Core-Needle Biopsy Is More Useful Than Repeat Fine-Needle Aspiration in Thyroid Nodules Read as Nondiagnostic or Atypia of Undetermined Significance by the Bethesda System for Reporting Thyroid Cytopathology

Na, Dong Gyu; Kim, Ji-Hoon; Sung, Jin Yong; Baek, Jung Hwan; Jung, Kyeong Cheon; Lee, Hunkyung; Yoo, Hyunju

doi:10.1089/thy.2011.0185

Cited by 223 publications

(338 citation statements)

References 25 publications

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“…[7][8][9]19 These studies reported that the rate of inconclusive CNB results ranged between 0% and 26%. Recently, Hahn et al 5 demonstrated that US-CNB is beneficial for the diagnosis of thyroid nodules with inconclusive US-guided FNA results.…”

Section: Discussionmentioning

confidence: 99%

Modified Core Biopsy Technique to Increase Diagnostic Yields for Well-Circumscribed Indeterminate Thyroid Nodules: A Retrospective Analysis

Han¹,

Shin²,

Hahn³

et al. 2016

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The results of conventional core biopsy for some thyroid nodules with indeterminate cytology have still remained indeterminate. The aim of this study was to evaluate whether the ultrasonography-guided core needle biopsy technique containing the nodule, capsular portion, and surrounding parenchyma was more effective than a conventional method in enhancing diagnostic yield for circumscribed solid thyroid nodules without malignant sonographic features.

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Section: Discussionmentioning

confidence: 99%

Modified Core Biopsy Technique to Increase Diagnostic Yields for Well-Circumscribed Indeterminate Thyroid Nodules: A Retrospective Analysis

Han¹,

Shin²,

Hahn³

et al. 2016

AJNR Am J Neuroradiol

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“…Because US-guided CNB using a spring-activated biopsy needle has been reported safe and effective by Quinn et al, 23 several investigators have demonstrated the usefulness of CNB in diagnosing thyroid nodules with 90.3% (range, 78.5%-100%) sensitivity and 98.4% (range, 87%-100%) positive predictive value for thyroid malignancy. [18][19][20][24][25][26] Currently, the role of CNB has focused on the diagnosis of nodules with previously nondiagnostic results on FNA and, therefore, on preventing unnecessary diagnostic surgery. 19,24,25,27 For the diagnosis of a specific type of malignancy, however, CNB has also showed the possibility of superior diagnostic performance to that of FNA for thyroid lymphoma, anaplastic carcinoma, and metastasis in a small series of studies.…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20][24][25][26] Currently, the role of CNB has focused on the diagnosis of nodules with previously nondiagnostic results on FNA and, therefore, on preventing unnecessary diagnostic surgery. 19,24,25,27 For the diagnosis of a specific type of malignancy, however, CNB has also showed the possibility of superior diagnostic performance to that of FNA for thyroid lymphoma, anaplastic carcinoma, and metastasis in a small series of studies. 26,[28][29][30][31] The complication rate was reported to be Ͻ1% and was considered to be similar to that of FNA if an experienced clinician performed the procedure.…”

Section: Discussionmentioning

confidence: 99%

The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions

Baek

et al. 2015

AJNR Am J Neuroradiol

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“…In addition, some studies (28,31) [but not all (30,32)] suggest that the ROM in a benign FNA after an initial AUS/FLUS biopsy is of intermediate risk between the two categories (i.e. the second benign FNA cannot make the first AUS/FLUS FNA go away).…”

Section: Current Management Of Cytologically Benign Thyroid Fna Biopsiesmentioning

confidence: 99%

Molecular markers in the diagnosis of thyroid nodules

Ward

Kloos²

2013

Arq Bras Endocrinol Metab

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SUMMARYAn indeterminate thyroid nodule cytology result occurs about every sixth fine-needle aspiration. These indeterminate nodules harbor a 24% risk of malignancy (ROM); too high to ignore, but driving surgery where most nodules are benign. Molecular diagnostics have emerged to ideally avoid surgery when appropriate, and to trigger the correct therapeutic surgery when indicated, as opposed to an incomplete diagnostic surgery. No current molecular test offers both high sensitivity and high specificity. A molecular diagnostic test with high sensitivity (e.g. Afirma Gene Expression Classifier sensitivity 90%) offers a high Negative Predictive Value when the ROM is relatively low, such as < 30%. Only such tests can "rule-out" cancer. In this setting, a molecularly benign result suggests the same ROM as that of operated cytologically benign nodules (~6%). Thus, clinical observation can replace diagnostic surgery; increasing quality of life and decreasing medical costs. However, its low specificity cannot "rule-in" cancer as a suspicious result has a Positive Predictive Value (PPV) of ~40%, perhaps too low to routinely reflex to definitive cancer surgery. Conversely, high specificity tests (BRAF, RAS, PPAR/PAX-8, RET/PTC, PTEN) offer high PPV results, and only these tests can "rule-in" cancer. Here a positive molecular result warrants definitive therapeutic surgery. However, their low sensitivity cannot "rule-out" cancer and a negative molecular result cannot dissuade diagnostic surgery; limiting their cost-effectiveness. Whether or not there is a useful and cost-effective role to sequentially combine these approaches, or to modify existing approaches, is under investigation. Arq Bras Endocrinol Metab. 2013;57(2):89-97 Keywords Biopsy, fine-needle; DNA mutational analysis; gene expression; genomics; molecular diagnostic techniques SUMáRioResultados indeterminados na citologia de um nódulo tireoidiano ocorrem em cerca de um a cada seis punções aspirativas por agulha fina. Esses nódulos indeterminados apresentam risco de malignidade (RM) de cerca de 24%, um valor alto demais para ser ignorado e que leva à cirurgia em casos em que a maioria dos nódulos é benigna. O diagnóstico molecular é uma forma ideal de se evitar a cirurgia quando apropriado e de se levar ao correto procedimento cirúrgico terapêutico quando indicado, em oposição à cirurgia diagnóstica incompleta. Atualmente, não existem testes moleculares com alta sensibilidade e especificidade. Um teste molecular de alta sensibilidade (por exemplo, a sensibilidade do teste Afirma Gene Expression Classifier é de 90%) tem um alto Valor Preditivo Negativo quando o RM é relativamente baixo, por exemplo, < 30%. Apenas esses testes podem "excluir" o câncer. Nesse contexto, um resultado molecular benigno sugere o mesmo RM de nódulos com resultado benigno na citologia e operados (~6%). Assim, a observação clínica pode substituir a cirurgia diagnóstica, aumentando a qualidade de vida e diminuindo os custos médicos. Entretanto, a baixa especificidade não pode "incluir" o cân...

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Core-Needle Biopsy Is More Useful Than Repeat Fine-Needle Aspiration in Thyroid Nodules Read as Nondiagnostic or Atypia of Undetermined Significance by the Bethesda System for Reporting Thyroid Cytopathology

Cited by 223 publications

References 25 publications

Modified Core Biopsy Technique to Increase Diagnostic Yields for Well-Circumscribed Indeterminate Thyroid Nodules: A Retrospective Analysis

Modified Core Biopsy Technique to Increase Diagnostic Yields for Well-Circumscribed Indeterminate Thyroid Nodules: A Retrospective Analysis

The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions

Molecular markers in the diagnosis of thyroid nodules

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