Second opinion in thyroid fine-needle aspiration biopsy by the Bethesda system

Park, Jae Hyun; Kim, Hyun Ki; Kang, Sang‐Wook; Jeong, Jong Ju; Nam, Kee‐Hyun; Chung, Woong-Youn; Park, Cheong Soo

doi:10.1507/endocrj.ej11-0274

Cited by 21 publications

(46 citation statements)

References 25 publications

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“…The rate of a false-negative diagnosis by FNA cytology on accessory nodules was 15% and that by ultrasound on accessory nodules was 6.2%. When combining the results by FNA cytology and ultrasound examination, among the 126 accessory nodules that were read as benign by low volume was significantly associated with discordance in the second review reported by Olson et al [83][84]. Furthermore, fewer diagnostic categories, such as a 4-tier system, were proved to show less disagreement than the 6-tier system, as reported by Walts et al, Cibas et al and Piana et al [85][86][87].…”

Section: False-negative Results In Thyroid Fna Cytologymentioning

confidence: 85%

“…It was 18% by Tan et al before Bethesda system was introduced [82]. Using Bethesda system it was still high at 26.3% (394/1499 cases) by Park et al [83]. Park et al using Bethesda system elucidated that the disagreement was highest in AUS category at 89.7%, followed by suspicious for malignancy at 75.7%, follicular neoplasm at 70.2% and lowest in malignant category at 7.4%, and the clinical management was changed for 20.0% of those patients [83].…”

Section: Observer Variabilitymentioning

confidence: 99%

“…Many cytopathologists and cytotechnologists are concerned about the poor reproducibility in the subclassification of the indeterminate category and the subclassification of follicular neoplasm because, even among experts, significant interobserver and intraobserver variability has been pointed out [37,49,61,[82][83][84][85][86][87]. It was 18% by Tan et al before Bethesda system was introduced [82].…”

Section: Observer Variabilitymentioning

confidence: 99%

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Introducing the reporting system for thyroid fine-needle aspiration cytology according to the new guidelines of the Japan Thyroid Association [Review]

et al. 2014

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Abstract. The Japan Thyroid Association (JTA) recently published new guidelines for clinical management of thyroid nodules. This paper introduces their diagnostic system for reporting thyroid fine-needle aspiration cytology. There are two points where the new reporting system that differs from existing internationally-accepted ones. The first is the subclassification of the so-called indeterminate category, which is divided into 'follicular neoplasm' and 'others'. The second is the subclassification of follicular neoplasm into 'favor benign', 'borderline' and 'favor malignant'. It is characterized by self-explanatory terminologies as to histological type and probability of malignancy to establish further risk stratification as well as to facilitate communication between clinicians and cytopathologists. The different treatment strategies adopted for thyroid nodules is deeply influenced by the particular diagnostic system used for thyroid cytology. In Western countries all patients with follicular neoplasms are advised to have immediate diagnostic surgery while patients in Japan often undergo further risk stratification without immediate surgery. The JTA diagnostic system of reporting thyroid cytology is designed for further risk stratification of patients with indeterminate cytology. If a surgeon applies diagnostic lobectomy to all patients with follicular neoplasm unselectively, this subclassification of follicular neoplasm has no practical meaning and is unnecessary. Cytological risk stratification of follicular neoplasms is optional and cytopathologists can choose either a simple 6-tier system without stratification of follicular neoplasm or a complicated 8-tier system depending on their experience in thyroid cytology and clinical management.

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Section: False-negative Results In Thyroid Fna Cytologymentioning

confidence: 85%

Section: Observer Variabilitymentioning

confidence: 99%

Section: Observer Variabilitymentioning

confidence: 99%

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Introducing the reporting system for thyroid fine-needle aspiration cytology according to the new guidelines of the Japan Thyroid Association [Review]

et al. 2014

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“…However, the "Second Opinion Medical Network" often represents a multiconsult useful decision-support tool not only in order to achieve a re-evaluation of the patient's case with a consequent optimization of treatment and prognosis [1,8,[26][27][28], but also to avoid unnecessary surgery and costs [29][30][31][32][33]. It involves a wide panel of specialists (including skilled and trained biologists or biotechnologists who can technically support the clinicians) to which patients affected by different synchronous or metachronous diseases not adequately satisfied in terms of diagnosis and treatment can interview for a clinical update.…”

Section: The "Second Medical Opinion Network" In Histopathologymentioning

confidence: 99%

“…Park, et al [28] designed a study to determine the impact of secondary review of Thyroid Fine Needle Aspiration (FNA) biopsy on surgical management by assessing the frequency of discordant diagnoses. FNA biopsy, indeed, which is a rapid and cost-effective test, recommended as primary diagnostic approach of thyroid nodules, is a worldwide approved screening test to distinguishing neoplastic from non-neoplastic nodules and to select proper surgical cases.…”

Section: Economic Impact Of the "Second Opinion Medical Network"mentioning

confidence: 99%

The “Second Opinion Medical Network”

Palmieri¹

2017

Int J Pathol Clin Res

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The "Second Opinion Medical Network" is a consultation referral web and medical office system recruiting a wide panel of real-time available specialists, to whom any patient affected by any disease or syndrome and not satisfied with the diagnosis or therapy can apply for an individual clinical audit. Due to the physician-patient communication gap, most of the patients usually wander around the medical websites looking for proper answers to their health problems. However, this search often becomes compulsive and obsessive and frequently ambiguous and frustrating. Palmieri, et al. defines this borderline or even pathological behavior as the "Web Babel Syndrome"-psychological imbalance affecting young and elderly patients, often with multiple synchronous diseases receiving by their care givers heterogeneous and misleading informations or advices, as well as, confused, contradictory statements and prescriptions. To deal with this problem, the "Second Opinion Medical Network" aims to be a useful "problem-solving" support revisiting each conflictual diagnostic and therapeutic step and properly re-addressing tailored treatments and prognoses, preventing unnecessary investigations and unhelpful and expensive medical and surgical interventions.The aim of this editorial is to describe the role and benefits of such a medical network in our web connected health care system. KeywordsSecond opinion, Network, Surgery, Cancer, EconomyIn 2002, a survey of 4,530 people in Europe and USA showed that 32% of Europeans and 43% of Americans preferred to use health web sites, sponsored by BBC and Yahoo, for health information [3]. However, the internet sites are often lacking of adequate information concerning disease complications and aftercare [4]. This web-searching behaviour is often continuous, compulsory, somehow obsessive, leading to the "Web Babel Syndrome", defined as a physician-patient communication gap frequently occurring when the patient affected by multiple synchronous pathologies, feeds back heterogeneous and misleading informations and prescriptions with the risk to drop in a confusionary state [5][6][7][8].In 1999, the Institute of Medicine report cited fatal medical errors in some 40,000-98,000 Americans PER year [8] supporting once more the concept that a further consultation or specialistic second opinion may be useful antidote to lethal misdiagnosis [9].The term "second opinion" has been widely reported also in histology [10,11] and pathology (e.g. thyroid pathology) [12][13][14][15][16][17][18][19][20] where the diagnosis is often difficult, misunderstood and strongly based on the healthcare professionals' experience. It has been defined as a qualified, interdisciplinary medical opinion, based on medical evidence, of an experienced medical specialist or a team [21]. An effective and helpful second opinion strategy in various pathologies (e.g. oral pathology) is the use of smartphones and software applications, such as WhatsApp Messenger, a crossplatform mobile messaging application that allows the exchang...

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The value of second opinion in thyroid cytology: A review

Gerhard

Boerner

2014

Cancer Cytopathology

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BACKGROUND: Second-opinion diagnosis (SOD) on pathological material is an accepted practice before definitive therapy is considered for referred patients. The thyroid gland is an anatomical site prone to diagnostic disagreement between pathologists. We performed a review of the literature that addressed the role of interinstitutional SOD on thyroid fineneedle aspirations (FNAs). METHODS: Nine studies comprising second opinions on thyroid FNAs were selected. The parameters analyzed included: discordances between the initial diagnoses (IDs) and SODs; cytohistologic correlation; changes in the clinical management of the patients with thyroid nodules after SOD. The same parameters were applied to the "indeterminate" diagnostic category comprising cases initially reported as "atypia," "atypia of undetermined significance/follicular lesion of undetermined significance," "suspicious for a follicular neoplasm," "follicular neoplasm," "suspicious," and "suspicious for malignancy." RESULTS: A total of 7154 thyroid FNAs were retrieved, showing an overall discordance rate between ID and SOD of 28.6%. In general, SOD was better supported by clinical follow-up and histologi-

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Second opinion in thyroid fine-needle aspiration biopsy by the Bethesda system

Cited by 21 publications

References 25 publications

Introducing the reporting system for thyroid fine-needle aspiration cytology according to the new guidelines of the Japan Thyroid Association [Review]

Introducing the reporting system for thyroid fine-needle aspiration cytology according to the new guidelines of the Japan Thyroid Association [Review]

The “Second Opinion Medical Network”

The value of second opinion in thyroid cytology: A review

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