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>

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.

Effects of fine-needle aspiration on the US appearance of the breast.

Radiology ◽  
1992 ◽  
Vol 185 (3) ◽  
pp. 709-711 ◽  
Author(s):  
W E Svensson ◽  
E Tohno ◽  
D O Cosgrove ◽  
T J Powles ◽  
B al Murrani ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Fine Needle ◽  
The Us

Rotterdam Criteria for Sentinel Node (SN) Tumor Burden and the Accuracy of Ultrasound (US) -Guided Fine-Needle Aspiration Cytology (FNAC): Can US-Guided FNAC Replace SN Staging in Patients With Melanoma?

2009 ◽  
Vol 27 (30) ◽  
pp. 4994-5000 ◽  
Author(s):  
Christiane A. Voit ◽  
Alexander C.J. van Akkooi ◽  
Gregor Schäfer-Hesterberg ◽  
Alfred Schoengen ◽  
Paul I.M. Schmitz ◽  
...  
Keyword(s):  
Sentinel Node ◽  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Fine Needle Aspiration Cytology ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
The Us ◽  
Needle Aspiration Cytology ◽  
Positive Results

Purpose Sentinel node (SN) status is the most important prognostic factor for overall survival (OS) for patients with stage I/II melanoma, and the role of the SN procedure as a staging procedure has long been established. However, a less invasive procedure, such as ultrasound (US) -guided fine-needle aspiration cytology (FNAC), would be preferred. The aim of this study was to evaluate the accuracy of US-guided FNAC and compare the results with histology after SN surgery was performed in all patients. Patients and Methods Four hundred consecutive patients who underwent lymphoscintigraphy subsequently underwent a US examination before the SN procedure. When the US examination showed a suspicious or malignant pattern, patients underwent an FNAC. Median Breslow thickness was 1.8 mm; mean follow-up was 42 months (range, 4 to 82 months). We considered the US-guided FNAC positive if either US and/or FNAC were positive. If US was suggestive of abnormality, but FNAC was negative, the US-guided FNAC was considered negative. Results US-guided FNAC identified 51 (65%) of 79 SN metastases. Specificity was 99% (317 of 321), with a positive predictive value of 93% and negative predictive value of 92%. SN-positive identification rate by US-guided FNAC increased from 40% in stage pT1a/b disease to 79% in stage pT4a/b disease. US-guided FNAC detected SN tumors more than 1.0 mm in 86% of cases, SN tumors of 0.1 to 1.0 mm in 46% of cases, and SN tumors less than 0.1 mm in 23% of cases. Estimated 5-year OS rates were 92% for patients with negative US-guided FNAC results and 51% for patients with positive results. Conclusion US-guided FNAC of SNs is highly accurate. Up to 65% of the patients with SN-positive results in our institution could have been spared an SN procedure.

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.

Time and Cost of Ultrasound-Guided Fine-Needle Aspiration Biopsy/Core-Needle Biopsy for Primary Laryngohypopharyngeal Squamous Cell Carcinoma

2020 ◽  
pp. 019459982094595
Author(s):  
Dongbin Ahn ◽  
Gil Joon Lee ◽  
Jin Ho Sohn
Keyword(s):  
Squamous Cell Carcinoma ◽  
Fine Needle Aspiration ◽  
Needle Biopsy ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Core Needle ◽  
Fine Needle ◽  
Biopsy Core ◽  
The Us

Objectives This study aimed to evaluate benefits in terms of time and cost of percutaneous ultrasound-guided fine-needle aspiration biopsy/core-needle biopsy (US-FNAB/CNB) for the diagnosis of primary laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC) in comparison with direct laryngoscopic biopsy (DLB) under general anesthesia. Study Design Retrospective case-control study. Setting Single operator of a single center. Subjects and Methods From 2018 to 2019, 28 patients who underwent percutaneous US-FNAB/CNB for the diagnosis of untreated LHSCC were enrolled. All US-FNAB/CNBs were performed in the outpatient department by a single head and neck surgeon. Their results were compared with those of 27 patients who underwent DLB under general anesthesia. Results No major complications occurred in the US-FNAB/CNB and DLB groups. Time to biopsy, time to pathologic diagnosis, and time to treatment initiation in the US-FNAB/CNB and DLB groups were 0 and 14 days ( P < .001), 7 and 20 days ( P < .001), and 24 and 35 days ( P = .001), respectively. Procedure-related costs were $368.5 and $981.0 in the US-FNAB/CNB and DLB groups ( P < .001). Conclusions US-FNAB/CNB offers true benefits in terms of time and cost over those given by conventional DLB for diagnosis of LHSCC in indicated patients.

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.

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