Size and Ultrasound Features Affecting Results of Ultrasound‐Guided Fine‐Needle Aspiration of Thyroid Nodules

Dong, Yijie; Mao, MinJing; Zhan, Wei; Zhou, Jianqiao; Zhou, Wei; Yao, Jiejie; Hu, Yifei; Wang, Yan; Ye, Tingjun

doi:10.1002/jum.14472

Cited by 18 publications

(30 citation statements)

References 21 publications

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“…They found that diagnostic accuracy was best in nodules sized 5 to 10 mm in diameter, and the false negative rate increased with increasing nodule size (> 20 mm), and false positive highest in the smallest nodules (< 5 mm). However, the majority of these nodules were micronodules (mean size 10.8 +/-7.6 mm) [13]. Without information on ultrasound characteristics in this study, we were unable to determine whether size or cystic nodules influenced the ND rate.…”

Section: Non-diagnostic Rates By Procedural Volume and Rosementioning

confidence: 78%

Factors affecting thyroid nodule fine needle aspiration non‐diagnostic rates: a retrospective association study of 1975 thyroid biopsies

et al. 2021

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Background Thyroid nodules are common in clinical practice, and it is important to distinguish benign nodules, the vast majority, from malignant ones. Non-diagnostic (ND) samples have the potential to delay or mis-diagnose or lead to unnecessary surgeries, and it is important to examine what factors influence the ND rate. Prior literature has suggested that the impact of bedside cytology on ND rate is dependent on the initial adequacy rate, whereby higher ND rates benefit most from bedside cytology. We aim to compare the impact of bedside adequacy review between specialist groups who perform high volume thyroid biopsies with low initial ND rates. Methods We reviewed the cytopathology results of 1975 thyroid nodule FNAs performed between January 1, 2017 to December 31, 2017 in a multi-centre Canadian city, and the corresponding histopathology reports of 340 resected nodules. Descriptive variables were used to describe the data along with chi-squared testing and univariate logistic regression. Results The FNA biopsies were performed by three different speciality groups, which differed by procedural volume: radiology performed the most at 1171, pathology performed 655 and surgery performed 103. We could not define the operator for 45 of the nodules. The ND rate was lowest in the speciality groups with highest procedural volume, 3.4 % in pathology and 8.3 % in radiology, compared to 37.9 % in surgery (p < 0.001). Completion of bedside cytology rapid onsite evaluation (ROSE) significantly reduced the ND rate from 16.7 to 4.2 % for all samples (p < 0.001). When ROSE was compared with non-ROSE within a high procedural group (radiology), it further reduced the ND rate from 12.5 to 5.1 % (p < 0.001). Of the 340 resected nodules, 10.7 % (18) were in the ND category, of which 28 % (5/18) of these were found to be malignant (4 papillary carcinoma and 1 lymphoma). Conclusions The results from this study demonstrate that thyroid FNAs performed with bedside ROSE can significantly reduce the ND rate compared with non-ROSE, even in experienced groups with low initial ND rates. It is therefore imperative that care providers managing patients with thyroid nodules ensure that thyroid FNAs are referred to specialized individuals/groups who do high volume, and ideally with the use of bedside ROSE, whether provided by a cytotechnologist or a pathologist.

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Section: Non-diagnostic Rates By Procedural Volume and Rosementioning

confidence: 78%

Factors affecting thyroid nodule fine needle aspiration non‐diagnostic rates: a retrospective association study of 1975 thyroid biopsies

et al. 2021

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“…Ultrasound and elastography both showed higher sensitivity for nodules larger than 10 mm and higher specificity for nodules smaller than 10 mm . Small nodules (≤5 mm) may also cause false‐positive FNAB results, whereas large nodules (>20 mm) tend to produce false‐negative FNAB results . We examined nodules that were larger than 1.5 cm and smaller than 1.5 cm, and we could not find a relationship between nodule size and malignancy.…”

Section: Discussionmentioning

confidence: 93%

“…32 Small nodules (≤5 mm) may also cause false-positive FNAB results, whereas large nodules (>20 mm) tend to produce false-negative FNAB results. 33 We examined nodules that were larger than 1.5 cm and smaller than 1.5 cm, and we could not find a relationship between nodule size and malignancy. We avoided nodules larger than 40 mm, as well as pure cystic and rough calcified nodules because these nodules were difficult to evaluate accurately for the SR, as described in the literature.…”

Section: Discussionmentioning

confidence: 94%

Which Is the Best Reference Tissue for Strain Elastography in Predicting Malignancy in Thyroid Nodules, the Sternocleidomastoid Muscle or the Thyroid Parenchyma?

Görgülü

2019

J of Ultrasound Medicine

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Objectives This study aimed to compare 2 types of strain ratios (SRs) in thyroid nodules. Two reference points were used: the sternocleidomastoid (SCM) muscle and the thyroid parenchyma. Methods A total of 101 nodules in 83 patients were prospectively enrolled in the study. For the semiquantitative analysis, 2 types of SRs were used: SR1, the ratio of the SCM muscle strain to the thyroid nodule strain; and SR2, the ratio of the surrounding normal thyroid tissue strain to the thyroid nodule strain. For each nodule, the SR1 and SR2 elastographic values were calculated, and their averages were compared. Results Eighty‐one (80.2%) of 101 thyroid nodules were benign, and 20 (19.8%) were malignant. In both benign and malignant histopathologic types, the SR1 averages were significantly higher than the SR2 averages (P = .001; P < .001, respectively). Both the SR1 and SR2 values were found to be significantly successful in differentiating benign from malignant histopathologic types (P < .001 for both). The areas under the curve were then compared for the methods, and the difference was found to be statistically significant (P = .046). The diagnostic accuracy of the SR1 was superior to that of the SR2. Conclusions The SR1 and SR2 are effective adjunctive diagnostic tools for identifying malignant thyroid nodules. Using the SCM muscle as a reference point instead of thyroid tissue may be a more valuable way to measure SRs.

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“…Shows the overview of FNA findings in both groups with its final surgical pathology findings (P-FNA: palpation-guided FNA; US-FNA: ultrasound-guided FNA). the diagnostic accuracy of US-guided FNA based on size and US findings [26]. The authors suggested that patients with smaller nodule size (≤5 mm) are more likely to have falsepositive findings; while the chances of false-negative FNA findings is more with larger thyroid nodules (>20 mm) and remarkable US features.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of preoperative palpation- versus ultrasound-guided thyroid fine needle aspiration cytology: an observational study

Taha

Al-Thani

El‐Menyar

et al. 2020

Postgraduate Medicine

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Background: Thyroid fine needle aspiration (FNA) is the mainstay for diagnosis of malignancy, and is an integral part of current thyroid nodule assessment. The present study analyzes the diagnostic accuracy of palpation-directed versus ultrasound guided fine-needle aspiration in patients who underwent surgery for thyroid nodules. Methods: A retrospective chart review of all consecutive patients who had FNA biopsy (palpation or ultrasound guided) of thyroid nodules and underwent thyroid gland surgery between 1998 and 2014 was conducted. The FNA findings of the palpation-guided and ultrasound-guided groups were compared for baseline characteristics. Moreover, the diagnostic accuracy of FNA findings and surgical histopathology results were analyzed. Results: A total of 1174 patients were included in the study with a mean age of 46.3 ± 11.7 years and the majority were females (75.5%). Among the study population, 392 (33.4%) patients underwent USguided FNA; 570 (48.6%) had palpation-guided FNA in clinic and no FNA was done in 212 (18%) cases. Patients underwent US-guided FNA were more likely to have suspicion of malignancy (p = 0.001), and had indeterminate findings (p = 0.001). On the other hand, palpation-guided FNA group had significantly higher frequency of benign cytology (p = 0.001). With respect to the suspicion for malignancy as well as malignancy, the US-guided group had a similar diagnostic accuracy in comparison to the palpation group. The proportion of malignancy finding on US-guided FNA (8.9%) was higher than the palpation-guided FNA (6.4%) that had been confirmed on postoperative histopathological examination (p = 0.95). Conclusion: The present study demonstrates higher sensitivity of US-guided thyroid FNA biopsies over palpation-guided FNA for the suspicion of malignancy; however, the accuracy is comparable. Moreover, both groups showed more postoperative malignancy in the benign and unsatisfactory categories than predicted in the Bethesda system. Further prospective studies are needed to underpin a realistic correlation between FNA and final histopathology reports.

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Size and Ultrasound Features Affecting Results of Ultrasound‐Guided Fine‐Needle Aspiration of Thyroid Nodules

Abstract: Tiny nodules (≤5 mm) with obscure borders tended to yield false-positive FNA results. Large nodules (>20 mm) with several US features tended to yield false-negative FNA results.

Cited by 18 publications

References 21 publications

Factors affecting thyroid nodule fine needle aspiration non‐diagnostic rates: a retrospective association study of 1975 thyroid biopsies

Factors affecting thyroid nodule fine needle aspiration non‐diagnostic rates: a retrospective association study of 1975 thyroid biopsies

Which Is the Best Reference Tissue for Strain Elastography in Predicting Malignancy in Thyroid Nodules, the Sternocleidomastoid Muscle or the Thyroid Parenchyma?

Diagnostic accuracy of preoperative palpation- versus ultrasound-guided thyroid fine needle aspiration cytology: an observational study

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