Assessing The Risk of False-Negative Fine-Needle Aspiration Cytology and of Incidental Cancer in Nodular Goiter

Negro, Roberto; Piana, Simonetta; Ferrari, Marisa; Ragazzi, Moira; Gardini, Giorgio; Asioli, Sofia; Pacchioni, Donatella; Riganti, Fabrizio; Valcavi, Roberto

doi:10.4158/ep12271.or

Cited by 13 publications

(10 citation statements)

References 25 publications

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“…Authors concluded that the large nodule size should not be accepted as an indication for surgery alone. Our results were consistent with studies which suggested decreased sensitivity and increased false‐negative rate of FNAC in large nodules . The present study supports that the cancerous focus may be missed during the FNAC procedure in large nodules despite multiple aspirations.…”

Section: Discussionsupporting

confidence: 92%

“…A previous study of McCoy et al revealed that the falsenegative rate of FNAC was high in thyroid nodules greater than or equal to 4 cm in size and recommended surgery for large nodules regardless of FNAC results 23. Negro et al observed that the risk of false-negative FNAC increased with nodule size 24. In the study of Meko and Norton frequency of false-negative results has been reported to be as high as 30% in large-mixed echoic nodules 11.…”

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confidence: 99%

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The influence of thyroid nodule size on the diagnostic efficacy and accuracy of ultrasound guided fine‐needle aspiration cytology

Aydoğan

Şahi̇n

Ceyhan

et al. 2019

Diagnostic Cytopathology

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Background Diagnostic accuracy of fine‐needle aspiration cytology (FNAC) in large and subcentimeter nodules is still debated. We aimed to evaluate the impact of nodule size on efficacy of the ultrasound‐guided FNAC. Methods B‐mode grayscale ultrasound (US), US‐guided FNAC according to Bethesda system and histopathological data of 514 nodules from 371 patients, who underwent thyroidectomy were examined retrospectively. Nodules were grouped by maximal diameter; group A nodules were smaller than 10 mm (n = 59), group B nodules were between 10 and 29 mm (n = 218), and group C nodules were 30 mm or greater (n = 130). Results Sensitivity, specificity, and accuracy of FNAC was 92.0%, 100%, and 95.1% in group A, 80.7%, 99.1%, and %92.9 in group B, 70.0%, 98.9%, and 95.8% in group C nodules, respectively. The prevalence of papillary thyroid cancer (PTC) and incidental PTC were 44.2% (n = 164) and 6.4% (n = 24), respectively. Malignancy rate was more frequent in group A when compared to groups B and C (P < 0.01). Nodule size was positively associated with follicular cancer risk (P = 0.009). The thyroid stimulating hormone level was positively associated with malignancy (P = 0.02) and optimal cut‐off value was 0.96 mIU/L. False‐negative rate was 8.0%, 19.3%, and 30.0% in groups A, B, and C nodules, respectively. Conclusions Although the malignancy rate was low in nodules ≥30 mm, diagnostic surgery for large nodules should be considered because of decreased reliability of FNAC, ineffectiveness of clinical and sonographic criteria. False‐negative rate was relatively low and malignancy rate was high in subcentimeter nodules, supporting the accuracy of FNAC.

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

The influence of thyroid nodule size on the diagnostic efficacy and accuracy of ultrasound guided fine‐needle aspiration cytology

Aydoğan

Şahi̇n

Ceyhan

et al. 2019

Diagnostic Cytopathology

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“…The incidence of thyroid carcinomas in thyroidectomy specimens from patients with benign goitre varies between 4 and 31% [16,20,21,22,23,24,25,26,27,28,29,30,31,32]. The risk of developing thyroid carcinoma in longstanding untreated goitre has been addressed in some previous, rather old studies [10,15,16,17,19] and they report on an annual incidence of 1.3-3.7 new cases per 1,000 goitre patients.…”

Section: Discussionmentioning

confidence: 99%

A Conservative Approach Is Reasonable in Patients with Non-Toxic Goitre: Results from an Observational Study during 30 Years

Järhult

Vedad

2014

Eur Thyroid J

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Background: There is a lack of consensus in Europe regarding the management of patients with benign goitre. The object of this study was to find out the long-term results of recommending to patients with clinically and cytologically benign non-toxic goitres not to be operated. Methods: 980 patients were initially referred for surgical evaluation due to non-toxic goitre, 508 of whom underwent directly thyroidectomy. The remaining 473 patients (median age 56 years) were not operated and followed prospectively for a median period of 145 months. Results: During follow-up, 38% of the 473 patients were re-referred to the surgeon for a new evaluation due to different complaints, mainly growth of the goitre and/or worsening of local symptoms. 102 of the 473 patients (22%) had surgery and 27 (5.7%) developed thyrotoxicosis. 14 patients (3%) were diagnosed with thyroid carcinoma, 4 (0.46%) of whom (all elderly women) died of the disease. Conclusions: In patients with non-toxic goitre in whom surgery is not deemed necessary at initial evaluation, a conservative approach is reasonable. There is, however, a small risk for the development of aggressive carcinomas, and a fourth of the patients are operated at a median follow-up of 12 years.

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“…In conclusion, a 12.2% overall prevalence of ITCs was found in the present large series of 2045 consecutive patients subjected to thyroidectomy for benign thyroid diseases. A lower mean prevalence (9.3%) was found among the studies published to date on ITCs in benign thyroid diseases (Ugolini et al 2007, Bradly et al 2009, Barczyń ski et al 2011, Minuto et al 2013, Negro et al 2013. The extreme variability observed among the different series could be due to the relatively low number of cases enrolled (!1000 in 17 of 20 series).…”

mentioning

confidence: 88%

“…The prevalence of ITCs reported in the 20 papers of the literature is extremely variable (3.3-21.6%), mostly due to the relatively low number of cases included (Ugolini et al 2007, Bradly et al 2009, Barczyń ski et al 2011, Minuto et al 2013, Negro et al 2013, and scanty molecular data are available (Ugolini et al 2007). A more accurate estimation of the actual prevalence of ITCs is of particular importance for the preoperative counseling of patients undergoing thyroidectomy for a supposed benign disease.…”

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confidence: 99%

Clinical and molecular analyses of thyroid cancer in patients treated for benign diseases

Leo¹,

Perrino²,

Badiali³

et al. 2013

Endocrine-Related Cancer

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Assessing The Risk of False-Negative Fine-Needle Aspiration Cytology and of Incidental Cancer in Nodular Goiter

Cited by 13 publications

References 25 publications

The influence of thyroid nodule size on the diagnostic efficacy and accuracy of ultrasound guided fine‐needle aspiration cytology

The influence of thyroid nodule size on the diagnostic efficacy and accuracy of ultrasound guided fine‐needle aspiration cytology

A Conservative Approach Is Reasonable in Patients with Non-Toxic Goitre: Results from an Observational Study during 30 Years

Clinical and molecular analyses of thyroid cancer in patients treated for benign diseases

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