The final outcome of indeterminate cytology of thyroid nodules in a District General Hospital

Doddi, Sudeendra

doi:10.11138/gchir/2015.36.3.122

Cited by 9 publications

(10 citation statements)

References 29 publications

(28 reference statements)

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“…The malignancy rate of nodules carrying a diagnosis of Bethesda category III who underwent immediate surgery, as per Western studies, ranged from 20%, 25% to 28%. [345] Allen S Ho et al demonstrated a malignancy rate of 26.3% in nodules 8 with two consecutive AUS/FLUS diagnoses that underwent surgical resection. [6] Among the AUS/FLUS nodules triaged for immediate surgery, the malignancy rate was observed to be 37.8%.…”

Section: Discussionmentioning

confidence: 99%

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Prospective study of bethesda categories III and IV thyroid nodules: Outcomes and predictive value of BRAF^V600E mutation

Chirayath

Pavithran

Abraham

et al. 2019

Indian J Endocr Metab

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Introduction: Atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has emerged as the most controversial category because of its heterogeneity and inconsistent reporting. There is a definite paucity in data available from the Indian subcontinent about the outcome of nodules carrying Bethesda category III or Bethesda category IV diagnoses. Aims and Objectives: The primary objective of our study was to determine the malignancy rate in Bethesda categories III and IV nodules. The secondary objectives were to determine predictive value of BRAF V600E mutation analysis on indeterminate thyroid nodules, predictive value of Thyroid image reporting and data system (TI-RADS) in malignancy prediction and to study the common histological variants in indeterminate nodules. Materials and Methods: This prospective study included 176 consecutive nodules of Bethesda categories III and IV, diagnosed over a period of 2 years from August 2015 to August 2017. A part of the fine needle aspirate was used to perform the BRAFV600E mutation analysis. The malignancy risk associated with these Fine needle aspiration Cytology categories were discussed with the patients. Those with Bethesda category IV diagnosis was advised surgery, whereas those with Bethesda category III were given the options of close follow-up with repeat FNA in 3 months or immediate surgery. Results: In our prospective study, there were 176 consecutive samples of categories III (140/79.5%) and IV (36/20.5%). Seventy-five (53.6%) category III nodules and 29 (80.6%) category IV nodules underwent immediate surgical excision. Fifty-five consecutive indeterminate cytology nodules were subjected for BRAF V600E . One of the samples was found to be positive for BRAF T1799A (V600E) mutation. The second sample harboured a missense mutation at position 1819 (TCC--GCC), wherein the codon 607 (TCC) coding for serine was substituted by alanine (GCC) which is a variant of unknown significance. In our study, the malignancy rate of Bethesda categories III and IV, which were triaged for immediate surgery were 54.6% and 72.4%, respectively. Conclusion: Malignancy rate in Category III at our center was much higher than that described by ATA and by other studies published from centers around the world, including the only two studies from India. In view of the strikingly high malignancy rate in these indeterminate nodules, strong consideration to surgery should be given to patients with FNA results suggesting these two categories. BRAFV600E mutation analysis in FNA specimen has limited utility in improving the preoperative diagnostic rate for malignancy.

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Section: Discussionmentioning

confidence: 99%

“…demonstrated a malignancy rate of 81% in Bethesda Category IV nodules. [5] In his study, Bethesda category IV nodules constituted 1.7% of the total 621 nodules. In our study, the malignancy rate of Bethesda categories III and IV which were triaged for immediate surgery were 54.6%, and 72.4% respectively.…”

Section: Discussionmentioning

confidence: 99%

Prospective study of bethesda categories III and IV thyroid nodules: Outcomes and predictive value of BRAF^V600E mutation

Chirayath

Pavithran

Abraham

et al. 2019

Indian J Endocr Metab

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“…Alexander [11], Mihai [12], Tysome [13], Dutta [14], Lakhani [15], Pagni [16], Wong [17], Rago [18], Brophy [19], Trombetta [20], Giusti [21], Khalil [22]. Finally, 13 articles; Agrawal [23], Dallari [24], Deandrea [25], Doddi [26], Fadda [27], Gill [28], Glynn [29], Kelly [30], Lobo [31], Mehanna [32], Montgomery [33], Mullen [34] and Parkinson [35] were included in the present systematic review and meta-analysis. These 13 studies describe a total of 3910 nodules with histological diagnosis and preoperative FNAC assessment according to The RCPath Thy terminology.…”

Section: Qualitative Analysis (Systematic Review)mentioning

confidence: 99%

Risk of malignancy in the various categories of the UK Royal College of Pathologists Thy terminology for thyroid FNA cytology: A systematic review and meta‐analysis

Poller

Bongiovanni

Trimboli³

2019

Cancer Cytopathology

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Background. The UK Royal College of Pathologists Thy terminology for reporting thyroid FNAC cytology was first published in 2009, used throughout the United Kingdom and Ireland, in some parts of Italy and Switzerland, and elsewhere. There is no review of the literature or meta-analysis of the risk of malignancy (ROM) in the various categories of the UK Thy terminology. The study goal was to establish the published ROM for each Thy category and compare results with other existing terminology systems where similar meta-analyses were available. Methods. A comprehensive literature search of online databases was conducted in May 2019 examining the ROM for histologically proven nodules with preoperative FNAC classified according to the UK Thy terminology. Results. 25 articles were identified showing results of both cytology and histology. 12 of these were excluded to prevent selection bias as they showed data in just one Thy category. In the remaining 13 articles the pooled ROM was as follows;

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“…Table showing all studies included in the current systematic review Lobo et al15 and Mehannah et al16 -although ROSE was undertaken for some patients it was impossible to be certain of the exact numbers of patients undergoing ROSE and those that did not and so these three articles were excluded from further analysis. Data from Sharma et al24 are detailed in bothTables 3 and 4as some patients underwent ROSE and some did not. Thyroid FNA patients undergoing ROSE assessment were excluded in one further article, Breeze et al10 as there was only one Thy 1 case in the ROSE patient subgroup.…”

mentioning

confidence: 99%

Rates of Thy 1‐non‐diagnostic thyroid fine needle aspiration using the UK Royal College of Pathologists Thy Terminology. A systematic review of the literature comparing patients who undergo rapid on‐site evaluation and those who do not

et al. 2020

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Introduction: The UK Royal College of Pathologists (RCPath) Thy terminology is an internationally recognised system for reporting thyroid fine needle aspiration. The terminology has been used throughout the UK and Ireland, in some parts of Italy and Switzerland, and elsewhere in the world. There is no systematic review of the literature specifically addressing the use of the non-diagnostic for cytological diagnosis-Thy1/Thy 1c category in the UK RCPath terminology. Methods: A comprehensive literature search of online databases was conducted in October 2019 specifically examining overall reported rates of Thy1 and Thy1c in aspirates classified according to the UK Thy terminology. Results: Twenty-five articles were identified showing a Thy1 rate of 13.4% (2540/18 920). The studies were then stratified according to whether or not the patients underwent rapid on-site evaluation (ROSE): 6.0% (353/5841; range 3.0%-10.9%) of ROSE aspirates were Thy1 whereas 18.5% (2072/11 204; range 7.9%-43.3%) of non-ROSE patients were Thy1; (P < .05). Three studies from 2016 reported Thy1c rates of 5.4%, 6.5% and 10.6%, respectively, implying Thy1 rates excluding Thy1c aspirates of 20.9%, 8.7% and 12.7%, respectively. Conclusion: This systematic review of the literature shows relatively high rates of aspirates non-diagnostic for cytological diagnosis-Thy1 in the peer-reviewed published literature using the UK terminology. Utilisation of ROSE appears to produce lower rates of Thy1 aspirates and ROSE should be considered if rates of non-diagnostic for cytological diagnosis-Thy1/Thy 1c are high.

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The final outcome of indeterminate cytology of thyroid nodules in a District General Hospital

Cited by 9 publications

References 29 publications

Prospective study of bethesda categories III and IV thyroid nodules: Outcomes and predictive value of BRAF^V600E mutation

Prospective study of bethesda categories III and IV thyroid nodules: Outcomes and predictive value of BRAF^V600E mutation

Risk of malignancy in the various categories of the UK Royal College of Pathologists Thy terminology for thyroid FNA cytology: A systematic review and meta‐analysis

Rates of Thy 1‐non‐diagnostic thyroid fine needle aspiration using the UK Royal College of Pathologists Thy Terminology. A systematic review of the literature comparing patients who undergo rapid on‐site evaluation and those who do not

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The final outcome of indeterminate cytology of thyroid nodules in a District General Hospital

Cited by 9 publications

References 29 publications

Prospective study of bethesda categories III and IV thyroid nodules: Outcomes and predictive value of BRAFV600E mutation

Prospective study of bethesda categories III and IV thyroid nodules: Outcomes and predictive value of BRAFV600E mutation

Risk of malignancy in the various categories of the UK Royal College of Pathologists Thy terminology for thyroid FNA cytology: A systematic review and meta‐analysis

Rates of Thy 1‐non‐diagnostic thyroid fine needle aspiration using the UK Royal College of Pathologists Thy Terminology. A systematic review of the literature comparing patients who undergo rapid on‐site evaluation and those who do not

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Prospective study of bethesda categories III and IV thyroid nodules: Outcomes and predictive value of BRAF^V600E mutation

Prospective study of bethesda categories III and IV thyroid nodules: Outcomes and predictive value of BRAF^V600E mutation