scholarly journals EU-TIRADS-Based Omission of Fine-Needle Aspiration and Cytology from Thyroid Nodules Overlooks a Substantial Number of Follicular Thyroid Cancers

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Tamas Solymosi ◽  
Laszlo Hegedüs ◽  
Miklos Bodor ◽  
Endre V. Nagy
Keyword(s):  
Fine Needle Aspiration ◽  
Nodular Goiter ◽  
Needle Aspiration ◽  
Lesion Size ◽  
Data Systems ◽  
Thyroid Cancers ◽  
Fine Needle ◽  
Irregular Border ◽  
Us Findings ◽  
The Eu

Background. The classification of nodules by Thyroid Imaging Reporting and Data Systems (TIRADS) is important in guiding management. Whether sensitivity in identifying thyroid cancers varies with thyroid cancer phenotype remains unclarified. Methods. The ultrasound (US) characteristics of nodules of 26,908 nodular goiter patients were recorded. Fine-needle aspiration cytology (FNA) was performed in all nodules >1 cm irrespective of US findings (n = 25,025) and in nodules between 5 mm and 10 mm with suspicious US characteristics (n = 1,883). Of the 3281 operated cases, 221, 30, and 23 were papillary (PTC), follicular (FTC), and medullary (MTC) cancers, respectively. The US-based indication of FNA, as defined by EU-TIRADS scores, combined with lesion size, was calculated. This study design is unique in avoiding the common selection bias when TIRADS’ sensitivity is tested in a cohort selected for FNA and surgery based on the same US characteristics on which TIRADS is based. Results. The EU-TIRADS score influences decision of FNA in the 10–20 mm range. In such nodules (n = 118), the number of suspicious features (marked hypoechogenicity, microcalcifications, irregular shape, and irregular border) per lesion was lower in FTC (0.7 ± 0.6) than in PTC (1.7 ± 1.0) or MTC (1.8 ± 0.7; p < 0.02 ), resulting in EU-TIRADS scores of 4.1 ± 0.6, 4.8 ± 0.3, and 4.9 ± 0.2, respectively ( p < 0.01 ). The EU-TIRADS-based FNA indication rate was lower in FTC (55.5%) compared to PTC (85.0%) and MTC (88.9%) ( p = 0.02 ). Conclusions. EU-TIRADS-defined suspicious US features are less common in FTC than in PTC and MTC. Therefore, a substantial number of FTCs in the 10–20 mm range escape surgery.

scholarly journals Ultrasound-Based Indications for Thyroid Fine-Needle Aspiration: Outcome of a TIRADS-Based Approach versus Operators’ Expertise

2020 ◽  
pp. 1-9
Author(s):  
Tamas Solymosi ◽  
Laszlo Hegedüs ◽  
Steen Joop Bonnema ◽  
Andrea Frasoldati ◽  
Laszlo Jambor ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Diagnostic Approach ◽  
Similar Proportion ◽  
Lower Sensitivity ◽  
Data Systems ◽  
Thyroid Cancers ◽  
Fine Needle ◽  
Diagnostic Potential ◽  
The Us

<b><i>Background:</i></b> Thyroid nodule image reporting and data systems (TIRADS) provide the indications for fine-needle aspiration (FNA) based on a combination of nodule sonographic features and size. We compared the TIRADS-based recommendations for FNA with those based on the personal expertise of qualified US investigators in the diagnosis of thyroid malignancy. <b><i>Methods:</i></b> Seven highly experienced ultrasound (US) investigators from 4 countries evaluated, online, the US video recordings of 123 histologically verified thyroid nodules. Technical resources provided the operators with a diagnostic approach close to the real-world practice. Altogether, 4,305 TIRADS scores were computed. The combined diagnostic potential of TIRADS (TIRSYS) and the personal recommendations of the investigators (PERS) were compared against 3 possible goals: to recognize all malignant lesions (allCA), nonpapillary plus non-pT1 papillary cancers (nPnT1PCA), or stage II-IV cancers (st2-4CA). <b><i>Results:</i></b> For allCA and nPnT1PCA, TIRSYS had lower sensitivity than PERS (69.8 vs. 87.2 and 83.5 vs. 92.6%, respectively, <i>p &#x3c;</i>0.01), while in st2-4CA the sensitivities were the same (99.1 vs. 98.6% and TIRSYS vs. PERS, respectively). TIRSYS had a higher specificity than PERS in all 3 types of cancers (<i>p</i> &#x3c; 0.001). PERS recommended FNA in a similar proportion of lesions smaller or larger than 1 cm (76.9 vs. 82.7%; ns). <b><i>Conclusions:</i></b> Recommendations for FNA based on the investigators’ US expertise demonstrated a better sensitivity for thyroid cancer in the 2 best prognostic groups, while TIRADS methodology showed superior specificity over the full prognostic range of cancers. Thus, personal experience provided more accurate diagnoses of malignancy, missing a lower number of small thyroid cancers, but the TIRADS approach resulted in a similar accuracy for the diagnosis of potentially aggressive lesions while sparing a relevant number of FNAs. Until it is not clearly stated what the goal of the US evaluation is, that is to diagnose all or only clinically relevant thyroid cancers, it cannot be determined whether one diagnostic approach is superior to the other for recommending FNA<b>.</b>

Pathology of thyroid cancer

2011 ◽  
pp. 609-615
Author(s):  
Yolanda C. Oertel
Keyword(s):  
Fine Needle Aspiration ◽  
Armed Forces ◽  
Medullary Carcinoma ◽  
Needle Aspiration ◽  
High Rate ◽  
Follicular Epithelium ◽  
Thyroid Cancers ◽  
Fine Needle ◽  
Thyroid Fine Needle Aspiration ◽  
Well Differentiated

The majority of thyroid cancers arise from the follicular epithelium, are usually well differentiated, and thus many have a follicular architecture with varying amounts of colloid present. Medullary carcinoma constitutes a minority of thyroid cancers and arises from the C cells. Fine-needle aspiration (FNA) biopsy is the accepted diagnostic test to determine whether a thyroid nodule is benign or malignant (1, 2). The role of the cytopathologist in the interpretation of smears has been considered crucial, and I believe this is partially valid. Based upon 30 years of experience as an ‘interventional pathologist’ who performs and interprets many aspirates, I emphasize that the quality of the sample is the crucial factor. The pathologist’s interpretation is only as good as the sample he/she obtains or receives, and not enough attention has been paid to the technique of aspiration. I have trained numerous physicians to perform FNAs in a skilful fashion in a short period of time, and I refer the reader to my previous publications (3–5). The high rate of ‘unsatisfactory specimens’ reported in the literature is concerning. This was discussed at the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference in October 2007 (6) and it was recommended that ‘at the end of training and for re-credentialing 90% diagnostic samples should be documented’. Please note that FNA biopsy should not be confused with needle biopsies (e.g. Tru-cut, Vim-Silverman, etc.) that yield tissue fragments that are processed for histological diagnosis. The usual classification of thyroid cancers is founded on their histological and cytological features, many of which have been correlated with the clinical behaviour of the tumours. In addition, the age of the patients and the extent of the tumours are particularly important to determine the prognosis. The classification I follow is that of the WHO (7) with some of the modifications by the Armed Forces Institute of Pathology (AFIP) (8). My discussion will be focused largely on the most common types (see Box 3.5.5.1). Prolonged follow-up of the patients and extensive modern studies of the tumours indicate that papillary carcinomas and follicular carcinomas have histological similarities and are usually of a low grade of malignancy, but they also have a variety of inherent differences.

Pleuro-Pulmonary Aspergillosis

1995 ◽  
Vol 36 (2) ◽  
pp. 122-126 ◽  
Author(s):  
T. Tikkakoski ◽  
P. Lohela ◽  
M. Päivänsalo ◽  
T. Kerola
Keyword(s):  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Biopsy ◽  
Diagnostic Yield ◽  
Pleural Empyema ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Pulmonary Aspergillosis ◽  
Fine Needle ◽  
The Us ◽  
Us Findings

We reviewed the US findings and the diagnostic yield of fine-needle aspiration biopsy (FNAB) for cytologic and microbiologic samples in 4 patients with pulmonary or pleural aspergillosis. All 3 apical Aspergillus abscesses were round, hypoechoic with irregular margins and one contained echo-densities with shadowing consistent with air. One pleural empyema was oval and hypoechoic. Cytology suggested inflammation in all cases and Aspergillus hyphae were detected in 2 of 4 aspirates. Culture of the aspirate was positive for Aspergillus in 3 of 4 cases, while one diagnosis was made after surgery. No complications occurred. Apico-pleural Aspergillus lesions are suitable targets for US-guided FNAB, thus avoiding more invasive methods. Our results suggest wider use of this procedure.

scholarly journals Diagnostic value of multiparametric ultrasound and the EU-TIRADS system for differentiation of focal thyroid lesions

2020 ◽  
pp. 29-37
Author(s):  
A. V. Pomortsev ◽  
O. S. Tokarenko
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Flow Mapping ◽  
Diagnostic Efficacy ◽  
Color Flow ◽  
Fine Needle ◽  
Benign Nodules ◽  
The Eu

Background. Over the last 15 years, there have been many recommendations for the management of patients with thyroid nodules, based on the assessment of various ultrasound (US) criteria in B-mode. In 2020, the EUTIRADS system (2017) was included in Russian Clinical Practice Guidelines. Shear wave elastography (SWE) increases the diagnostic efficacy of ultrasonic B-mode examination of thyroid nodules and can be recommended for inclusion in the existing classification system. Objective. To assess the diagnostic efficacy of multiparametric US combining SWE and color flow mapping in differentiating between benign and malignant thyroid nodules to define their stage according to the EUTIRADS system for deciding on the need for fine-needle aspiration biopsy. Material and methods. A total of 150 thyroid nodules from 116 patients were analyzed. Lesions were then classified according to the EU-TIRADS system, SWE with an assessment of the color map and tissue stiffness was performed (Emean). In all tumors, cytological and histological (in operated patients) verification was carried out. Results. After B-mode US with color flow mapping, differentiation of palpable thyroid abnormalities by the EUTIRADS system was carried out. 78 nodules were classified as EU-TIRADS 2 (52%), 42 – EU-TIRADS 3 (28%), 26 – EU-TIRADS 4 (17.3%), 4 – EU-TIRADS 5 (2.7%). On cytological examination 42 tumor nodules were detected. Of these, 6 (14.3%) cases were reported as papillary thyroid carcinoma, 36 (85.7%) as follicular neoplasm, 22 (61%) among the last prove to be follicular carcinoma. Qualitative and quantitative evaluation of elastograms was performed. Benign nodules were colored primarily in blue, while suspicious for malignancy revealed red areas of different size. Elasticity index in benign nodules was 24.3 ± 5.63 kPa for colloid goiter, 27.8 ± 6.35 kPa for cellular goiter; in suspicious for malignancy – 80.9 ± 50.9 kPa for follicular neoplasm, 114 ± 56.8 kPa – for papillary thyroid cancer. The stiffness cutoff value for malignancy indicated with ROC-analysis was estimated as 45.4 kPa. Mean elasticity index (kPa) was significantly higher in suspicious for malignancy nodules than in benign nodules (р < 0.05). Of 120 (80%) nodules, primarily assessed as benign and defined as EU-TIRADS 2 and 3, 18 (12%) nodules after SWE revealed areas of high stiffness exceeding the cutoff value. After that, these nodules were transferred to EU-TIRADS 4 and 5, and these stages require fine-needle aspiration. Of these, 11 (7.3%) cases were reported as follicular neoplasm, 6 (4%) among the last prove to be follicular thyroid carcinoma. Conclusion. Using multiparametric approach with SWE will give the opportunity to classify correctly the nodule according to the EU-TIRADS and to identify greater number of thyroid tumors for fine-needle aspiration. SWE made it possible to increase the specificity of US using the EU-TIRADS system. The characteristics of the SWE score were: sensitivity = 81%, specificity = 90.3%, positive predictive value = 88%, negative predictive value = 91%, and accuracy of comprehensive study = 88.4%.

scholarly journals Biochemical Markers in Nodular Goiter in Children Indications, methods and outcome of the Surgical Treatment

2019 ◽  
Vol 70 (3) ◽  
pp. 996-999
Author(s):  
Flore Varcus ◽  
Gabriela Delia Ciobanu ◽  
Alexandru Grigorovici ◽  
Marius Valeriu Hinganu ◽  
Delia Hinganu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Thyroid Carcinoma ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Pediatric Population ◽  
Follicular Adenoma ◽  
Nodular Goiter ◽  
Needle Aspiration ◽  
Fine Needle

Nodular goiter is a rare condition in children and adolescents and compared with adults, thyroid nodules are more frequent malignant in pediatric population. We have investigated the prevalence of thyroid carcinoma among the thyroid disorder emphasizing on the surgical treatment in term of indication, methods and complications. Retrospective study of 35 children and adolescents with nodular goiter. Demographic data, thyroid ultrasonographic features, fine needle biopsy aspiration, hormonal profile, surgical treatment procedure as well as histological aspects were recorded. Study included 26 (74%) girls and 9 (26%) boys with a mean age of 11.66 years. Fine needle aspiration biopsy was performed in 10 cases due to the TIRADS score � 4 with Bethesda II in 3 cases, Bethesda III in 4 cases and Bethesda V in 3 cases. The surgical treatment was performed in 16 (45.7%) cases due to fine needle aspiration biopsy results or due to the relapse after medical treatment. Lobectomy was performed in 7 (43.7%) cases while total thyroidectomy was the final option for the rest of 9 (56.3%) patients. As a result of pathological examination in 8 cases the thyroid carcinoma has been found. The rest of 8 patients presented benign thyroid findings (follicular adenoma, toxic adenoma and Graves� disease with follicular adenoma). The prevalence of thyroid carcinoma among the pediatric population with thyroid nodules was 22.8% most affected being the female gender.

scholarly journals Solitary Nodular Goiter: Role of Ultrasonography in Fine-Needle Aspiration Cytology Diagnosis

2000 ◽  
Vol 9 (3) ◽  
pp. 205-213 ◽  
Author(s):  
Dilip K. Das ◽  
Chandra S. Pant ◽  
Krishan L. Chachra ◽  
Ashish K. Mandal ◽  
Rajan Kumar ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Nodular Goiter ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Needle Aspiration Cytology
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