Specimen adequacy and diagnostic specificity of ultrasound-guided fine needle aspirations of nonpalpable thyroid nodules

Abstract

Ultrasound-guided fine needle aspiration (USG-FNA) is a safe, effective, and dependable test used to assess thyroid nodules. However, the size of the lesion can adversely affect the outcome of the procedure. The aim of this study was to assess specimen adequacy and diagnostic specificity in USG-FNA of thyroid nodules measuring < or = 1.5 cm. A total of 219 thyroid FNAs were performed in a one year; 26 were obtained by pathologists, 139 by clinicians, and 54 by radiologists under ultrasound guidance. Of the 54 ultrasound-guided aspirates, 19 cases (35%) were performed on nodules < or = 1.5 cm (range 0.8-1.5 cm, mean 1.3 cm). Cytologic material from these 19 cases was reviewed along with corresponding available follow-up surgical material. Standard criteria for specimen adequacy and established morphologic criteria for diagnostic specificity were assessed in each case. All 19 cases met criteria for specimen adequacy, and in 17 cases (89%) specific cytologic diagnoses were made (cellular/adenomatous nodule--2 cases, colloid nodule--10 cases, Hashimoto's thyroiditis--4 cases, and papillary cystic carcinoma--1 case). The diagnoses were confirmed by surgical follow-up in six cases including the case of papillary carcinoma. One case diagnosed as suspicious for a papillary carcinoma subsequently was found to be a follicular adenoma by histology. In one case, a diagnosis of lymphocytic thyroiditis versus intrathyroidal lymphoid tissue was made (See Table I). In majority of cases of USG-FNA of nonpalpable thyroid nodules, adequate material may be obtained for a specific cytopathologic diagnosis.

The UK Royal College of Pathologists Thyroid Fine-Needle Aspiration Diagnostic Classification Is a Robust Tool for the Clinical Management of Abnormal Thyroid Nodules

“…Until recently, various diagnostic terminologies, including ‘atypical’, ‘indeterminate’, and ‘suspicious for malignancy’, were used to describe diagnostically challenging cases [26,27]. Furthermore, until recently there were no uniform criteria established for the specimen adequacy [28,29]. This resulted in diagnostic inconsistencies and difficulties in conveying the clinical implications of the thyroid FNA result to the various clinical teams.…”

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

“…Fig. 1 shows the flow diagram of the results of clinico-pathological correlation of Categories III (A), IV (B), and V (C) by the Bethesda System, which were rela- Further, until recently, there were no uniform criteria established for the various diagnostic categories and specimen adequacy [22,23]. As a result, diagnostic inconsistencies exist among different laboratories as well as pathologists within the same laboratories.…”

A comparative study of free-hand fine needle aspiration cytology and ultrasound guided fi ne needle aspiration cytology in the diagnosis of thyroid swellings at BP Koirala Institute of Health Sciences- a tertiary care centre in Nepal

“…In 2006, Kelly NP et al reported that on ultrasound guided FNA of non palpable thyroid nodules adequate material may be obtained for a specific cytopathological diagnosis and in 17 (89%) cases specific cytological diagnosis was made. 10 In the indeterminate category 4 cases were found to colloid goitre with cystic changes, and three cases were reported as colloid goitre due to adequate material. One midline swelling clinically diagnosed as thyroglossal cyst turned out to be papillary carcinoma on biopsy.…”