Thyroid Fine Needle Aspiration Cytology Research Articles

A Comparative Cross-sectional Study to Evaluate Thyroid Imaging Reporting and Data System and Fine-needle Aspiration Cytology in Predicting Benign and Malignant Nature of Thyroid Nodules

Abstract Introduction: Thyroid ultrasound (US) should be performed in the initial assessment of the gland. The fine-needle aspiration cytology (FNAC) is an inexpensive and useful tool for detecting thyroid cancer. In the management of thyroid nodule patients, recommending who should be submitted to FNAC is still controversial. Aim: The aim of the study was to evaluate whether the US-based Thyroid Imaging Reporting and Data System (TI-RADS) scoring system is reliable in differentiating between benign and malignant thyroid nodules when compared to FNAC and its practical application in clinical decision-making. Materials and Methods: A total of 59 patients having solitary thyroid nodules were studied over 20 months. Thyroid function tests, US and FNAC of the thyroid were done. Using US, the thyroid nodule was evaluated for five sonological features: internal composition, echogenicity, margins, presence and type of calcification and shape of the lesion. The nature of the lesion was assessed based on the TI-RADS score calculated from the five US parameters. This result, along with FNAC, which was reported using The Bethesda System for Reporting Thyroid Cytopathology was finally compared with the histopathology reports. Results: When the suspicious sonological features were evaluated, the presence of solid components and taller-than-wide shapes was found to be maximum sensitive but less specific. Specificity, positive predictive value and negative predictive value were found to be maximum for the presence of microcalcification and presence of hypoechogenicity. The sensitivity of TI-RADS to detect malignancy was higher (100%) than FNAC (66.7%). The specificity of TI-RADS to detect malignancy was lower (36.2%) as compared to FNAC. Conclusion: TI-RADS can be used to avoid unnecessary fine-needle aspirations. It helps in decreasing confusion and assists in deciding when FNAC should be performed. TI-RADS is cost-effective and has a vital role in the initial evaluation and investigation of patients presenting with solitary nodules of the thyroid. Moreover, it is simple to use, reliable and easily reproducible.

Interpreting thyroid fine-needle aspiration biopsy

One of the most commonly seen abnormalities of the thyroid gland is the thyroid nodule. A thorough clinical evaluation of the nodule includes careful history taking and physical examination, laboratory tests, neck ultrasound (US), and fine-needle aspiration (FNA). Although thyroid FNA serves as an important test with an accurate result, when paired along with US, the results obtained are superior to that obtained only with an FNA. Thyroid FNA or biopsy is an accurate test for determining malignancy in a nodule and is an integral part of current thyroid nodule evaluation. Results are superior when FNA is performed with ultrasound guidance. FNA results are classified as diagnostic (satisfactory) or nondiagnostic (unsatisfactory). The hypocellular specimens produce unsatisfactory or nondiagnostic smears whereas satisfactory or diagnostic smears are categorized as benign, indeterminate, or malignant. In this article, we describe the indications and interpretation of thyroid fine-needle aspiration cytology. The Bethesda Cytologic Classification has a 6-category classification and has been described in the text.

Non-papillary thyroid carcinoma diagnoses in The Bethesda System for Reporting Thyroid Cytopathology categories V and VI: An institutional experience

BackgroundThe non-papillary thyroid carcinoma (PTC) subgroups of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) categories V (Suspicious for malignancy) and VI (Malignant) are rare, and specific tumor typing is difficult. We aimed to analyze histologic outcomes and to investigate the points of caution. MethodsWe reviewed the electronic database and identified 12,215 cases of thyroid fine-needle aspiration cytology between 2013 and 2022. In total, 2783 patients were diagnosed with TBSRTC V or VI. Of these, 51 patients with non-PTC diagnosis were identified. Histological outcomes were analyzed with the cytologic findings. ResultsThe subgroups of non-PTC diagnoses in TBSRTC category V or VI consisted of medullary thyroid carcinoma (MTC) (13/51, 25.5 %), anaplastic thyroid carcinoma (3/51, 5.9 %), lymphoma (2/51, 3.9 %), metastatic tumor (4/51, 7.8 %), and malignant, not otherwise specified (NOS) (29/51, 56.9 %). The concordance rate of the histological outcomes was 30 % (12/40), predominantly comprising MTC cases. The obscuring factors for specific tumor typing in the suspicious for malignancy/malignant NOS cytology diagnosis group was mixed pattern of well differentiated thyroid carcinoma and less differentiated carcinoma cells (9/24, 37.5 %), low cellularity (7/24, 29.2 %) and a history of non-thyroid organ malignancy (6/24, 25 %). The less differentiated carcinoma component in mixed pattern consisted of 2 poorly differentiated thyroid carcinomas, 2 anaplastic thyroid carcinomas, 4 high-grade PTCs and 1 high-grade MTC. ConclusionThe high-grade feature of PTC or MTC cytology is a noteworthy obscuring factor in specific tumor typing of non-PTC cytology diagnosis.

The Asian Thyroid Working Group, from 2017 to 2023.

The Asian Thyroid Working Group was founded in 2017 at the 12th Asia Oceania Thyroid Association (AOTA) Congress in Busan, Korea. This group activity aims to characterize Asian thyroid nodule practice and establish strict diagnostic criteria for thyroid carcinomas, a reporting system for thyroid fine needle aspiration cytology without the aid of gene panel tests, and new clinical guidelines appropriate to conservative Asian thyroid nodule practice based on scientific evidence obtained from Asian patient cohorts. Asian thyroid nodule practice is usually designed for patient-centered clinical practice, which is based on the Hippocratic Oath, "First do not harm patients," and an oriental filial piety "Do not harm one's own body because it is a precious gift from parents," which is remote from defensive medical practice in the West where physicians, including pathologists, suffer from severe malpractice climate. Furthermore, Asian practice emphasizes the importance of resource management in navigating the overdiagnosis of low-risk thyroid carcinomas. This article summarizes the Asian Thyroid Working Group activities in the past 7 years, from 2017 to 2023, highlighting the diversity of thyroid nodule practice between Asia and the West and the background reasons why Asian clinicians and pathologists modified Western systems significantly.

DIAGNOSTIC ACCURACY OF ULTRASONOGRAPHY IN DIFFERENTIATING BENIGN AND MALIGNANT THYROID NODULES

This study aimed to compare the effectiveness of ultrasonography and fine-needle aspiration cytology (FNAC) in distinguishing between benign and malignant thyroid nodules. To conduct this cross-sectional study, we obtained ethical approval from the institutional review board and collected data from KRL Hospital between December 1, 2021, and April 30, 2022. We included patients of either gender, aged 18 years or above, referred to the radiology department for diagnosis of benign or malignant thyroid nodules or FNAC of nodules, using non-probability consecutive sampling. After giving informed consent, all patients underwent high-resolution Gray ultrasonography performed by a consultant radiologist. The results showed that ultrasonography had a sensitivity of 90.62%, specificity of 88.37%, positive predictive value of 85.29%, negative predictive value of 92.68%, and an overall accuracy of 89.33% in detecting benign and malignant thyroid nodules, as compared to the gold standard, FNAC. Based on these findings, we conclude that ultrasonography is an excellent non-invasive diagnostic tool, with high accuracy and no invasiveness, making it the preferred method for identifying malignant thyroid nodules.

A retrospective analysis of molecular testing in cytologically indeterminate thyroid nodules with histologic correlation: Experience at a heterogenous multihospital system.

Thyroid malignancy is one of the most common types of cancer in developed nations. Currently, fine-needle aspiration cytology (FNAC) is the most practical screening test for thyroid nodules. However, cytologically indeterminate samples comprise approximately 15%-30% of cases. These include cases classified as atypia of undetermined significance (AUS), follicular neoplasm (FN), and suspicious for malignancy (SFM). Indeterminate cases can be sent for molecular testing for more definitive classification to help guide management and prevent overtreatment of benign thyroid nodules. We conducted a retrospective review on molecular testing of indeterminate thyroid FNAC and reviewed subsequent histologic diagnoses in resection specimens to assess how molecular testing supported a diagnosis and its effect on clinical management of patients at our institution. A retrospective chart review was performed on all thyroid FNAC specimens, corresponding molecular testing, and subsequent surgical resection specimens over a 6-year period. A total of 10,253 thyroid FNAC were performed in our hospital system during our study period, of which 10% (n = 1102/10,253) had indeterminate FNAC results. Molecular testing was performed in 16% (n = 178/1102) of indeterminate cytology cases. Genetic alterations were identified in 39% (n = 69/178) of the cases sent for molecular testing. The majority of cytologically indeterminate cases sent for molecular testing were follicular-patterned lesions and their corresponding resection specimens revealed mostly low grade follicular derived neoplasms (i.e., follicular adenoma, non-invasive follicular thyroid neoplasm with papillary-like nuclear features, and follicular variant of papillary thyroid carcinoma). Of the cases with identified genetic alterations, 75% (n = 52/69) were treated surgically. In cases with no genetic alterations identified, only 18% (n = 20/109) were treated surgically. Molecular testing on cytologically indeterminate thyroid nodules can help provide a more accurate risk of malignancy assessment in patients with lesions that are difficult to diagnosis based solely on FNAC morphology. The types of genetic alterations identified in the resected thyroid lesions were consistent with what has been previously described in the literature. Additionally, we found that in the patients with indeterminate thyroid FNAC with adjunct molecular testing, more than half did not undergo surgical resection. This finding emphasizes the value of adding molecular testing in patients, particularly when attempting to reduce unnecessary surgical intervention.

Thyroid FNA cytology: Impact of the COVID-19 pandemic and vaccination in a Brazilian series.

The coronavirus disease 2019 pandemic prompted changes in medical practice, with a reduction in cytopathology volumes and a relative increase in the malignancy rate during lockdown and the initial postlockdown period. To date, no study has evaluated the impact of these changes on the volume of rapid on-site evaluation (ROSE) or on the frequency of cases according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) categories after vaccination. Ultrasound-guided thyroid fine-needle aspiration (FNA) and ROSE assessments performed from January 2019 to May 2022 were evaluated retrospectively according to TBSRTC categories for three periods: prepandemic (period 1), from transmission to expansion (period 2), and after vaccination (period 3). There were 7531 nodules from 5815 patients. FNA cases increased throughout the pandemic despite a drop during lockdown. The frequency of TBSRTC categories changed. Nondiagnostic cases had an increase of 18.1% in period 2 and 76.2% after vaccination compared with prepandemic levels. Malignant cases increased from 2.3% to 4.2% in period 2 and to 5.1% in period 3, representing increases of 83.1% and 121.2%, respectively, compared with period 1. Data corrected by time showed increases in categories IV, V, and VI and a decrease in benign nodules during the two pandemic periods. ROSE was performed in 787 cases during the prepandemic period, and there were decreases of 29.4% and 22.8% in periods 2 and 3, respectively. The ROSE-to-category I ratio was reduced significantly after vaccination. Increased volume with sustained lower benign rates and higher malignant rates before and after vaccination indicate better selection of patients for FNA. A worse adequacy rate was correlated with a decrease in the number of ROSE assessments.

Diagnostic Value and Challenges of BRAF V600E Molecular Testing and Thyroid Fine-Needle Aspiration Cytology: A Retrospective Study from a Tertiary Institution in Southern Hunan Province, China

Introduction: Combined thyroid fine-needle aspiration (FNA) cytology and valine-to-glutamate substitution at codon 600 of B-Raf proto-oncogene, serine/threonine kinase (BRAF V600E) mutation detection are procedures used for diagnosing thyroid nodules in many Chinese tertiary institutions. This retrospective study at our institution aimed to explore the effectiveness and challenges of the combined approach in diagnosing thyroid nodules and the correlation between BRAF V600E mutation status and behavior of papillary thyroid carcinoma. Methods: Thyroid FNA cytology and BRAF V600E mutation detection results were reviewed between November 2020 and July 2022. A total of 623 patients, each of whom underwent thyroidectomy and final pathological examination after FNA cytology diagnosis, were included in the study. The relationship between the BRAF V600E mutational status and pathological parameters was analyzed using the χ² test. The effectiveness and challenges of FNA cytology alone and the combined procedure were also evaluated based on the final pathology. Results: Of 623 patients, 591 were diagnosed with papillary thyroid carcinoma (PTC), of which 456 were positive for the BRAF V600E mutation. It demonstrated near-perfect specificity for identifying PTC, and its incidence rate showed an age-specific curve with an inverted U-shaped distribution. The final pathological examination showed that the combined procedure had a higher sensitivity (83.91%) than FNA cytology alone (63.45%) for distinguishing PTC from other lesions (p < 0.001). Mutational status was associated with a larger maximum tumor diameter (p = 0.003) and a tendency of capsular invasion (p = 0.0542) but possibly unrelated to central lymph node metastasis (p = 0.1846). Nodular goiters accounted for most benign entities initially designated as Bethesda categories III–V. Conclusion: BRAF V600E mutational analysis complements cytopathology and improves the PTC detection rate in FNA cytology samples due to the high prevalence of the mutation in China. BRAF V600E mutation does not show a statistical correlation with tumor aggressiveness. Morphological pitfalls such as histocyte aggregation, cystic-lining cells in nodular goiters, and oncocytes in Hashimoto’s thyroiditis, were overwhelmingly found in BRAF V600E-negative specimens.

Evaluation of Thyroid Nodules in Patients With Fine-Needle Aspiration Biopsy.

The incidence of thyroid nodules has increased in the last 50 years due to the widespread use of imaging methods and incidental detection of small thyroid nodules. Thyroid fine-needle aspiration biopsy (FNAB) is the most accurate, reliable, and cost-effective test to evaluate thyroid nodules. In this research, we aimed to elucidate thyroid fine-needle aspiration cytology (FNAC) to understand how suspicious cases predict malignancy. Within this research's scope, 411 patients over 16 years old who were evaluated in IzmirKatipCelebi University, Ataturk Training and Research Hospital Internal Medicine (Izmir, Turkey) outpatient clinic for thyroid nodules between2018 and 2022and underwent thyroid FNAC followed by thyroid surgery were analyzed retrospectively. The age, gender, thyroid FNAC, operation type, and histopathology of all the patients were reviewed. Individuals with a history of head and neck cancer were excluded from the analysis. No statistically significant relationship between the pathology results and demographic characteristics was found. A statistically significant correlation existed between the pathology and FNAB results (p<0.05). Although 84.5% of the patients were diagnosed as benign, 14.7% as suspicious, and 0.8% as malignant in FNAC, all of these cases were diagnosed as benign in final histopathology results. Similarly, 21.9% of the patients were diagnosed asbenign, 58.8% as suspicious, and 19.4% as malignant in FNAC and all of these cases were diagnosed as malignant in final histopathology results. A correlation was determined between the two measurements (Cohen's kappa(κ)=0.557; p<0.001). The test's sensitivity was 47%, and the specificity was 99.1%. According to the FNAC results, the rate of being diagnosed with malignancy (positive predictive value (PPV)) was 93.9%, and the rate of being diagnosed as benign (negative predictive value (NPV)) was 85.8% for the individuals initially diagnosed as benign. Although FNAB remains the most important diagnostic tool to identify benigncases with a high accuracy rate, the operation decision is not clear in suspicious atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) cytology findings. In conclusion, this study highlights the importance of FNA results andhelps in surgical decision-making by emphasizing that the possibility of malignancy in the post-operative final histopathology report is higher, especially in the presence of suspicious FNAC results.

Thyroid Fine Needle Aspiration Cytology: The Impact of COVID-19 Pandemic and Vaccination in a Brazilian Series

Thyroid Fine Needle Aspiration Cytology: The Impact of COVID-19 Pandemic and Vaccination in a Brazilian Series

Predictors of bethesda i category in thyroid fine needle aspiration cytology

Predictors of bethesda i category in thyroid fine needle aspiration cytology

Comparison between Fine Needle Aspiration Cytology with Histopathology in the Diagnosis of Thyroid Nodules.

Accurate diagnosis of thyroid nodules is crucial for avoiding unnecessary surgeries and enabling timely treatment. Fine needle aspiration cytology (FNAC) and ultrasound are commonly employed diagnostic techniques, but their reliability is debated. This study aimed to compare the diagnostic accuracy of FNAC and ultrasounds using histopathology as the reference standard. A retrospective review was conducted on 344 patients who underwent thyroidectomy between January 2017 and May 2022. An ultrasound and FNAC were performed before surgery, and histopathological findings were compared. Statistical analyses were conducted to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false positive rate, false negative rate, and overall accuracy for each diagnostic method. Among the study population, 38.67% of thyroid tumors were malignant. Ultrasound showed a sensitivity of 68.18%, specificity of 76.55%, PPV of 64.74%, NPV of 79.20%, and overall accuracy of 73.31%. FNAC had a sensitivity of 89.31%, specificity of 48.44%, PPV of 78%, NPV of 68.89%, and accuracy of 75.89%. The correlation coefficient between ultrasound and FNAC was 0.512 (p < 0.0000001). Ultrasound correlated with histopathology with a coefficient of 0.408 (p < 0.0000001), while FNAC with histopathology had a coefficient of 0.304 (p < 0.00001). The correlation coefficient between these three diagnostic methods was 0.423 (p < 0.0001). In the diagnosis of thyroid nodules, both FNAC and ultrasound demonstrated moderate diagnostic accuracy. Ultrasound showed a higher specificity, while FNAC exhibited a higher sensitivity. Combining these techniques may improve diagnostic accuracy. Further research and the development of more reliable diagnostic methods are warranted to optimize the management of thyroid nodules and avoid unnecessary surgeries.

Probability of malignancy and molecular alterations as determined by ThyroSeq v3 genomic classifier in Bethesda Category IV.

ThyroSeq molecular testing assesses the probability of malignancy (POM) in thyroid fine-needle aspiration cytology (FNAC) with indeterminate cytology. The aim was to investigatewhether Bethesda category IV (BIV) subcategories are associated with specific molecular alterations, molecular-derived risk of malignancy (MDROM), and risk of malignancy (ROM). FNAC slides, associated ThyroSeq, version 3, Genomic Classifier results, and surgical follow-up were retrieved for BIV nodules. Nodules were subcategorized as follicular neoplasm (FN) with or without cytologic atypia or oncocytic follicular neoplasm (OFN). The MDROM, ROM, and frequency of molecular alterations in FN and OFN were analyzed. p < .05 was considered significant. A total of 92 FNAC were identified and subcategorized into 46 FN (15 with and 31 without cytologic atypia) and 46 OFN. The benign call rate and the positive call rate were 49% and 51%, respectively. The MDROM in BIV was 34.3%, trending lower in OFN than in FN. RAS mutations were significantly more frequent in FN when compared to OFN (p = .02). Chromosomal copy number alterationswere more often present in OFN than in FN (p < .01). On histologic follow-up, ROM in OFN was trending lower than in FN (p = .1). The most common diagnosis in OFN was oncocytic adenoma, whereas follicular variant papillary thyroid carcinoma was most common in FN. The MDROM and ROM were trending lower in OFN compared with FN, and the molecular alterations differed between OFN and FN subcategories.

FNAC (Fine needle aspiration cytology) and histopathological correlation and reclassification of thyroid neoplasm in accordance with WHO classification 2022

While assessing whether a patient requires surgery or conservative treatment, the thyroid FNAC is crucial. “The Bethesda System of Reporting Thyroid Cytopathology” was introduced to resolve the problem of standardising terminology in Thyroid FNA diagnosis. This study aims to evaluate the histopathological correlation and to also assess the diagnostic accuracy of TBSRTC at an institutional level with respect to histopathology. Additionally, reclassification of these cases in accordance with new Update of WHO Classification of Thyroid tumors 2022.This is a 3-year retrospective study of thyroid lesions from August 2019 to August 2022 comprising of 160 cases. Data was retrieved from institutional database and analysed. Fine needle aspiration Cytology- Histopathological correlation followed by determination of diagnostic accuracy of TBSRTC was done using Sensitivity, Specificity, PPV, NPV and accuracy. Reclassification was done on the 160 histopathological diagnosis based on the new updated classification.Study showed female predominance and largest cohort belonged to the age group of 21–40 years. Cytohistopathological correlation was done and 4 discordant cases were identified. The Sensitivity, Specificity, PPV, NPV and Accuracy was found to be 95.77, 98.87, 98.55%, 96.7% and 97.5% respectively. On reclassification, the tumors were now classified based on cell of origin and maximum no. of cases were identified under the category of Follicular- cell derived.FNAC is a sensitive and specific method of evaluating thyroid lesions. TBSRTC shows excellent diagnostic accuracy in detecting malignant lesions and can be used for screening neoplasm. The new classification demonstrates classification based on tumour cell of origin. It is crucial for Clinicians and Pathologists to be informed of new terminologies and classification schemes to aid more therapeutic options for patients.

Correlation between thyroid fine needle aspiration cytology and postoperative final histopathology: a 5-year single-centre retrospective study

Background: Thyroid nodules are common problems encountered in our routine practice. Fine needle aspiration cytology (FNAC) is the most accurate and cost-effective method for evaluating thyroid nodules. It is the procedure of choice for identifying patients who require surgical excision. Methods: This is a retrospective single-center observational study in Salmaniya Medical Complex, a tertiary care center, in Kingdom of Bahrain that aims to to correlate preoperative FNAC results with the post-surgical histopathology report, and to compare our diagnostic performance results to previously published literature. Results: The post-operative histology was reported as benign in 62% of patients and malignant in 38% of patients. Bethesda II was the most common category in our sample, with 14.3% having a final histopathological diagnosis of malignancy (false negative results). Malignancy was found in 84% and 96.8% of Bethesda V and VI, respectively. Our FNAC data achieved an 80.95% sensitivity, specificity of 93.51% specificity, and a total accuracy of 87.86%. The positive predictive value was 91.07%, and an 85.71% negative predictive value, which were comparable to data from published series. Conclusions: FNAC remains the most accurate and cost-effective method for evaluating thyroid nodules. However, its diagnostic value varies among different institutions. Our results demonstrated higher rates of malignancy compared to other published series in both category I and II. Due to the chance of false negative rates in these categories and the slow-growing nature of thyroid malignancy, it is important that patients with benign FNAC should have periodic clinical and radiological follow up.

Study of Fine Needle Aspiration Cytology (FNAC) of Thyroid Gland According to the Bethesda System.

Fine needle aspiration cytology (FNAC) of thyroid gland is a powerful diagnostic tool for thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) classifies thyroid FNAC findings into six categories. It is a standardized, simple, and convenient method of reporting which also provides guidelines for management. To study the cytomorphology of thyroid lesions and classify them as per TBSRTC.Determine the epidemiology and distribution of various thyroid lesions in our tertiary care hospital.Correlation of cytopathology with histopathological diagnosis in cases which were operated in our hospital. This is a prospective analytical study of 105 patients with clinically enlarged thyroid gland presenting at G.K. General Hospital, Bhuj during July 2018 to August 2020. FNAC smears of these patients were studied and correlated with histopathology wherever available. Out of a total 105 cases, 94 were non-neoplastic, eight were neoplastic, and three were unsatisfactory for evaluation. There were 94 cases in the benign category (category II), with colloid goiter being the most common cytological diagnosis (38 cases). There were no cases in categories III and V, respectively. On cytology, two cases in category IV were diagnosed as follicular neoplasm. Category VI had six cases comprising papillary carcinoma of thyroid (five cases) and medullary carcinoma of thyroid (one case). Out of a total 105 cases, 55 patients were operated in our center and hence their cytopathological findings were correlated with histopathological findings. Out of 55 operated cases, 45 cases (81.8%) had benign lesion and 10 cases (18.2%) were malignant. The sensitivity of FNAC was 70% and specificity was 100%. Thyroid cytology proves to be a reliable, simple, and cost-effective first-line diagnostic procedure with high patient acceptance and with rare, usually easily treated and not life-threatening complications. The Bethesda system is very useful for a standardized and reproducible system of reporting thyroid FNAC. It satisfactorily correlates with the histopathological diagnosis and helps in comparing results amongst various institutes.

Thyroid FNA cytology: The Eastern versus Western perspectives.

This commentary describes differences in the practice of thyroid fine‐needle aspiration cytology (FNAC) between the West and the East. Clinical management strategies are different in the East and the West, as are the statistics related to thyroid FNAC. When thyroid cytology reports from other institutions and countries are evaluated, it is important to be aware of these background differences before clinical management strategizing.

Digital droplet PCR TERT promoter mutational screening in fine needle aspiration cytology of thyroid lesions: A highly specific technique for pre-operative identification of high-risk cases.

Despite the advent of comprehensive molecular testing in surgical pathology, most centers still rely on the morphological assessment of fine-needle aspiration cytology (FNAC) to triage patients with thyroid nodules for surgery. Subsets of patients could benefit from the inclusion of molecular testing to increase the diagnostic and/or prognostic properties of the cytology analysis, including the assessment of TERT promoter mutations, an event coupled with thyroid malignancy, and poor prognosis. In this prospective study, preoperative FNAC material from 65 cases was assessed for TERT promoter hotspot mutations C228T and C250T using the digital droplet PCR (ddPCR) technique on frozen pellets and re-evaluated postoperatively. Our cohort consisted of 15 B-III (23%), 26 B-IV (40%), 1 B-V (2%), and 23 (35%) B-VI lesions according to the Bethesda System for Reporting Thyroid Cytopathology. TERT promoter mutations were detected in 7 cases; 4 papillary thyroid carcinomas (all with preoperative B-VI status), two follicular thyroid carcinomas (one B-IV and one B-V status), and one poorly differentiated thyroid carcinoma (with B-VI status). All mutated cases were verified by mutational analysis of tumor tissue derived from postoperative formalin-fixed paraffin-embedded tissue, while all cases identified as wild-type on FNAC remained wild-type postoperatively. Moreover, the occurrence of a TERT promoter mutation was significantly associated with malignant disease and higher Ki-67 proliferation indices. In the present cohort, we found that ddPCR is a highly specific method for detecting high-risk TERT promoter mutations on thyroid FNAC material that could guide different surgical approaches in subsets of indeterminate lesions if reproduced in larger materials.

The sonographic pattern of nodule and thyroid fine needle aspiration cytology in the evaluation of thyroid malignancy risk

Introduction: Thyroid fine-needle aspiration biopsy (TFNAB), which is basically planned according to the ultrasonographic features is of clinical importance; since it helps early diagnosis of malignancy, facilitates the selection of patients who will undergo thyroid surgery and prevents unnecessary surgical procedures. In our study, we aimed to evaluate the adequacy of TFNAB as well as the retrospective investigation of the link between the estimated malignancy risk and the descriptive features, radiologic findings and biopsy cytology of patients who underwent ultrasonography guided TFNAB.Methods: In this study, the ultrasonographic characteristics of 659 thyroid nodules belonging to 523 patients who underwent TFNAB between 2018 and 2021 were evaluated. The correlation between the risk of malignancy and demographic data, thyroid hormone levels, and ultrasonographic characteristics of nodules was examined. The diagnostic accuracy performances of European thyroid imaging reporting and data system (EU-TIRADS) classification prepared by the European Thyroid Association (ETA), the risk classification systems recommended by the American Thyroid Association (ATA) and the Society of Endocrinology and Metabolism of Turkey (TEMD) were compared with The Bethesda System for Reporting Thyroid Cytopathology (Bethesda). The adequacy of biopsy was also evaluated. The data which is obtained from the study was statistically analyzed by means of SPSS 20.0 (Statistical Package for the Social Sciences; SPSS Inc. Chicago, IL, USA) program.Results: In this study, the biopsies of 41 (6.2%) among 659 thyroid nodules appeared to be malignant. A statistically significant correlation was detected between malignancy and hypoechogenicity (p=0.011), microcalcification (p=0.005), irregular margins (p=0.028), and accompanying pathological lymph node (p=0.002). Compared to the surgical pathology results, the accuracy that was closest to that of Bethesda System (AUC: 0.778) (Area Under Curve) was found in EU-TIRADS (AUC:0.715). In the biopsies performed in our own endocrinology clinic (43.7% of the total biopsies), the ratio of non-diagnostic results was found to be 8.3%, whereas it was 29.1% in the biopsies performed in other clinics (56.3% of the total biopsies).Conclusion: It should always be kept in mind that, in the cytologic evaluation, the ultrasonographic nodule pattern recommended by the guidelines is very important in the management of patients, because cytology may show false negative and false positive results as well as unclear or non-diagnostic pathological findings. However, clinicians should also understand that classification systems may have strengths and weaknesses. Our study also emphasizes the importance of how experienced a clinic performing biopsy is as well as the role of cytopathologist in obtaining diagnostic results in biopsy.Keywords: Thyroid nodule, neoplasia, ultrasonography, biopsy fine-needle

Annotation-Free Deep Learning-Based Prediction of Thyroid Molecular Cancer Biomarker BRAF (V600E) from Cytological Slides.

Thyroid cancer is the most common endocrine cancer. Papillary thyroid cancer (PTC) is the most prevalent form of malignancy among all thyroid cancers arising from follicular cells. Fine needle aspiration cytology (FNAC) is a non-invasive method regarded as the most cost-effective and accurate diagnostic method of choice in diagnosing PTC. Identification of BRAF (V600E) mutation in thyroid neoplasia may be beneficial because it is specific for malignancy, implies a worse prognosis, and is the target for selective BRAF inhibitors. To the authors' best knowledge, this is the first automated precision oncology framework effectively predict BRAF (V600E) immunostaining result in thyroidectomy specimen directly from Papanicolaou-stained thyroid fine-needle aspiration cytology and ThinPrep cytological slides, which is helpful for novel targeted therapies and prognosis prediction. The proposed deep learning (DL) framework is evaluated on a dataset of 118 whole slide images. The results show that the proposed DL-based technique achieves an accuracy of 87%, a precision of 94%, a sensitivity of 91%, a specificity of 71% and a mean of sensitivity and specificity at 81% and outperformed three state-of-the-art deep learning approaches. This study demonstrates the feasibility of DL-based prediction of critical molecular features in cytological slides, which not only aid in accurate diagnosis but also provide useful information in guiding clinical decision-making in patients with thyroid cancer. With the accumulation of data and the continuous advancement of technology, the performance of DL systems is expected to be improved in the near future. Therefore, we expect that DL can provide a cost-effective and time-effective alternative tool for patients in the era of precision oncology.