Review of a single institution's fine needle aspiration results for thyroid nodules: Initial observations and lessons for the future

Ronen, Ohad; Cohen, Hector; Abu, Mor

doi:10.1111/cyt.12739

Cited by 13 publications

(16 citation statements)

References 37 publications

(81 reference statements)

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“…BSRTC V had a 91.3% malignancy rate, much higher than the 50%‐75% or 45%‐60% (if NIFPT is to be considered malignant, respectively) reported in the 2017 BSRTC. While some reports have supported this as a suggested rate, 21 others found a rate between 80% and 90%, 15,21,22 and others have supported our study's findings of a malignancy rate exceeding 90% 22,23 and even reaching 98.7% 23 . Possible causes for the variability in the malignancy rate differences may be pathologist preferences and known interobserver variability 24 .…”

Section: Discussionsupporting

confidence: 81%

Outcomes of the Bethesda system for reporting thyroid cytopathology: Real‐life experience

Avior

Dagan

Shochat

et al. 2020

Clinical Endocrinology

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Objective The 2017 revised Bethesda System for Reporting Thyroid Cytopathology (BSRTC) included new malignancy rates for each category as well as new management recommendations. Here, we evaluate the malignancy rate and test performance for BSRTC categories in a middle‐sized institution outside the United States (US). Design Retrospective single centre case series with chart review. Patients All patients who underwent thyroid surgery with a preoperative BSRTC between the years 2010 and 2018 at our institution. Measurements In order to assess the malignancy rate for each BSRTC, all medical records were reviewed to collect demographics, nodule's size, BSRTC and final pathology. Results Three hundred and sixty‐four patients were included, with an overall malignancy rate of 34.3%. The malignancy rate for BSRTC categories I‐VI was as follows: 13.3%, 5.1%, 25.0%, 24.4%, 91.3% and 95.2%, respectively. The most sensitive test was when BSRTC III‐VI were evaluated (91%). Overall best performance (sensitivity, specificity, PPV, NPV and accuracy) was obtained when BSRTC V‐VI were grouped together with a substantial decrease when adding BSRTC III‐IV (90%, 97%, 94%, 95%, 95% vs, respectively, 91%, 73%, 62%, 95%, 79%, respectively). Conclusions Despite differences from the reported 2017 BSRTC malignancy rates, we demonstrated that the revised 2017 BSRTC management recommendations for thyroid nodules are also valid in smaller non‐US centre, supporting its use globally.

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Section: Discussionsupporting

confidence: 81%

Outcomes of the Bethesda system for reporting thyroid cytopathology: Real‐life experience

Avior

Dagan

Shochat

et al. 2020

Clinical Endocrinology

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“…Based on the presented findings, routine GSC testing in the UK, Australia, USA and Israel is the preferred strategy when malignancy rates are below 22.6%‐37.1%, depending on the country in which the test is performed. Therefore, it is cost effective for nodules with Bethesda classification of AUS/FLUS, and perhaps for nodules of Bethesda category IV, that harbour higher ROM 17,19,28 . Regardless of cost considerations, molecular testing of indeterminate thyroid nodules reduces the number of surgical resections, thereby reducing complication rates.…”

Section: Discussionmentioning

confidence: 99%

“…Patients considered for an upfront total thyroidectomy, such as in cases of suspicious nodules in the contralateral lobe, nodules larger than 4 cm, extracapsular finding on preoperative ultrasound and previous exposure to radiation, were not included 16 . Malignancy rates were determined according to published data 17‐19 . In order to simplify the tree model, the following assumptions were made, similar to the model by Wu et al 9 All patients with GSC suspicious nodules, as well as all thyroid nodules of indeterminate significance that did not undergo molecular testing, were assumed to be referred for diagnostic thyroid lobectomy.…”

Section: Methodsmentioning

confidence: 99%

National differences in cost analysis of Afirma Genomic sequencing classifier

Ronen

Oichman

2021

Clinical Endocrinology

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Context Thyroid nodules of indeterminate cytology can be subjected to molecular testing such as the Afirma Genomic Sequencing Classifier (GSC), thereby minimizing the number of unnecessary diagnostic surgeries. Objective This work aimed to evaluate and compare the cost of routine GSC testing of indeterminate thyroid nodules in different countries. Design, Patients and Main Outcome Measures The cost of diagnostic hemithyroidectomy of indeterminate thyroid nodules was calculated by performing a Monte Carlo simulation cost analysis on a Markov decision‐analytic model and then compared to that of GSC testing in the UK, Australia, USA, and Israel. Results Assuming that patients are treated by surgical resection and routine GSC testing is performed for all nodules of indeterminate significance, we found the GSC test to be more cost effective compared with diagnostic hemithyroidectomy when malignancy rates of thyroid nodules are less than 22.6%‐37.1%, depending on the country where the test is performed. Given the cost of a thyroidectomy in the UK, Australia and Israel, performing routine GSC tests on all Bethesda IV nodules is more expensive than routine diagnostic hemithyroidectomy and becomes cost effective for Bethesda III when the GSC cost is below 3,031‐3,087 USD. In comparison, in the USA, higher cost of thyroidectomy makes the GSC test cost effective for Bethesda III nodules at its current cost, but not for Bethesda IV nodules where it becomes cost effective under the price of 3,031 USD. Conclusions Different molecular testing and surgical costs in different countries should be considered when performing cost analysis. In addition, since different medical centres have different malignancy rates, personalized in‐house assessment of cost‐effectiveness is warranted.

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“…Therefore, US needs to be performed by trained radiologists with thyroid expertise to improve pre-operative assessment of thyroid nodules and better assess the need for FNAC, as unnecessary FNAC can lead to diagnosis difficulties and avoidable surgeries. Moreover, FNAC has a high sensitivity for thyroid cancer diagnosis, at around 94–97%, but a poor specificity and positive predictive value, with both estimated to be approximately 50% [ 13 , 48 ]. This could partly explain the low thyroid cancer prevalence (30 to 40%) often observed among operated patients who have had a FNAC prior to surgery [ 13 , 36 , 48 , 49 , 50 ], a result concordant with the result observed herein.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, FNAC has a high sensitivity for thyroid cancer diagnosis, at around 94–97%, but a poor specificity and positive predictive value, with both estimated to be approximately 50% [ 13 , 48 ]. This could partly explain the low thyroid cancer prevalence (30 to 40%) often observed among operated patients who have had a FNAC prior to surgery [ 13 , 36 , 48 , 49 , 50 ], a result concordant with the result observed herein. This low prevalence also likely reflects the heterogeneity of patients undergoing surgery, as some will be operated on for other reasons than a suspicious malignant nodule.…”

Section: Discussionmentioning

confidence: 99%

Influence of Care Pathway on Thyroid Nodule Surgery Relevance: A Historical Cohort Study

Castellnou

Lifante

Polazzi

et al. 2020

JCM

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Background: Guidelines recommend using fine-needle aspiration cytology (FNAC) to guide thyroid nodule surgical indication. However, the extent to which these guidelines are followed remains unclear. This study aimed to analyze the quality of the preoperative care pathway and to evaluate whether compliance with the recommended care pathway influenced the relevance of surgical indications. Methods: Nationwide historical cohort study based on data from a sample (1/97th) of French health insurance beneficiaries. Evaluation of the care pathway of adult patients operated on between 2012 and 2015 during the year preceding thyroid nodule surgery. The pathway containing only FNAC was called “FNAC”, the pathway including an endocrinology consultation (ENDO) with FNAC was called “FNAC+ENDO”, whereas the no FNAC pathway was called “NO FNAC”. The main outcome was the malignant nature of the nodule. Results: Among the 1080 patients included in the study, “FNAC+ENDO” was found in 197 (18.2%), “FNAC” in 207 (19.2%), and “NO FNAC” in 676 (62.6%) patients. Cancer diagnosis was recorded in 72 (36.5%) “FNAC+ENDO” patients and 66 (31.9%) “FNAC” patients, against 119 (17.6%) “NO FNAC” patients. As compared to “NO FNAC”, the “FNAC+ENDO” care pathway was associated with thyroid cancer diagnosis (OR 2.67, 1.88–3.81), as was “FNAC” (OR 2.09, 1.46–2.98). Surgeries performed in university hospitals were also associated with thyroid cancer diagnosis (OR 1.61, 1.19–2.17). Increasing the year for surgery was associated with optimal care pathway (2015 vs. 2012, OR 1.52, 1.06–2.18). Conclusions: The recommended care pathway was associated with more relevant surgical indications. While clinical guidelines were insufficiently followed, compliance improved over the years.

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Review of a single institution's fine needle aspiration results for thyroid nodules: Initial observations and lessons for the future

Cited by 13 publications

References 37 publications

Outcomes of the Bethesda system for reporting thyroid cytopathology: Real‐life experience

Outcomes of the Bethesda system for reporting thyroid cytopathology: Real‐life experience

National differences in cost analysis of Afirma Genomic sequencing classifier

Influence of Care Pathway on Thyroid Nodule Surgery Relevance: A Historical Cohort Study

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