Fine-Needle Aspiration May Miss a Third of All Malignancy in Palpable Thyroid Nodules

Tee, Yoon Y; Lowe, Adrian J.; Brand, Caroline; Judson, Rodney

doi:10.1097/sla.0b013e3180f61adc

Cited by 179 publications

(133 citation statements)

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“…Even though sensitivity and specificity can be improved by combining these parameters, no single suspicious US feature is sufficiently sensitive or specific for diagnosing malignancy and the overall performance of US is not satisfactory [3][4][5][6]. Currently, fine needle aspiration cytology (FNAC) is the standard procedure to determine malignancy and is the method with the highest specificity (60-98 %), but with a varying sensitivity of 54-90 % [7]. However, FNAC is invasive and about 10-20 % of biopsies yield inadequate results and need repetition.…”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of acoustic radiation force impulse technology in the differentiation of thyroid nodules: accuracy and interobserver variability assessment

et al. 2014

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Purpose The aim of this study is to assess the diagnostic efficacy and interobserver agreement of acoustic radiation force impulse (ARFI) elasticity imaging in differentiating thyroid nodules. Methods In our study, 74 consecutive patients (52 females, 22 males; age range 27-77 years, mean: 41 years) with 82 thyroid nodules (60 benign nodules, and 22 malignant) were examined by two radiologists with different experience. Patients underwent either cytology using fine needle aspiration cytology or thyroid surgery. The diagnostic performance of the two operators at ARFI with sensitivity, specificity, positive predictive and negative predictive value, and ROC curves was estimated. Interreader variability between the two operators was defined using Cohen's k.Results According to receiver operating characteristics ROC curves (AUROC = 0.86 for observer 1; 0.81 for observer 2) sensitivity, specificity, PPV and NPV of reader 1 and 2 were respectively: 90, 75, 90.91 and 96.55 %; (cutoff value of shear wave: 2.455 m/s); 90, 72, 90 and 96.90 % (cut-off value shear wave: 2.365 m/s). Concordance between the two operators was good (k = 0.755). Conclusions This work is a feasibility study evaluating ARFI imaging. Its results suggest that ARFI imaging is a reproducible method which can be utilized with good diagnostic performance in the thyroid for discriminating benign and malignant nodules using the cut-off value of 2.455 m/s. However, larger studies are needed to validate this method.Keywords Acoustic radiation force impulse (ARFI) Á Elastography Á Benign thyroid nodules Á Malignant thyroid nodules Á Ultrasound Riassunto Scopo Lo scopo di questo studio è la valutazione della efficacia diagnostica e della concordanza inter-osservatore dell'imaging elastografico ARFI, per la differenziazione di noduli tiroidei. Metodo Nel nostro studio, 74 pazienti consecutivi (52 femmine, 22 maschi; range di età 22-77 anni, età media 41 anni) con 82 noduli tiroidei (60 noduli benigni e 22 maligni), sono stati esaminati da due radiologi con diverso livello di esperienza. I pazienti sono stati sottoposti o a citologia aspirativa con ago sottile (FNAC), o a chirurgia tiroidea. La performance diagnostica dei due operatori all' ARFI è stata stimata con la sensibilità, la specificità, il valore predittivo positivo (VPP) e negativo (VPN), attraverso le curve ROC (receiver operating characteristics). La variabilità inter-osservatore tra i due operatori, è stata definita usando la kappa di Cohen. (2014( ) 17:13-20 DOI 10.1007 Risultati Secondo le curve ROC (AUROC = 0.86 per il primo osservatore; 0.81 per il secondo osservatore) la sensibilità, la specificità, il VPP e il VPN per gli osservatori 1 e 2, erano rispettivamente: 90, 75, 90,91, e 96.55 %; (valore medio di shear wave: 2.455 m/s); 90, 72, 90 e 96.90 % (valore medio di shear wave: 2.365 m/s). La concordanza tra I due operatori era buona (k = 0.755). Conclusioni Questo lavoro è uno studio preliminare che valuta l'imaging elastografico con Acustic Radiation Force Impulse. I risultati sug...

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Section: Introductionmentioning

confidence: 99%

Prospective evaluation of acoustic radiation force impulse technology in the differentiation of thyroid nodules: accuracy and interobserver variability assessment

et al. 2014

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“…Fine needle aspiration biopsy (FNAB) plays an important role in diagnosing thyroid nodules with sensitivity 90% and specificity 74% (Tee et al, 2007;Cibas, 2010). Although cytology examination is a reliable diagnostic test; however, 10-40% FNAB specimens are diagnosed as indeterminate (Kato and Fahey, 2009; having the fact that approximately 44% of cytology results was indeterminate for malignant diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Surgical Perspective of T1799A BRAF Mutation Diagnostic Value in Papillary Thyroid Carcinoma

Brahma

Yulian

Ramli³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: Throughout Indonesia, thyroid cancer is one of the ten commonest malignancies, with papillary thyroid carcinoma (PTC) in our hospital accounting for about 60% of all thyroid nodules. Although fine needle aspiration biopsy (FNAB) is the most reliable diagnostic tool, some nodules are diagnosed as indeterminate and second surgery is common for PTC. The aim of this study was to establish the diagnostic value and feasibility of testing the BRAF T1799A mutation on FNA specimens for improving PTC diagnosis. Materials and Methods: This prospective study enrolled 95 patients with thyroid nodules and future surgery planned. Results of mutational status were compared with surgical pathology diagnosis. Results: Of the 70 cases included in the final analysis, 62.8% were PTC and the prevalence of BRAF mutation was 38.6%. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for BRAF mutation analysis were 36%, 100%, 100% and 48%, respectively. With other data findings, nodules with "onset less than 5 year" and "hard consistency" were proven as diagnostic determinants for BRAF mutation with a probability of 62.5%. This mutation was also a significant risk factor for extra-capsular extension. Conclusions: Molecular analysis of the BRAF T1799A mutation in FNAB specimens has high specificity and positive predictive value for PTC. It could be used in the selective patients with clinical characteristics to facilitate PTC diagnosis and for guidance regarding extent of thyroidectomy.

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“…Most published studies publish a false negative rate in the range of 1-10% (19,20,21). However all these included only surgically resected nodules in the calculation and therefore suffered from selection bias.…”

Section: Bsrtc Category 2: Benignmentioning

confidence: 99%

The Bethesda system for reporting thyroid cytopathology: Should Sri Lanka adopt it?

Silva

2013

Ceylon J Otolaryngology

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Fine needle aspiration (FNA) is a frontline investigation in the management of solitary thyroid nodules. It reduces unnecessary surgery in patients with benign nodules and helps to triage patients with malignant nodules for surgery. If FNA is to be clinically useful, the cytopathology report has to be unambiguous and should guide the referring physician to appropriate therapy. It is also essential for endocrinologists, physicians and surgeons to be familiar with the reporting format and terminology used. This article will describe the Bethesda system for reporting thyroid cytopathology (BSRTC), compare it with the existing system used in Sri Lanka and discuss why it should adopted in this country. DOI: http://dx.doi.org/10.4038/cjo.v3i1.5211 Ceylon Journal of Otolaryngology Vol.3(1) 2013 pp.9-14

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Fine-Needle Aspiration May Miss a Third of All Malignancy in Palpable Thyroid Nodules

Cited by 179 publications

References 40 publications

Prospective evaluation of acoustic radiation force impulse technology in the differentiation of thyroid nodules: accuracy and interobserver variability assessment

Prospective evaluation of acoustic radiation force impulse technology in the differentiation of thyroid nodules: accuracy and interobserver variability assessment

Surgical Perspective of T1799A BRAF Mutation Diagnostic Value in Papillary Thyroid Carcinoma

The Bethesda system for reporting thyroid cytopathology: Should Sri Lanka adopt it?

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