Accuracy of ultrasonography-guided fine needle aspiration cytology and significance of non-diagnostic cytology in the preoperative detection of thyroid malignancy

Chieng, Julian Sau Lian; Lee, Chau Hung; Karandikar, Amit; Goh, Julian Park Nam; Tan, Susanna Soo See

doi:10.11622/smedj.2018105

Cited by 10 publications

(10 citation statements)

References 38 publications

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“…In this study, solidity, hypoechogenicity, irregular margins, taller-than-wide shape, microcalcifications and posterior echo attenuation associated with malignant nodules, whereas regular halo associated with benign nodules. Furthermore, taller-than-wide shape, microcalcifications, hypoechogenicity and irregular margins were independent risk factors for malignancy, consistent with the results of previous studies ( 15 , 18 , 39 , 40 , 41 ). Taller-than-wide shape is a highly specific indicator of thyroid cancer, with studies reporting a specificity of 81.5–98.5% for malignant thyroid nodules with a taller-than-wide shape ( 15 , 23 , 42 ).…”

Section: Discussionsupporting

confidence: 91%

The combination of ATA classification and FNA results can improve the diagnostic efficiency of malignant thyroid nodules

Wang

Zhu

et al. 2020

Endocrine Connections

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Purpose: To determine the diagnostic efficiency of the ATA classification and ultrasound-guided fine-needle aspiration (FNA) results in identifying the risk factors of malignancy, we analyzed the thyroid nodules of patients who underwent thyroidectomy and compared preoperative ATA classifications with FNA results. Methods: We retrospectively analyzed 274 nodules of 196 patients who underwent ultrasonography, FNA and thyroidectomy. Histopathological findings of thyroid nodules were considered as the gold standard in the analysis of the diagnostic efficiency of the ATA classification and FNA results. Univariate analysis and binary multivariate logistic regression analysis were applied to identify the ultrasound features associated with malignancy. Results: The overall malignancy rate of 274 nodules was 41.6%. The areas under the ROC curves (AUCs) for the ATA classification and FNA results were 0.88 and 0.878, respectively (P<0.001). The sensitivity and specificity of the ATA classification were 86% and 86.9%, whereas those of FNA results were 68.5% and 91.4%, respectively. The specificity (98.7%) and sensitivity (94.3%) increased after the combined use of the ATA classification and FNA results. Taller-than-wide shape, microcalcifications, hypoechogenicity and irregular margins were independent risk factors for malignancy. Microcalcifications had the highest OR (7.58), and taller-than-wide shape had the highest specificity in BSRTC I, II, III and IV cytologies. Conclusion: The diagnostic efficiency of the ATA classification and FNA results in identifying malignant nodules was high, and the use of both criteria improved the diagnostic accuracy. Taller-than-wide shape, microcalcifications, hypoechogenicity and irregular margins were independent risk factors for malignancy.

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Section: Discussionsupporting

confidence: 91%

The combination of ATA classification and FNA results can improve the diagnostic efficiency of malignant thyroid nodules

Wang

Zhu

et al. 2020

Endocrine Connections

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“…A study showed that the sensitivity, speci city, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of FNA were 96.9%, 81.7%, 73.8%, 98%, and 86.9%, respectively [36]. In the study of Chieng J et al, FNAC predicted malignancy with a sensitivity, speci city, PPV, NPV, false positive rate, false negative rate and total accuracy of 90.7%, 53.6%, 43.3%, 93.7%, 46.4%, 9.3% and 64.1%, respectively [37]. However, FNAC is considered to be "uninterpretable" in 10 to 20% of cases or simply "suspicious" in 9 to 38% of cases [38].In addition, it is currently estimated that cytologically indeterminate results are diagnosed in up to 25% to 30% of thyroid biopsies [39,40].Therefore, the use of molecular markers is important for improving diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 96%

Evaluation of peripheral blood E2F3 mRNA as a potential diagnostic biomarker in human papillary thyroid cancer

Zhao¹,

Zhao²,

Wu³

et al. 2020

Preprint

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Background: The transcription factor E2F3 plays a vital role in regulating cell cycle progression and proliferation. In addition, many reports have shown that E2F3 exerts an oncogenic role in various cancers and is a promising therapeutic target for the treatment of some human cancers. However, the value of E2F3 in the molecular diagnosis and prognosis evaluation of papillary thyroid cancer (PTC) has rarely been reported. The aim of this study was to evaluate the clinical signiﬁcance of E2F3 in the early diagnosis and monitoring of PTC.Materials and methods: Peripheral blood samples from 20 patients with PTC, 20 patients with benign thyroid lesions and 20 normal controls were collected. Peripheral blood E2F3 mRNA and thyroid sample E2F3 mRNA expression were detected by quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). The expression of E2F3 protein in normal thyroid tissue and thyroid tissue from benign thyroid lesions and PTC were detected by immunohistochemistry. The optimal cut-off value for differentiating PTC was obtained by using receiver operating characteristic (ROC) curve analysis.Results: E2F3 mRNA expression levels in peripheral blood and thyroid samples were significantly higher in PTC patients than in patients with benign thyroid lesions and normal subjects (P<0.05). Moreover, benign hyperplasia had higher E2F3 expression than normal tissue (P<0.01).There was no significant association between the level of E2F3 mRNA and aggressive clinicopathologic features of PTC, including TNM staging, extrathyroidal invasion, multifocality, and lymph node metastasis (P>0.05).With a cut-off value of 2.3, blood E2F3 mRNA showed 90% sensitivity, 60.9% specificity, a 70.5% positive predictive value, an 85.47% negative predictive value and 74.4% accuracy for discriminating PTC from benign hyperplasia disease of the thyroid and normal tissue. In addition, immunohistochemical results showed that E2F3 protein expression was also higher in the PTC group than in the other groups.Conclusions: The highest expression of E2F3 was found in peripheral blood and thyroid tissue of PTC patients. Moreover, blood E2F3 mRNA can be considered a promising diagnostic marker for discriminating PTC from benign thyroid diseases.

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“…The sensitivity of FNAC varies in literature between 55% and 95% and our value is on the lower end of the spectrum. [8,10,11,19,20] The variation exists due to the different methods of calculation of these variables in different studies. The discrepancy arises mostly in the categorizing of Bethesda 3 (AUS) and Bethesda 4 (follicular neoplasm) into benign or malignant categories.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of fine-needle aspiration cytology for detecting cancer in resected thyroid nodules at a referral hospital

Akmal

Alawadhi²,

Matalkah

et al. 2021

Journal of Diabetes and Endocrine Practice

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Background: Thyroid nodules are a common presentation in clinical practice. Fine-needle aspiration cytology (FNAC) is a useful method of triaging patients between benign, suspicious, and malignant categories. Materials and Methods: This is a retrospective review of the electronic medical record of all surgical thyroid patients presenting to our institution between July 2015 and June 2017. The cytological and histological data were reviewed and correlated based on the Bethesda system for reporting thyroid cytopathology. Results: Two hundred and seven patients underwent thyroidectomies during that period of which 164 had preoperative FNAC. The female-male ratio of 4.9:1. On histology, 52% of nodules were benign and 48% of nodules were malignant. When comparing with cytologic diagnosis, FNAC showed a sensitivity of 52%, specificity of 95%, positive predictive value of 92%, negative predictive value of 64%, false positive rate 5%, and false negative rate 48%. Total accuracy was found to be 72%. Conclusion: FNAC is a useful tool in deciding management options for patients, but has limitations, particularly when evaluating follicular lesions. This leads to discrepancy in the calculation of statistical values in literature.

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Accuracy of ultrasonography-guided fine needle aspiration cytology and significance of non-diagnostic cytology in the preoperative detection of thyroid malignancy

Abstract: The accuracy of ultrasonography-guided FNAC at our institution was comparable to that reported in the literature. There appears to be very low probability of malignancy in sonographically benign nodules with initial non-diagnostic FNAC results.

Cited by 10 publications

References 38 publications

The combination of ATA classification and FNA results can improve the diagnostic efficiency of malignant thyroid nodules

The combination of ATA classification and FNA results can improve the diagnostic efficiency of malignant thyroid nodules

Evaluation of peripheral blood E2F3 mRNA as a potential diagnostic biomarker in human papillary thyroid cancer

Accuracy of fine-needle aspiration cytology for detecting cancer in resected thyroid nodules at a referral hospital

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