Complications after fine-needle aspiration cytology: a retrospective study of 7449 consecutive thyroid nodules

Cappelli, Carlo; Pirola, Ilenia; Agosti, Barbara; Tironi, Andrea; Gandossi, Elena; Incardona, Paolo; Marini, F; Guerini, Andrea Emanuele; Castellano, Maurizio

doi:10.1016/j.bjoms.2016.11.321

Cited by 56 publications

(37 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…FNA is a safe procedure that helps to distinguish benign from malignant thyroid nodules. Serious complications are rare, although pain and small hematomas can occur 124125. The main limitation of this diagnostic test is the indeterminate result found in around 20-30% of samples 126127…”

Section: Estimating the Risk Of Thyroid Cancer And Management After Tmentioning

confidence: 99%

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Ospina

Iñiguez-Ariza

Castro

2020

BMJ

View full text Add to dashboard Cite

Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient’s values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.

show abstract

Section: Estimating the Risk Of Thyroid Cancer And Management After Tmentioning

confidence: 99%

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Ospina

Iñiguez-Ariza

Castro

2020

BMJ

View full text Add to dashboard Cite

show abstract

“…FNA is currently the most simple, accurate, safe, and cost-effective method of identifying malignant thyroid nodules [4,7,13]. Unfortunately, 15% to 30% of aspirations yield in the "gray zone" of indeterminate findings in which malignancy cannot be excluded [14].…”

Section: Discussionmentioning

confidence: 99%

“…International guidelines clearly indicate which nodules should undergo fine needle aspiration cytology (FNA) [4][5][6]. FNA is clinically safe, cost-effective, minimally invasive, and has few complications [7]. Its limitations arise for nodules that are reported as showing indeterminate cytology (TIR3) because, even if at a relatively low rate, malignancy cannot be excluded.…”

Section: Introductionmentioning

confidence: 99%

Could Serum TSH Levels Predict Malignancy in Euthyroid Patients Affected by Thyroid Nodules with Indeterminate Cytology?

Cappelli

Pirola

Gandossi

et al. 2020

International Journal of Endocrinology

View full text Add to dashboard Cite

Background. Serum TSH levels in the upper-normal range were reported to be associated with increased risk of thyroid malignancy. However, measurement of TSH levels is currently not recommended for assessing the risk of malignancy in patients with newly diagnosed thyroid nodules. Objective. To evaluate a possible relationship between the serum levels of TSH and the histological outcome of patients undergoing thyroidectomy for thyroid nodules with indeterminate cytology. Materials and Methods. We collected the clinical data of all patients who had performed ultrasound-guided FNA of thyroid nodules with cytological diagnosis of indeterminate lesions (TIR3A and TIR3B) and serum TSH levels within the normal range. All patients had been submitted to thyroid surgery (hemi or thyroidectomy, as appropriate), and histological diagnosis had been performed. Results. A histological diagnosis of thyroid malignancy was rendered in 74/378 (19.6%) nodules. Patients with histologically proven thyroid malignancy were characterized by higher serum levels of TSH as compared to patients with histologically proven benign nodules (3.03 ± 1.16 vs. 2.37 ± 1.19 mIU/L, p<0.001). To further analyze the role of serum TSH in predicting thyroid cancer, patients were stratified in 4 groups according to quartiles of TSH concentrations. The prevalence of malignancy was 12.2% for the first quartile and 50.0% for the last quartile. ROC curve analysis identified that a serum TSH level of ≥2.7 mIU/L predicted thyroid malignancy with a sensitivity of 61% and a specificity of 65%. Conclusions. TSH levels in the upper-normal range are associated with an increased risk of thyroid malignancy in patients affected by thyroid nodules with indeterminate cytology at FNA. The measurement of serum TSH levels represents an easily performed additional tool for decision-making in patients with indeterminate cytological findings.

show abstract

“…Local pain and minor hematomas are the most common complications, but serious complications such as carotid intramural hematoma, tumor seeding, puncture of trachea or larynx, and dysphagia have been reported. 22 Therefore, in the selection of patients for FNA, the potential of 3D ultrasound to aid in differentiation of benign LNs from malignant LNs becomes important.…”

Section: Discussionmentioning

confidence: 99%

Virtual evaluation of selected cervical lymph nodes with three‐dimensional ultrasound in thyroid cancer patients after thyroidectomy

2018

View full text Add to dashboard Cite

Background We evaluated the usefulness of three‐dimensional (3D) ultrasound of cervical lymph nodes (LN), when two‐dimensional (2D) ultrasound evaluation is not sufficient to clearly evaluate lymph node characteristics, in thyroid cancer patients being followed after thyroidectomy. Methods Two readers retrospectively analyzed 2D and 3D images of 147 LNs; LNs were categorized as normal, reactive, suspicious, or indeterminate, and confidence level was rated. Results were compared to cytological/clinical data. Inter‐reader agreement was calculated. Results Addition of 3D ultrasound significantly increased specificity (0.787 with 2D ultrasound vs 0.905 with 2D + 3D ultrasound for reader 1, P = .009; 0.701 with 2D ultrasound vs 0.898 with 2D + 3D ultrasound for reader 2, P = .01). Addition of 3D ultrasound significantly increased confidence level of readers (P < .001). Inter‐reader agreement in LN categorization was almost perfect with 2D + 3D ultrasound. Conclusion 3D ultrasound of cervical LNs enables better demonstration of imaging features that are important in differentiating benign and malignant LNs. These improvements can potentially obviate the need for FNA in post thyroidectomy cancer patients.

show abstract

Complications after fine-needle aspiration cytology: a retrospective study of 7449 consecutive thyroid nodules

Cited by 56 publications

References 27 publications

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Could Serum TSH Levels Predict Malignancy in Euthyroid Patients Affected by Thyroid Nodules with Indeterminate Cytology?

Virtual evaluation of selected cervical lymph nodes with three‐dimensional ultrasound in thyroid cancer patients after thyroidectomy

Contact Info

Product

Resources

About