scholarly journals Thyroid Nodules Located in the Lower Pole Have a Higher Risk of Malignancy than Located in the Isthmus: A Single-Center Experience

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Gulhan Duman ◽  
Baris Sariakcali
Keyword(s):  
Thyroid Nodules ◽  
Care Center ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Diagnostic Methods ◽  
Lower Pole ◽  
Single Center Experience ◽  
Risk Of Malignancy ◽  
Histopathologic Findings ◽  
Localization Information

Purpose. The aim of our study is to investigate whether thyroid nodules (TNs) localization has value as a predictor of malignancy. Ultrasonography provides very valuable information in the evaluation of TNs, but it does not correlate perfectly with histopathologic findings. Therefore, studies that will include new diagnostic methods that can improve these unknowns can be welcomed gratefully. Methods. This study was carried out retrospectively in a tertiary care center from September 2016 to January 2020. The study included 862 adult patients who have one or more nodules. Ultrasonography of characteristics of nodules such as echogenicity, content, margins, calcifications, size, and localization was recorded. Fine-needle aspiration biopsy (FNAB) was performed on dominant and suspicious 1142 nodules. Results. The patients were composed of 692 (80.3%) females and 170 (19.7%) males. Compared to nodules located in the isthmus; the malignancy risk increased 8.39 (OR: 8.39 (2.34–30.12), p  = 0.001) times in the lower pole, 4.27 (OR: 4.27 (1.16–15.72), p  = 0.029), times in the middle pole, 8.09 (OR: 8.09 (2.11–30.94), p  = 0.002) times in the upper pole, and 7.63 (OR: 7.63 (1.95–29.81), p  = 0.003) times in the nodules covering the whole of the lobe. Although the most nodular location was in the middle pole, the risk of malignancy was less than that in the lower and upper poles. Conclusions. Unlike the other localization studies, we found a higher risk of malignancy in the lower and similarly upper thyroid poles. Besides well-defined malignancy indicators in the literature and guidelines, localization information is promising for this purpose in the future.

scholarly journals Rate of malignancy for thyroid nodules with AUS/FLUS cytopathology in a tertiary care center – a retrospective cohort study

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Kalpesh Hathi ◽  
Tarek Rahmeh ◽  
Vicki Munro ◽  
Victoria Northrup ◽  
Ali Sherazi ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Care Center ◽  
Tertiary Care ◽  
Treatment Pathway ◽  
Malignancy Rate ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
Undetermined Significance

Abstract Background Thyroid nodules are stratified through fine-needle aspiration (FNA) and are often categorized using The Bethesda System for Reporting Thyroid Cytopathology, which estimates the risk of malignancy for six cytopathological categories. The atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS) categories have varying malignancy rates reported in the literature which can range from 6 to 72.9%. Due to this heterogeneity, we assessed the malignancy rate and effectiveness of repeat FNA (rFNA) for AUS/FLUS thyroid cytopathology at our institution. Methods Electronic health records of patients with AUS/FLUS thyroid cytopathology on FNA at our center since the implementation of the Bethesda System on May 1, 2014–December 31, 2019 were retrospectively reviewed. Patient demographics, treatment pathway, and pathology results were collected. The treatment pathway of the nodules, the rFNA results, and the malignant histopathology results were reported. Malignancy rates were calculated as an upper and lower limit estimate. Results This study described 182 AUS/FLUS thyroid nodules from 177 patients. In total, 24 thyroid nodules were deemed malignant upon histopathology, yielding a final malignancy rate of 13.2–25.3%. All of the malignancies were variants of papillary thyroid carcinoma. The malignancy rate of the nodules which underwent resection without rFNA (21.5%) was lower than the malignancy rate of the nodules which underwent resection after rFNA (43.8%). 45.5% of the rFNA results were re-classified into more definitive categories. Conclusion The malignancy rate of AUS/FLUS thyroid cytopathology at our center is in line with the risk of malignancy stated by the 2017 Bethesda System. However, our malignancy rate is lower than some other Canadian centers and approximately half of our rFNAs were re-classified, highlighting the importance of establishing center-specific malignancy and rFNA re-classification rates to guide treatment decisions.

scholarly journals Diagnostic Accuracy of the Bethesda System of Reporting Thyroid Cytopathology in the Evaluation of Thyroid Nodule in a Tertiary Care Hospital of Kolkata

2021 ◽  
Vol 8 (05) ◽  
pp. 241-245
Author(s):  
Sweta Verma ◽  
Mita Saha Dutta Chowdhury ◽  
Souradeep Ray ◽  
Ruma Guha
Keyword(s):  
Diagnostic Accuracy ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Care Hospital ◽  
Risk Of Malignancy ◽  
Needle Aspiration Cytology ◽  
Thyroid Cytopathology ◽  
The Bethesda System

BACKGROUND Thyroid cancer has the most rapidly increasing incidence of all major cancers in India. The overall prevalence of thyroid malignancy is approximately 1 - 5 % of all cancers in women and less than 2 % in men. Thyroid nodules are a common clinical finding and have a reported prevalence of 4 – 7 % in the general population. The vast majority of these nodules are non-neoplastic or benign and the risk of malignancy varies from 5 to 10 %. Fine needle aspiration cytology (FNAC) is an efficient and reliable means for the evaluation of thyroid nodules. A key challenge for clinicians is to choose which thyroid nodule is to be investigated further and treated. Early detection and treatment of malignant thyroid nodules is associated with excellent outcomes. The aim of our study is to compare and correlate between fine needle aspiration cytology and histopathology of resected specimen and to determine the diagnostic accuracy of TBSRTC (The Bethesda System for Reporting Thyroid Cytopathology) in thyroid nodule. METHODS This is a cross sectional validation study conducted in a tertiary care hospital (R.G. Kar Medical College) of Kolkata to find the sensitivity, specificity and diagnostic accuracy of TBSRTC in evaluation of thyroid nodule. RESULTS We have observed that TBSRTC is highly sensitive and specific in stratifying the malignancy risk of thyroid nodule. CONCLUSIONS It aids the clinician to choose the thyroid nodules which require further evaluation and intervention. It also guides the clinician to decide the operability of thyroid nodule. TBSRTC is highly accurate and is highly specific in stratifying the risk of malignancy of thyroid nodule. KEYWORDS TBSRTC, FNAC, Thyroid Nodules, Thyroid Cancer

Risks of Neoplasia and Malignancy in Surgically Resected Cystic Parotid Lesions

2019 ◽  
Vol 162 (1) ◽  
pp. 79-86
Author(s):  
Brian C. Boursiquot ◽  
Nancy J. Fischbein ◽  
Davud Sirjani ◽  
Uchechukwu C. Megwalu
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Cross Sectional Study ◽  
Preoperative Imaging ◽  
Cross Sectional ◽  
Risk Of Malignancy ◽  
History Of ◽  
Diagnostic Samples ◽  
Cystic Masses

Objectives To evaluate the risks of neoplasm and malignancy in surgically treated cystic parotid masses compared with solid or mixed lesions and to evaluate the performance of fine-needle aspiration (FNA) in parotid cysts. Study Design Retrospective cross-sectional study. Setting Single-institution academic tertiary care center. Subjects and Methods Patients without a history of human immunodeficiency virus or head and neck cancer who underwent parotidectomy for parotid masses and had preoperative imaging to characterize lesions as cystic, solid, or mixed (ie, partially cystic and partially solid). We assessed the risks of neoplasia and malignancy, adjusting for age, sex, race/ethnicity, facial nerve weakness, and history of malignancy. We also evaluated the sensitivity and specificity of FNA. Results We included 308 patients, 27 of whom had cystic parotid masses (5 simple and 22 complex). Cystic masses were less likely to be neoplastic compared to solid or mixed masses (44% vs 97%; odds ratio [OR], 0.03; 95% confidence interval [CI], 0.01-0.07); however, there was no difference in the risk of malignancy (22% vs 26%; OR, 0.81; 95% CI, 0.32-2.10). Cystic masses were more likely to yield nondiagnostic FNA cytology results, but for diagnostic samples, FNA was 86% sensitive and 33% specific for diagnosing neoplasia and 75% sensitive and 83% specific for diagnosing malignancy. Conclusion In our population, cystic masses undergoing surgery were less likely to be neoplastic but had a similar risk of malignancy as solid masses. The risk of malignancy should be considered in the management of cystic parotid masses.

scholarly journals Thyroid Fine-Needle Aspiration under Ultrasound Guidance: Experience from an Academic Tertiary Care Center in Lebanon

10.3823/2432 ◽  
2017 ◽  
Vol 10 ◽  
Author(s):  
Rita Hajj Boutros ◽  
Maurice Haddad ◽  
Fouad Boulos ◽  
Asma Arabi
Keyword(s):  
Thyroid Cancer ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Ultrasound Guidance ◽  
Care Center ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Radiology Department ◽  
Tertiary Care Center ◽  
Fine Needle

Thyroid nodules are common. Malignancy was reported in only 5-15% of cases. Fine needle aspiration under US guidance (USG-FNA) proved to be accurate for the detection of thyroid cancer. This is a retrospective review of 400 radiology and cytology USG-FNA reports, randomly selected among those done at the Radiology Department at a tertiary care center in Beirut during the last five years. The specimen was inadequate in 60 (12%) of cases but FNA was repeated in 10 cases only. The final diagnosis was benign in 76.7% of cases, mostly in women. 35% of the malignant and 19% of the benign nodules were hypoechoic, p=0.03. No significant correlation was observed between malignancy and other ultrasonic characteristics. Hypoechogenecity was also more common in nodules with inadequate specimen (40% versus 21.4%, p=0.01). Age, gender, location and size of the nodule did not differ between groups of adequate and inadequate specimen. In conclusion, 3 out of 4 thyroid nodules referred for USG-FNA are benign, mostly in women. Inadequate specimen was observed in 12% of cases. Hypoechogenecity but not other ultrasonic characteristics was associated with malignancy and with test failure.   Key words: Thyroid nodule, fine needle aspirate, ultrasound guidance, thyroid cancer, inadequate.   

scholarly journals The value of repeating fine-needle aspiration for thyroid nodules

2021 ◽  
Vol 41 (1) ◽  
pp. 36-42
Author(s):  
Aseel Doubi ◽  
Nuha S. Alrayes ◽  
Abdulaziz K. Alqubaisi ◽  
Saleh F. Al-Dhahri
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Final Pathology ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Level Of Agreement

BACKGROUND: Fine-needle aspiration (FNA) is an invaluable technique used in the evaluation of thyroid nodules. OBJECTIVES: Evaluate the concordance of results for consecutive FNA readings. DESIGN: Retrospective, descriptive. SETTINGS: Two tertiary care centers. METHODS: Demographics were collected along with every FNA result and final pathology results for all patients (aged 9-90 years old) who underwent thyroid surgery from 2010 to 2017. The Bethesda system was used for cytology. Agreement levels were calculated and compared with final pathology. SAMPLE SIZE: Of 1237 initially included, 1134 had at least one FNA performed with results available for review. RESULTS: For the 1134 patients, demographic and clinical data were collection and a comparison was made between the three FNA results; the highest agreement was between FNA 2 and 3 (53.6%); however, the kappa value was consistently low for all comparisons, indicating a poor level of agreement overall. Also, the risk of malignancy was higher in this study than in the 2017 Bethesda system for reporting thyroid cytopathology in FNA cytology categories I and II. CONCLUSION: Repeating FNA biopsies yield different results every time; hence, there is a low level of agreement. The clinical decision should therefore include other important risk factors. Prospective studies could help shed more light on this topic. LIMITATIONS: Retrospective design. CONFLICT OF INTEREST: None.

scholarly journals Usefulness of accessible imaging methods in thyroid nodules with indeterminate cytology

2021 ◽  
Vol 28 (1) ◽  
pp. R1-R9
Author(s):  
Pedro Weslley Rosario ◽  
Tiara Grossi Rocha ◽  
Gabriela Franco Mourão
Keyword(s):  
Fdg Pet ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Diagnostic Methods ◽  
Imaging Method ◽  
Fine Needle ◽  
Risk Of Malignancy ◽  
Indeterminate Cytology ◽  
Rule Out

In thyroid nodules (TN) submitted to fine-needle aspiration (FNA), Bethesda categories III and IV are considered ‘indeterminate’ cytology. This result corresponds to 10–25% of all FNAs and the risk of malignancy (RoM) ranges from 10% to 30% for category III and from 15% to 40% for category IV. This review analyzed the practical applicability of accessible imaging method in the management of patients with cytologically indeterminate TN > 1 cm (ITN). When ITN are highly suspicious on ultrasonography (US), the RoM supports surgical indication even in the absence of additional tests. The same can be applied to ITN of intermediate suspicion but with elevated stiffness on elastography. Follow-up without additional tests is acceptable in the case of ITN with low-risk cytology and low-suspicion appearance on US and elastography (if obtained). In the case of ITN without highly suspicious US appearance, 123I scintigraphy may be obtained in patients with TSH < 1–1.5 mIU/L to rule out hyperfunctioning nodules before requesting diagnostic methods that are more expensive and less accessible. In addition, in ITN with not very suspicious US appearance, 18FDG-PET may be obtained. If this method does not reveal nodular uptake, the risk of the nodule corresponding to a macrocarcinoma is sufficiently low in order to allow follow-up. The positive predictive value of focal nodular uptake on 18FDG-PET depends on the pre-test RoM, cytological findings, and maximum SUV. There is currently no evidence for the use of CT, MRI or imaging using 99mTc-MIBI to define the nature of ITN.

scholarly journals Ultrasound Parameters of Thyroid Nodules and the Risk of Malignancy: A Retrospective Analysis

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482094597
Author(s):  
Minxin Wang ◽  
Ping Sun ◽  
Xiaodong Zhao ◽  
Yongmei Sun
Keyword(s):  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Diagnostic Methods ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Risk Of Malignancy ◽  
Needle Aspiration Cytology

Ultrasonography-guided fine-needle aspiration biopsy is the common choice for diagnosis of the suspected thyroid nodule. An algorithm(s) that finds the malignant potential of a nodule preoperatively, to overcome unnecessary diagnostic methods, does not exist. The objective of the study was to correlate thyroid nodule sizes measured by ultrasonography and risk of malignancy assessed by cytologic and histologic examinations. Data regarding fine-needle aspiration cytology and the results of histologic examinations of surgical specimens of 260 nodules were collected and analyzed. The macro or multiple calcifications, the complex echo pattern, and posterior region homogeneity were considered suspicious in ultrasonography. Bethesda system for classification of thyroid nodules was used for cytopathology. Histopathology performed as per the 2004 World Health Organization classification system. The benefit score analysis was performed for determination of clinical usefulness. Twenty-eight of 49 malignant nodules and 46 of 68 malignant nodules detected through ultrasound following fine-needle aspiration cytopathology and histopathology were <2 cm in size. A correlation was found for malignancy rate detected by ultrasonography-guided fine-needle aspiration cytology and those of the surgical specimen ( r = 0.945, P = .015, R 2 = 0.894). Ultrasonography-guided fine-needle aspiration cytology had 0.994 sensitivities, 0.721 accuracies, and 0.08 to 0.945 diagnostic confidence for the detection of malignant nodules. Nodule size less than 2 mm ( P = .011) was associated with the malignancy potential of thyroid nodules. Ultrasonography-guided fine-needle aspiration cytology had 19 (7%) results as a false negative and 1 (1%) results were false positive. Ultrasound-guided fine-needle aspiration cytopathology reported oversize of thyroid nodule than original but can predict the risk of malignancy. Level of Evidence: III.

scholarly journals CORRELATION BETWEEN ULTRASOUND-BASED ACR TI-RADS AND BETHESDA SYSTEM FOR REPORTING THYROID-CYTOPATHOLOGY: A PROSPECTIVE STUDY AT TERTIARY CARE CENTER IN EASTERN INDIA

2020 ◽  
pp. 1-4
Author(s):  
Kapse Pratik Siddheshwar ◽  
Beena Devi Agarwal ◽  
S. S. G. Mohapatra ◽  
Niranjan Sahu ◽  
Apoorva Dixit
Keyword(s):  
Prospective Study ◽  
Thyroid Nodules ◽  
Care Center ◽  
Tertiary Care ◽  
Imaging Tool ◽  
Risk Of Malignancy ◽  
Initial Imaging ◽  
A Prospective Study ◽  
Risk Of Cancer

BACKGROUND: Ultrasound(USG) is the initial imaging tool for the assessment of thyroid lesions, due to its easy availability and no radiation risk.USG based TIRADS uses particular lexicons for reporting a focal thyroid nodule,based on which risk of malignancy is calculated and finally a TIRADS category is assigned.The lexicons used are helpful for effective communication between the practitioners. OBJECTIVE:To determine the efficacy of ACR based TIRADS in predicting suspicious thyroid nodules and categorizing the patients in need of further evaluation with FNAC or follow up. MATERIALS AND METHODS: This prospective study was done over a period of 1 year (January 2019–January 2020)and include 50 patients. Patients having thyroid nodules in B-mode ultrasound were included in the study. The nodules were then grouped into their respective categories based on ACR TI-RADS and further management was decided. Pathological correlation using Bethesda classification and cancer risk of each TIRADS category was determined in the follow-up period simultaneously. RESULTS:All the 6 nodules classified under the TIRADS 5 category were found to be malignant while none of the TIRADS 2 nodules out of 29 were malignant i.e.Bethesda IV or higher.The risk of malignancy for ACR TI-RADS categories 1,2,3,4 and 5 was 0, 14.3, 62.5 and 100%, respectively.The risk of cancer in our study is almost comparable to other prominent studies. CONCLUSION:ACR based TIRADS classification is reliable in predicting thyroid malignancy.

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