Characteristics of False-Negative Thyroid Fine-Needle Aspirates

2017 ◽  
Vol 62 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Andrew A. Renshaw ◽  
Edwin W. Gould
Keyword(s):  
False Negative ◽  
False Negative Rate ◽  
Sampling Errors ◽  
Fine Needle ◽  
Fine Needle Aspirates ◽  
Negative Rate ◽  
Risk Of Malignancy ◽  
Rare Cells ◽  
Thyroid Fna

Introduction: False-negative thyroid fine-needle aspirates (FNA) are not well characterized. Methods: We correlated the results of all thyroid aspirations from 1997 to 2016 with histologic follow-up. Results: There were 13,733 aspirates, 2,112 (15.3%) resections, and 678 malignancies (32.1%). Eighteen (2.7%) false-negative cases were identified (interpretation, n = 6; sampling, n = 7; and new nodules, n = 5). Interpretive false-negative cases were significantly less likely when the indeterminate rate was greater than 13% (p = 0.01). Interpretive errors involved rare cells with poorly developed features of malignancy. Sampling errors were not associated with scant cellularity in the specimen. The majority of false-negative cases were not resected because of a clinical suspicion of malignancy. The sensitivity of FNA for 9-mm papillary carcinomas was 44.3%. Conclusion: In this cohort, the false-negative rate of thyroid FNA was 2.7% and the risk of malignancy for a benign diagnosis was 3.5%. Interpretative errors involved rare cells with poorly developed features of malignancy. There is little evidence that either the false-negative rate or the risk of malignancy of a benign thyroid FNA is different in patients who do and do not undergo resection.

Fine-needle aspiration biopsies in the management of indeterminate follicular and Hurthle cell thyroid lesions

2009 ◽  
Vol 140 (5) ◽  
pp. 715-719 ◽  
Author(s):  
Tamara Mijović ◽  
Louise Rochon ◽  
Olguta Gologan ◽  
Michael P. Hier ◽  
Martin J. Black ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
False Negative ◽  
False Negative Rate ◽  
Diagnostic Category ◽  
Case Series ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Cytologic Atypia ◽  
Hürthle Cell ◽  
Risk Of Malignancy

Objectives: To determine the value of fine-needle aspiration biopsies (FNABs) of the thyroid and stratify the risk of malignancy within the indeterminate FNAB diagnostic category at our institution. Study design: Case series with chart review of preoperative FNABs of consecutive patients who underwent total thyroidectomy between 2005 and 2007. Subjects and Methods: A total of 115 cases were reviewed, and FNABs were categorized into four groups: benign, positive or suspicious for malignancy, indeterminate (follicular or Hurthle cell lesions), and nondiagnostic. Cytohistologic correlation was then established. Results: The accuracy of FNAB in detecting thyroid malignancy was 88 percent with false-negative and false-positive rates of 13 percent and 7 percent, respectively. Overall, 52 percent of the indeterminate cases were carcinomas (48 percent of follicular lesions and 62 percent of Hurthle cell lesions). In the presence of cytologic atypia, the rate of malignancy increased to 75 percent and 83 percent for the follicular and Hurthle cell lesions, respectively. Conclusions: FNAB is an accurate and helpful method for the evaluation of thyroid nodules with results directly correlating with management. Surgery should be considered for FNABs categorized as indeterminate, especially in the presence of cytologic atypia. Because of the high false-negative rate, benign FNABs require close follow-up with ultrasound examination and periodic biopsies.

Compliance with Short-Interval Follow-up MRI after Benign Concordant MRI-guided Breast Biopsy

2020 ◽  
Author(s):  
Shruthi Ram ◽  
Helaina Regen-Tuero ◽  
Grayson L Baird ◽  
Ana P Lourenco
Keyword(s):  
Breast Biopsy ◽  
Short Interval ◽  
False Negative ◽  
False Negative Rate ◽  
Negative Rate ◽  
Guided Biopsy ◽  
Institutional Review ◽  
Biopsy Report ◽  
Mri Guided

Abstract Objective To evaluate compliance with short-interval follow-up MRI after benign concordant MRI-guided breast biopsy. Methods This institutional review board-approved retrospective study included all benign concordant MRI-guided biopsies performed between January 1, 2010, and May 1, 2018. The following was collected from the electronic medical record: patient and lesion characteristics, short-interval follow-up MRI recommendation, communication to referring physician, follow-up imaging, repeat biopsies, biopsy outcome, and patient insurance status. Compliance with recommendations was defined as follow-up MRI within 9 months of biopsy. Results Among 98 patients, there were 107 lesions with benign concordant MRI-guided biopsy results that met study criteria. After excluding 7 patients who underwent subsequent mastectomy, 50/91 (54.9%) patients were recommended short-interval follow-up MRI. Of these, 33/50 (66.0%) had a short-interval follow-up MRI. Direct communication of the short-interval follow-up recommendation was documented in the biopsy report for 4/50 (8%) patients. Subsequent MRI was available for 77/107 (72%) lesions at a median of 29 months following MRI-guided biopsy (range, 3–96 months). Subsequent mammography was available for 21/30 (70%) remaining lesions at a median of 47 months following MRI-guided biopsy (range, 23–88 months). There were two repeat biopsies, with one subsequent malignancy, resulting in a false-negative rate of 0.9% (1/107). Conclusions When short-interval follow-up MRI was recommended following benign concordant MRI-guided breast biopsy, compliance was 66.0%. Lack of communication of the recommendation may at least partially explain the low compliance. The low false-negative rate (0.9%) suggests routine short-interval follow-up MRI may be unnecessary following benign concordant MRI-guided biopsy.

Outcomes of Indeterminate Thyroid Nodules Managed Nonoperatively after Molecular Testing

2020 ◽  
Author(s):  
Catherine Y Zhu ◽  
Ines Donangelo ◽  
Deepashree Gupta ◽  
Dalena T Nguyen ◽  
Joana E Ochoa ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
False Negative ◽  
False Negative Rate ◽  
Molecular Testing ◽  
Test Results ◽  
Molecular Test ◽  
Negative Rate ◽  
Indeterminate Nodules

Abstract Context Molecular testing to refine the diagnosis of cytologically indeterminate thyroid nodules has become increasingly popular, but data on long-term durability of test results and the rate of delayed operation are limited. Objective Determine the delayed rate of surgical resection in indeterminate nodules with benign/negative molecular testing and the risk of false-negative molecular test results. Design Prospective follow-up of the Gene Expression Classifier vs Targeted Next-Generation Sequencing in the Management of Indeterminate Thyroid Nodules randomized controlled trial comparing the diagnostic test performance of Afirma Gene Expression Classifier and ThyroSeq v2. Setting University of California, Los Angeles. Participants Patients who underwent thyroid biopsy with indeterminate (Bethesda III/IV) cytology (April 2016 to July 2017). Intervention Ultrasound surveillance. Main Outcome Measure False-negative rate of molecular testing. Results Of 95 indeterminate nodules with negative/benign molecular test results, 12 nodules underwent immediate resection (11 benign nodules, 1 noninvasive follicular thyroid neoplasm nodule with papillary-like nuclear features). Nonoperative management was pursued for 83 (87.4%) nodules. The median surveillance was 26.7 months. Ten nodules were resected during surveillance and malignancy was identified in 4 nodules (overall false-negative rate of 5.8%). In the 4 malignant nodules that underwent delayed operation, surgery was prompted by sonographic changes during surveillance. Conclusions The majority of indeterminate nodules with negative molecular testing have a stable clinical course over 3 years of follow-up, but our finding of a 6% false-negative rate highlights the importance of continuing sonographic surveillance. Long-term studies are needed to determine the optimal length of follow-up.

scholarly journals Association between thyroid nodule size and malignancy rate

2020 ◽  
Vol 102 (1) ◽  
pp. 43-48
Author(s):  
M Jinih ◽  
F Faisal ◽  
K Abdalla ◽  
M Majeed ◽  
AA Achakzai ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
False Negative ◽  
False Negative Rate ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Nodule Size ◽  
Malignancy Risk ◽  
Negative Rate

Introduction The diagnostic performance of ultrasound-fine needle aspiration to identify thyroid nodules harbouring malignancy remains variable. The aim of this study was to determine thyroid nodule size and cytological classification as predictors of malignancy risk. Materials and methods We conducted a retrospective cohort analysis at an academic hospital involving 499 consecutive patients who underwent thyroid surgery between 2004 and 2015. Results A total of 503 thyroid nodules (499 patients, 84% female; mean age 50.8 years, standard deviation, SD, 15.4 years) were analysed. Of these, 19.5% were malignant. The mean (± SD) nodule size was 3.28 ± 1.63 cm and 3.27 ± 1.54 cm for benign and malignant nodules, respectively. The odds of malignancy for thyroid nodules less than 3.0 cm was similar to those for nodules of 3.0 cm or greater (0.26 compared with 0.29; p=0.77). Overall, the sensitivity and specificity of fine-needle aspiration in this cohort were 71.4% and 100%, respectively. The overall false negative rate was 5.4%. When the cut-off of 3.0 cm was used, the false negative rate in thyroid nodules less than 3.0 cm was 0% compared with 7.0% in nodules of 3.0 cm or greater. Thus, class (p<0.01) but not nodule size (p=0.49), was associated with higher malignancy risk. Conclusions Our results suggest that thyroid nodule size did not accurately predict the risk of thyroid malignancy irrespective of fine-needle aspiration cytology. Routine diagnostic thyroid lobectomy solely owing to thyroid nodule size of 3.0 cm or greater is currently not justified.

Performance Characteristics of Adenoid Cystic Carcinoma of the Salivary Glands in Fine-Needle Aspirates: Results From the College of American Pathologists Nongynecologic Cytology Program

2015 ◽  
Vol 139 (12) ◽  
pp. 1525-1530 ◽  
Author(s):  
Z. Laura Tabatabai ◽  
Manon Auger ◽  
Daniel F. I. Kurtycz ◽  
Alice Laser ◽  
Rhona J. Souers ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Adenoid Cystic Carcinoma ◽  
Statistical Difference ◽  
False Negative ◽  
False Negative Rate ◽  
General Category ◽  
Fine Needle ◽  
Fine Needle Aspirates ◽  
Significant Statistical Difference ◽  
Adenoid Cystic

Context Although the cytomorphology of adenoid cystic carcinoma (ACC) has been well described, the accuracy of this diagnosis in fine-needle aspirates (FNAs) of the salivary glands has not been extensively evaluated. Objective To assess participants' responses in the College of American Pathologists (CAP) Nongynecologic Cytology (NGC) Program to determine the accuracy and false-negative rate of ACC cases in salivary gland FNAs. Design A retrospective review of the CAP NGC Program's cumulative data from 2000–2010 was performed for the general and the specific reference diagnosis categories for ACC in salivary gland FNAs according to preparation and participant types. Results Of 5156 responses, the overall concordance rates for both the general category of malignancy and the specific category of ACC were 63.6% (3279 of 5156) and 38.6% (1966 of 5088), respectively, with a false-negative rate of 36.4% (1877 of 5156). The most frequent false-negative responses were pleomorphic (1080) and monomorphic (526) adenoma (1614 of 5088, 31.5%), while lymphoma was the most frequent malignant misinterpretation. There was a significant statistical difference in concordance to the reference interpretation between the reader types: 39.9% (1006 of 2521) concordance rate for pathologists compared to 33.8% (503 of 1488) for cytotechnologists. However, there was no significant statistical difference for concordance to the general category or reference interpretation, based on preparation type (Papanicolaou versus modified Giemsa stained). Conclusions In this interlaboratory comparison educational program, accurate identification of ACC has shown to be problematic, with ACC representing an important cause of false-negative responses. The most common diagnostic pitfall is distinguishing this entity from pleomorphic and monomorphic adenoma in the benign category and from lymphoma and adenocarcinoma in the malignant one.

scholarly journals LO21: Ability of single negative ultrasound to rule out deep vein thrombosis in pregnant women. A systematic review and meta analysis

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S13-S14
Author(s):  
K. Al Lawati ◽  
J. Aljazeeri ◽  
W. Chan ◽  
K. de Wit
Keyword(s):  
Deep Vein Thrombosis ◽  
Pregnant Women ◽  
False Negative ◽  
False Negative Rate ◽  
Risk Of Bias ◽  
Hard Copy ◽  
Vein Thrombosis ◽  
Negative Rate ◽  
Deep Vein

Introduction: The accuracy of ultrasound (US) for diagnosing lower extremity deep vein thrombosis (DVT) in non-pregnant patients has been well validated. However, in pregnant women with suspected DVT and an initial negative US (with imaging of the iliac veins), serial US is recommended. We aimed to determine the ability of single negative US to exclude DVT in symptomatic pregnant women. Methods: Two authors independently reviewed the following databases: MEDLINE, PubMed and EMBase from inception until May 2017. Three authors reviewed all full text papers and data were extracted from included studies by four authors. An overlap among study populations was identified in 4 of the manuscripts, all from one multicentre Canadian study. Two authors performed data re-extraction from the hard copy research charts from this study. We assessed the risk of bias using the CLARITY group tool for prognostic studies. Results: Of 109 potentially relevant articles, 8 studies (7 prospective studies and 1 retrospective) were included. Risk of bias was low for the included populations, and low or moderate for method of measurement and for completeness of follow up. A total of 635 pregnant patients with symptoms of DVT had an initial negative US examination. Of those, 6 had positive DVT during serial US (0.94%) and 3 developed DVT during 3-month follow-up after serial ultrasound (0.47%). Using random-effects model, the pooled false negative rate of a single ultrasound was 1.27% (95% confidence interval, 0.42 to 2.56), I2= 27%. Conclusion: The false negative rate of a single ultrasound with iliac vein imaging for DVT in pregnancy is low. Our results will help inform shared decision making around planning repeat ultrasound scans in these patients.

scholarly journals A Study to Evaluate the Size of Thyroid Nodules as an Indicator for Malignancy

2020 ◽  
Vol 3 (1) ◽  
pp. 16-20
Author(s):  
Ajay Kumar Jha ◽  
Ajit Kumar Sinha
Keyword(s):  
Thyroid Nodules ◽  
Current Practice ◽  
False Negative ◽  
False Negative Rate ◽  
Needle Aspiration ◽  
Indication For Surgery ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Risk Of Malignancy ◽  
Needle Aspiration Cytology

Background: Several authors have questioned the accuracy of fine- needle aspiration cytology (FNAC) in large thyroid nodules. It’s the current practice to provide thyroidectomy to patient with thyroid nodules 4 cm or larger regardless of the FNAC results. The aim of the study is to answer two questions: is the size of nodule associated with higher risk of malignancy and is the size indication for surgery. Subjects and Methods: This study included 20 patients who underwent thyroidectomy. We compared all thyroid nodules with benign FNAC and their final histopathology reports. Patients were divided into two groups based on the size of the nodule (< 4cm or >4cm) and indication of surgery. Results: 20 patients with thyroid nodule underwent thyroid surgery. 13 patients had nodule <4cm and 7 patients were 4 cm. For patients with nodules <4 cm, 3 patients had a malignancy, and for those with nodules 4 cm, 1 patients had a malignancy. For benign cases FNAC and histopathology reports are showing same results, (p<0.05). Conclusion: Thyroid nodules 4 cm are not risk factor of malignancy. Thyroid nodules 4 cm with benign FNAC should not undergo thyroidectomy as false negative rate is low. Therefore, the decision for surgery ought not to be taken based on the size of the nodule.

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