Discordance Between Cytologic Results in Multiple Thyroid Nodules Within the Same Patient

Levenson, Jonathan N.; Santaella, Idalia; Wachtel, Mitchell S.; Levenson, David I.

doi:10.1159/000325231

Cited by 7 publications

(7 citation statements)

References 29 publications

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“…The current study was performed to determine how many nodules need to be biopsied in a patient with multiple thyroid nodules. Currently, there are conflicting data regarding whether these additional nodules have a lower or higher rate of malignancy, and whether the risk of malignancy in these additional nodules is independent of the number of nodules (and hence all nodules need to be aspirated) or whether the risk of malignancy declines with additional nodules aspirated and at some point approaches the risk of a benign aspirate …”

Section: Discussionmentioning

confidence: 99%

“…November 2017 malignancy in these additional nodules is independent of the number of nodules (and hence all nodules need to be aspirated) 6,8,11,13 or whether the risk of malignancy declines with additional nodules aspirated and at some point approaches the risk of a benign aspirate. 7,10 To the best of our knowledge, the current study, which included 63 patients in whom at least 4 nodules were biopsied, is the largest series published to date.…”

Section: Cancer Cytopathologymentioning

confidence: 99%

“…Fine‐needle aspiration of thyroid nodules is becoming more frequent, and often involves aspiration of >1 nodule . Although there is disagreement regarding whether the risk of malignancy is higher in solitary nodules, multiple nodules, or the same, there is a high rate of discordance reported between the histology of multiple nodules, and multiple nodules can be malignant . Some studies have suggested that the risk of malignancy is independent of the number of nodules, whereas others suggest that the dominant nodule is most likely to be malignant and the rate of malignancy may decrease when >2 nodules are present, perhaps because these additional nodules are smaller .…”

Section: Introductionmentioning

confidence: 99%

“…Some studies have suggested that the risk of malignancy is independent of the number of nodules, whereas others suggest that the dominant nodule is most likely to be malignant and the rate of malignancy may decrease when >2 nodules are present, perhaps because these additional nodules are smaller . As a result, recommendations regarding how many nodules to sample vary, and range from sampling all nodules that meet criteria for aspiration or up to 4 nodules because sampling only 2 nodules may miss approximately 33% to 42% of malignancies . The 2015 American Thyroid Association Management Guidelines for fine‐needle aspiration of the thyroid state that “each nodule >1 cm carries an independent risk of malignancy,” and suggest that all nodules with sufficiently worrisome clinical characteristics should be biopsied.…”

Section: Introductionmentioning

confidence: 99%

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Adequate sampling of multiple thyroid nodules by fine‐needle aspiration

Renshaw

Gould

2017

Cancer Cytopathology

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BACKGROUND Recommendations regarding how many nodules to biopsy with thyroid fine‐needle aspiration vary. METHODS The authors reviewed fine‐needle aspiration specimens of 12,763 nodules from 10,506 patients and correlated them with the number of nodules biopsied. RESULTS Compared with patients in whom only a single nodule was biopsied, patients in whom multiple nodules were biopsied were found to be significantly younger, more likely female, and to have larger tumors, and those tumors were more often papillary (all P<.001). On fine‐needle aspiration, patients who had multiple nodules biopsied were more often diagnosed with benign findings (P<.001), but usually had no significant difference in the risk of malignancy associated with any cytologic diagnosis. Performing biopsy in 3 nodules detected all carcinomas in the current series. Combining all cases in the literature demonstrated that performing only 3 biopsies in a patient with at least 4 suspicious nodules had a risk of malignancy of 1.2%. CONCLUSIONS Biopsy of 3 different nodules in patients with multiple nodules appears to lower the risk of malignancy to that of a benign fine‐needle aspiration specimen. Although exceptions can occur, cytologists may be able to improve the accuracy of their diagnoses by focusing predominantly on identifying papillary carcinoma after the first 2 nodules have been biopsied. Cancer Cytopathol 2017;125:848–53. © 2017 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Cancer Cytopathologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adequate sampling of multiple thyroid nodules by fine‐needle aspiration

Renshaw

Gould

2017

Cancer Cytopathology

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“…Tiroid ince iğne aspirasyonu (İİA), tiroid nodüllerini değerlendirmede ilk basamak testtir (1)(2)(3). Tiroid İİA, multinodüler guatr olgularında ultrasonografik olarak şüpheli nodüllerin tümüne ya da şüpheli nodül olmadığında dominant nodüle uygulanır (2,(4)(5)(6)(7)(8)(9)(10). Ancak rutinde aspirasyon yapılacak nodül sayısı ve nodül başına hazırlanan preparat sayısı örnekleme yapan kişiden kişiye değişkenlik gösterebilmektedir (11).…”

Section: Introductionunclassified

Ti̇roi̇d İnce İğne Aspi̇rasyonlarinda İncelenen Preparat Sayisi İle Tani Arasindaki̇ İli̇şki̇

Tan

İşisağ

2022

SDÜ Tıp Fakültesi Dergisi

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Objective: The first method used in the diagnosis of thyroid nodules is the Bethesda system, which is the most widely used system to evaluate aspiration. The adequacy of aspiration applied to symptomatic and asymptomatic nodules is important for appropriate follow-up and treatment of the patient. The aim of the study is to evaluate the relationship between the number of slides prepared from thyroid nodules and nodules sampled at the same time, and diagnostic efficiency. Material and Methods: 5092 aspirations from 3747 cases were included in the study. The age and gender of the cases, the diameter of the nodules, the number of preparations, the number of nodules and the diagnosis of all nodules were noted. The number of preparations and the number of sampled nodules were categorized and their relationship with the diagnosis was examined. All data were analyzed using SPSS 20. Results: Of the aspirations, 3929 (77.2%) were female and 1163 (22.8%) were male patients, and the mean age was 52.3 (11-93 years). The diagnostic rate of aspirations examined with a single preparation was lower than multiple preparations (p=0.001). Suspicious group and malignant diagnoses were higher in those who were examined with multiple preparations, and the rate of benign diagnosis was higher in those who were examined with a single preparation (p=0.013). Considering the diagnostic categories, while benign diagnoses were more common in aspirations from multiple nodules, suspicious and malignant diagnoses were more common in single nodule aspirations. Conclusion: Ultrasonographic features of the nodule and the accuracy of the procedure directly affect the diagnosis. It has been concluded that aspiration from several areas of the nodule and the preparation of aspirations with two or more preparations compared to a single preparation are important both to increase the diagnosis and to increase the probability of suspicious and malignant diagnosis.

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Granulomatous Thyroiditis (de Quervain)

Nosé¹

2018

Diagnostic Pathology: Endocrine

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Discordance Between Cytologic Results in Multiple Thyroid Nodules Within the Same Patient

Cited by 7 publications

References 29 publications

Adequate sampling of multiple thyroid nodules by fine‐needle aspiration

Adequate sampling of multiple thyroid nodules by fine‐needle aspiration

Ti̇roi̇d İnce İğne Aspi̇rasyonlarinda İncelenen Preparat Sayisi İle Tani Arasindaki̇ İli̇şki̇

Granulomatous Thyroiditis (de Quervain)

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