Is a five-category reporting scheme for thyroid fine needle aspiration cytology accurate? Experience of over 18 000 FNAs reported at the same institution during 1998-2007

Piana, Simonetta; Frasoldati, Andrea; Ferrari, Marisa; Valcavi, Roberto; Froio, Elisabetta; Barbieri, Verter; Pedroni, Corrado; Gardini, Giorgio

doi:10.1111/j.1365-2303.2010.00777.x

Cited by 51 publications

(40 citation statements)

References 69 publications

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“…[16][17][18] Thus, Theoharis et al 16 studied its diagnostic accuracy on a cohort of more than 3200 thyroid FNAs: 11.1% of the thyroid nodules were deemed unsatisfactory, 73.8% benign, 3% indeterminate (AUS/FLUS), 5.5% follicular neoplasm, 1.3% suspicious for malignancy, and 5.2% positive for malignancy, supporting the use of the 6-tier diagnostic approach. Although it has been argued that the AUS/FLUS category should be better defined to avoid becoming a "waste basket" diagnostic category, [19][20][21] we feel that its judicious use meets the needs advocated by the Bethesda system. 12,18 Obviously, standardized reporting with specific categories should not be intended as a substitute for the interpretation of cytologic data, since numbers alone cannot and should not be used to replace a diagnostic analysis or to reduce the need for clinicopathologic correlation.…”

Section: Preoperative Thyroid Cytologymentioning

confidence: 88%

Fine-Needle Aspiration and Intraoperative Consultation in Thyroid Pathology: When and How?

Tallini

Gallo

2011

Int J Surg Pathol

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Fine-needle aspiration (FNA) and frozen section evaluation are traditional components of the management of thyroid lesions. Their role and usefulness are dictated by some basic facts about thyroid pathology: (a) nodules are very common; (b) they are benign in the majority of cases; and (c) the diagnosis of malignancy is primarily based on cytologic features in the case of papillary carcinoma, and on the presence of invasion of the tumor capsule or of blood vessels in the case of follicular carcinoma. The common occurrence of benign thyroid nodules mandates a cost-effective effective method for preoperative screening. Since, as already stated, the diagnosis of papillary thyroid carcinoma (by far the most common thyroid malignancy) is based on the identification of characteristic cytologic features, FNA has easily emerged in the past 30 years as the most accurate and cost-effective tool-indeed a true cornerstone-for the preoperative management of thyroid nodules. Standardized terminology to report cytologic diagnoses is highly recommended and is being implemented worldwide. Conversely, the importance of intraoperative frozen section diagnosis has been constantly decreasing over the past years, as a direct consequence of the widespread application of FNA. It may, however, be very useful in cases that are suspicious for papillary carcinoma on FNA and in selected cases with an indeterminate cytologic diagnosis.

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Section: Preoperative Thyroid Cytologymentioning

confidence: 88%

Fine-Needle Aspiration and Intraoperative Consultation in Thyroid Pathology: When and How?

Tallini

Gallo

2011

Int J Surg Pathol

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“…Transient hyperthyroidism and late hypothyroidism are likewise rare (103). No pathological changes have been found in tissue adjacent to the ablated area in patients who subsequently underwent surgery (95,106). The low risk of major complications (about 1%) and the high tolerability of LAT have been confirmed in a recent multicentre study (105).…”

Section: Laser Ablationmentioning

confidence: 94%

DIAGNOSIS OF ENDOCRINE DISEASE: Thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications

Papini

Pacella

Hegedűs

2014

European Journal of Endocrinology

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In patients with thyroid nodules, ultrasound (US) imaging represents an indispensable tool for assessment of the risk of malignancy. Over approximately four decades, innovative technology and successive improvements have facilitated its entry into the routine management and greatly improved its predictive value. When US features cannot reliably rule out thyroid cancer, US guidance allows a correct and safe sampling also of small or deeply located thyroid lesions. Obtained in this way, cytological or microhistological specimens may reliably define the nature of most thyroid nodules, and the information from histochemical or molecular markers shows promise in the classification of the remaining indeterminate cases. While a prompt surgical treatment can be offered in the minority of suspicious or definitely malignant cases, most individuals warrant only a follow-up. However, at initial evaluation, or over the years, a fraction of these benign lesions may grow and/or become symptomatic. Such cases may benefit from US-guided minimally invasive procedures as an alternative to surgery. Image-guided percutaneous treatments most often achieve relief of neck complaints, are inexpensive, and can be performed on an outpatient basis. The risk of major complications, after adequate training, is very low. Importantly, thyroid function is preserved. Currently, percutaneous ethanol injection for cystic lesions and thermal ablation, with laser or radiofrequency, for solid nodules are increasingly used and disseminated beyond the initial core facilities. In centres with expertise and high patient volume, their use should be considered as first-line treatment alternatives to surgery for selected patients with benign enlarging or symptomatic thyroid lesions.

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“…Some cytopathology experts claim that they can safely render indeterminate diagnoses much less often, but considering the potentially high number of false negative results (missed cancers) in operated cytologically benign nodules (4,17,18), there may be significant risk with very low cytology indeterminate rates, assuming the rate is lowered by moving many of these samples to the benign cytology category (24). Classification systems with one indeterminate cytology category have postulated that subdividing this category into subcategories at higher and lower risk could improve clinical care (25,26). The Bethesda system created three indeterminate categories: atypia or follicu-multicenter clinical trials investigating immunohistochemical markers are lacking (34).…”

Section: Application Of Immunohistochemistry To Fna Cytologymentioning

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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Is a five-category reporting scheme for thyroid fine needle aspiration cytology accurate? Experience of over 18 000 FNAs reported at the same institution during 1998-2007

Cited by 51 publications

References 69 publications

Fine-Needle Aspiration and Intraoperative Consultation in Thyroid Pathology: When and How?

Fine-Needle Aspiration and Intraoperative Consultation in Thyroid Pathology: When and How?

DIAGNOSIS OF ENDOCRINE DISEASE: Thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications

Molecular markers in the diagnosis of thyroid nodules

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