus, reducing anxiety and pain may decrease the incidence of non-diagnostic outcomes.

ChatGPT-assisted deep learning model for thyroid nodule analysis: beyond artifical intelligence.

To develop a deep learning model, with the aid of ChatGPT, for thyroid nodules, utilizing ultrasound images. Thecytopathology of the fine needle aspiration biopsy (FNAB) serves as the baseline. After securing IRBapproval, a retrospective study was conducted, analyzing thyroid ultrasound images and FNAB results from 1,061 patients between January 2017 and January 2022. Detailed examinations of their demographic profiles, imaging characteristics, andcytological features were conducted. The images were used for training a deep learning model to identify various thyroidpathologies. ChatGPT assisted in developing this model by aiding in code writing, preprocessing, model optimization, andtroubleshooting. The model demonstrated an accuracy of 0.81 on the testing set, within a 95% confidence interval of0.76 to 0.87. It presented remarkable results across thyroid subgroups, particularly in the benign category, with high precision(0.78) and recall (0.96), yielding a balanced F1-score of 0.86. The malignant category also displayed high precision (0.82) andrecall (0.92), with an F1-score of 0.87. The study demonstrates the potential of artificial intelligence, particularlyChatGPT, in aiding the creation of robust deep learning models for medical image analysis.

One nodule-one punction-one slide: Optimizing thyroid fine-needle aspiration for a digital workflow.

Interventional pathologists have expanded their expertise by acquiring proficiency in ultrasound-guided thyroid fine-needle aspiration biopsy (FNAB) and are now required to optimize punction procedures due to low resources and digital workflows. The aim of this study is to compare FNAB sample adequacy in two series with one versus two slides available for cytopathological analysis and its influence on diagnosis categorization, time taken to reach a final diagnosis, scanning time and size of the digital files produced. Patients were retrospectively selected based on the sampling of thyroid nodules using either two glass slides (two-slide group) or one slide only (one-slide group) and cytological diagnosis was performed using the second edition of the Bethesda system. For each group, the initial 15 cases were sorted to be scanned. From a total of 713 procedures, 328 were sampled into two slides and 385 on one slide only. No significant differences were found regarding nodule size, location or EU-TIRADS classification between the two groups. The one-slide group did not exhibit a higher prevalence of non-diagnostic or atypia of undetermined significance (AUS) categories. As expected, the mean time taken to finalize diagnoses in cases where only one slide was prepared was 1.2 days faster. Scanning time and total file size were also significantly smaller in the one-slide group. Adopting the 'one nodule-one puncture-one slide' strategy for thyroid FNAB optimization enhances procedural efficiency in digital workflows, leading to cost savings without compromising diagnostic accuracy.

Effect of Music on Anxiety and Pain Levels of Patients Undergoing Thyroid Fine Needle Aspiration Biopsy: A Randomized Controlled Study

Despite being a minimally invasive procedure, biopsy can cause pain and anxiety in patients. Therefore, it is important to reduce the pain and anxiety levels of patients. The present study aims to investigate the effect of music on patient anxiety and pain levels during thyroid fine needle aspiration biopsy. In this randomized controlled single-blind study, a validated State-Trait Anxiety Inventory (STAI) consisting of 40 questions in total was used to evaluate patient anxiety rates. The STAI consists of two sections: the state anxiety scale (SAS) measuring instant anxiety and the trait anxiety scalemeasuring general anxiety. Patients were divided into two groups: Group 1 those who did not listen to music during a biopsy and group 2 those who listened to music. The Visual Analogue Scalewas used to evaluate patient pain levels. Group 1 consisted of 46 patients and Group 2 consisted of45 patients. After the procedure, the mean SAS scores of Groups 1 and 2 were not significantly different (p=0.24). However, The state anxiety scale differences, which represents the decrease in pre-procedure and post-procedure anxiety levels (SAS1-SAS2) was statistically different among the groups (p=0.01). There was a significant difference between the two groups in terms of VAS score distribution (p=0.01). Music therapy is an easily applicable, cheap, and safe method that can be used to decrease anxiety and pain levels in patients during thyroid biopsy as evidenced by this research.

FRI468 The Needle And The Crown, Who Is The Culprit? A Case Of Transient Hyperthyroidism In The Setting Of COVID-19 Infection And Recent Thyroid Biopsy

Abstract Disclosure: D. Caesario: None. K.L. Hermayer: None. Introduction: Transient hyperthyroidism (TH) is most commonly associated with thyroiditis, such as subacute thyroiditis (SAT). However, TH has also been reported as a complication of thyroid fine needle aspiration biopsy (FNAB), called post-aspiration thyrotoxicosis (PAT). We report a case of TH in the setting of COVID-19 infection and recent thyroid FNAB. Case Report: A 52-year-old male with history of type 1 DM was evaluated for neck enlargement over the past year. Examination was remarkable for enlarged, nontender thyroid. Thyroid function tests were normal. Thyroid US revealed a 7 cm solid mass with calcifications on the right lobe, with extension to the isthmus. The extension was predominantly solid with cystic components. FNAB of the mass showed benign findings. Around 1 week after FNAB, patient developed cough, sore throat, anorexia, neck pain, and multiple vomiting episodes. He had no dyspnea. He was brought to the ED. He was tachycardic and hypertensive, with an enlarged thyroid that was tender. Labs showed leukocytosis with left shift, glucose 651, anion gap 30, TSH 0.03, and free T4 1.68. He tested positive for COVID-19. He was admitted with DKA and COVID-19 infection. He received no steroids due to not meeting the indications for COVID-19 treatment, and was mainly treated for the DKA. Thyroid antibodies were negative and repeat thyroid US revealed no post-biopsy hemorrhage. Hyperthyroidism was deemed to be secondary to SAT and no active intervention was given for it. Repeat free T4 during hospitalization continued to trend down and was subsequently normalized by the time of discharge and outpatient follow-up. Discussion: SAT is a self-limiting inflammatory disorder of the thyroid that typically presents with fever, myalgia, malaise, thyroid pain and tenderness. The usual course of the disease is hyperthyroidism, then hypothyroidism, followed by resolution. Some cases may persist for months or may reoccur. SAT is usually associated with infection of the upper respiratory tract by one of the several common respiratory viruses, and is diagnosed clinically, supported by lab findings of decreased TSH in the setting of negative thyroid antibodies. At the start of the COVID-19 pandemic, it was initially unknown if SARS-CoV-2 virus could also be associated with SAT. However, more cases of SAT following COVID-19 infection have been reported since then. The patient above has findings consistent with SAT in the setting of COVID-19 infection. However, recent FNAB resulting in PAT can also cause TH in his case. PAT was identified in around 1% of thyroid FNAB patients. The affected patients experienced neck pain. Interestingly, thyrotoxicosis occurred only in patients who had a cystic component in the nodule. This patient with a history of recent FNAB might have PAT as a complication, or even in combination with SAT. Although patient’s condition resolved, hyperthyroidism may reoccur in SAT in the future. Presentation: Friday, June 16, 2023

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

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

Endocrine side effects of immunotherapeutic drugs

BACKGROUND. Immunotherapy is an innovative approach to treatment that is changing the paradigm in oncology and is achieving significant results in the fight against malignant tumors including leukemia, melanoma, lung cancer, kidney cancer and many others. This treatment uses the power of the body’s immune system to fight cancer cells. Immunotherapy can lead to long-term remission or even complete disappearance of tumors in patients with certain types of cancer. The success of therapy depends on many factors, including the type of cancer and individual patient characteristics. As with any treatment, patients with immunotherapy may experience side effects. As a result of treatment with pembrolizumab (and other immunotherapeutic drugs), patients may develop endocrine disorders. The most common endocrine side effects include thyroiditis (which can lead to hyper- or hypothyroidism), inflammation of the parathyroid glands, hypophysitis, and diabetes mellitus.&#x0D; OBJECTIVE. Based on the literature data, to investigate the possible side effects of immunotherapeutic drugs on the endocrine system.&#x0D; MATERIALS AND METHODS. Object: endocrine complications due to immunotherapy. Research method: review of literary sources.&#x0D; RESULTS. Among the manifestations of the endocrine system, the most common are thyroid dysfunction and diabetes mellitus. It is important to monitor the levels of thyroid-stimulating hormone (TSH), free T4, blood glucose and glycated hemoglobin for timely detection of endocrine pathology, prevention of unwanted complications and improvement of patients’ quality of life.&#x0D; CONCLUSIONS. Immunotherapy is vital for cancer patients. Given the possible development of various side effects, including those from the endocrine system, patients should monitor the main indicators of the thyroid gland (TSH, free T4) and carbohydrate metabolism (blood glucose, glycated hemoglobin) both before starting immunotherapy and during treatment. Patients with pre-existing endocrine disorders require more careful monitoring. It is possible that such patients, in the process of immunotherapy, may require correction of hypoglycemic drugs: speaking of diabetes mellitus, a possible option may be a dose correction of tableted antidiabetic drugs, a change in the therapy regimen or insulin therapy; in diseases of the thyroid gland, the doctor may suggest dose adjustment of thyroid drugs, ultrasound diagnostics and/or fine-needle aspiration biopsy of thyroid nodules.