Ultrasound‐guided fine needle aspiration cytology in the diagnosis and management of thyroid nodules

Cai, Xiaopin; Valiyaparambath, N.; Nixon, P P; Waghorn, Alison; Giles, T; Helliwell, Tim

doi:10.1111/j.1365-2303.2006.00397.x

Cited by 94 publications

(71 citation statements)

References 20 publications

(61 reference statements)

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“…Considering that 187 of the 558 thyroid nodules (33.5%) were smaller than 1 cm, the rate of inadequate sampling for USgFNAC was low. In addition, after histopathologic examination, the positive predictive value of USgFNAC in our study was 90.2%, indicating that our procedure was more sensitive and accurate than in previous reports [10,12].…”

Section: Discussioncontrasting

confidence: 46%

“…Previously, the rate of inadequate sampling for FNAC done "freehand" was 11-13% [10,11,15]. More recent studies using USgFNAC have reported rates of 6-7.2% [10,12,13]. Although the mean tumor size in our study was 16.4 ± 11.3 mm, we performed USgFNAC on all tumors larger than 3 mm.…”

Section: Discussionmentioning

confidence: 60%

“…Previous studies have reported that incidental thyroid nodules are commonly detected at a rate of 30-50% on sonography [5,6] with a malignancy rate of about 7-15% [7][8][9][10]. Fine needle aspiration cytology (FNAC) is now established as a reliable and safe method to distinguish between benign and malignant thyroid nodules [8,11,12]. It has been recently reported that ultrasonography-guided fine needle aspiration cytology (USgFNAC) has improved diagnostic accuracy compared to FNAC by palpation in thyroid nodules [1,3,10].…”

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confidence: 99%

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High Prevalence of Carcinoma in Ultrasonography-guided Fine Needle Aspiration Cytology of Thyroid Nodules

2008

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Abstract. Objective: The purpose of this study was to assess the rate of malignancy in thyroid nodules incidentally detected at sonography and to determine the diagnostic value of ultrasonography-guided fine needle aspiration cytology (USgFNAC) in thyroid nodules. Methods: Five hundred patients (84 men and 416 women) who had thyroid incidentalomas underwent USgFNAC at Konkuk University Hospital between August 2005 and July 2006. Thyroid sonography and guided aspiration was performed on all single nodules and on dominant nodules with suspected malignancy in cases of multinodular goiter. Results: Five hundred fifty-eight nodules from 500 patients were aspirated using ultrasonography guidance. The USgFNAC results for all patients were as follows: 307 (61.4%) benign, 108 (21.6%) suggestive of malignancy, 56 (11.2%) indeterminate, and 29 (5.8%) inadequate for cytologic diagnosis. The rate of malignancy was significantly higher in women than in men (23.6% in women vs 11.9% in men, p<0.01). Ultrasonographic characteristics that had a significant association with thyroid malignancy included solid echocomponent, hypoechogenecity, ill defined margin, and presence of microcalcifications (p<0.05). Eighty-eight patients underwent surgical resection. The positive predictive value of USgFNAC was 90.2% (74/82), and the accuracy index was 84.1% (74/ 88). In 80 patients with well-differentiated thyroid carcinoma after surgery, 49% (39/80) had lesions smaller than 1 cm. Conclusion: The rate of malignancy in incidental thyroid nodules on USgFNAC was 21.6%. Ultrasonographic features could be useful in differentiating between benign and malignant nodules.

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Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 60%

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confidence: 99%

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High Prevalence of Carcinoma in Ultrasonography-guided Fine Needle Aspiration Cytology of Thyroid Nodules

2008

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“…The differences described above in epidemiological situations of examined populations result in significant differences in the reported data on FP and FN results, as well as sensitivity (from 65 to 99%) and specificity (from 72 to 100%) of thyroid FNAB (30,(35)(36)(37)(38)(39)(40).…”

Section: Second Version (%)mentioning

confidence: 99%

The fine-needle aspiration biopsy efficacy of small thyroid nodules in the area of recently normalized iodine supply

Słowińska-Klencka

Popowicz²,

Lewiński³

et al. 2008

European Journal of Endocrinology

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Objective: To evaluate the incidence of focal lesions in the thyroid in the area of recently normalized iodine supply as well as to compare the efficacy of fine-needle aspiration biopsy (FNAB) of small (infracentimetric) and large thyroid lesions in this area. Methods: The outcomes of 13 646 ultrasound (US) examinations, 13 437 US-guided FNABs of the thyroid and 1694 results of post-operative histopathological examinations were analysed. Results: Infracentimetric nodules (INs %10 mm) were revealed by US examinations in 43.5% of patients; in the majority of the cases (82.2%) INs were multiple. The percentage of revealed carcinomas by aspiration of INs is similar to that observed when large nodules (LNs O10 mm) are examined cytologically. However, the efficiency of preoperative diagnosis of INs is lower than LNs with respect to both US selection of lesions for FNAB and the percentage of false negative results of FNAB (29.8 vs 5.4%, P!0.001). In post-operative histopathological examination, extrathyroidal extension of thyroid cancers was observed in nearly 30% of microcarcinomas. Conclusions: In endemic or post-endemic areas, the efficiency of FNAB is lower in the case of small lesions than larger ones. In spite of this, the percentage of cytologically revealed carcinomas among small lesions is not lower than larger ones. Thus, it is particularly indicated to follow up small thyroid lesions with repeated US examinations in such areas.European Journal of Endocrinology 159 747-754

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“…First, criteria used to determine adequacy of thyroid FNAC vary in the literature, 15,20 and in some other studies, lower numbers of follicular cells were required to reach adequacy in colloid nodules or cysts. 21,22 In our study, 5 to 6 groups, each with 10 or more benign cells, were required to reach adequacy; this also applied to pure cystic or colloid nodules. This is in accord with the Bethesda system for thyroid FNAC, which recommends that FNAC obtained from cysts and comprising pure colloid or macrophages without follicular cellular elements be reported as nondiagnostic/unsatisfactory followed by the subcategory cyst fluid only.…”

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confidence: 99%

Liquid‐based FNAC of the thyroid

Geers

Bourgain²

2010

Cancer Cytopathology

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BACKGROUND:The aims of this study were to analyze cytomorphological features of Tripath PREP (BD SurePath, Burlington, NC) preparations in thyroid nodules and to examine adequacy and accuracy of SurePath and frozen sections for both clinical outcome and histological diagnosis when applicable.METHODS:Gathered during a period of 4 years, 712 SurePath specimens of the thyroid were included. Histological (n = 207) or clinical follow‐up (n = 505) was available in all cases. During the same period, 253 frozen sections of surgical thyroid resection specimens were also assessed. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated.RESULTS:Sensitivity was 77% for SurePath and 29% for frozen section; specificity was 81% for SurePath and 100% for frozen section; accuracy was 80% for SurePath and 90% for frozen section. One hundred seventy‐eight (25%) SurePath patients were considered unsatisfactory for diagnosis. In this study, sensitivity, specificity, and accuracy were comparable for SurePath and other reported results of liquid‐based thyroid cytology. Presence of free colloid or pure cystic changes favored a benign diagnosis. Cellular smears with nuclear atypia of papillary carcinoma allowed an overt diagnosis of malignancy.CONCLUSIONS:The authors concluded that SurePath is a reliable technique for assessment of thyroid nodules and offers the advantage of easy identification of colloid and atypical nuclei. Supplementary frozen section analysis should be limited to an FNAC diagnosis of suspicious for papillary carcinoma. Cancer (Cancer Cytopathol) 2011. © 2010 American Cancer Society.

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Ultrasound‐guided fine needle aspiration cytology in the diagnosis and management of thyroid nodules

Abstract: Ultrasound-guided FNAC has a significantly lower yield of inadequate aspirates than palpable FNAC. The ability of FNAC to predict neoplasia in 89% patients and to exclude neoplasia in 95.9% patients makes an important contribution to the multidisciplinary assessment of patients.

Cited by 94 publications

References 20 publications

High Prevalence of Carcinoma in Ultrasonography-guided Fine Needle Aspiration Cytology of Thyroid Nodules

High Prevalence of Carcinoma in Ultrasonography-guided Fine Needle Aspiration Cytology of Thyroid Nodules

The fine-needle aspiration biopsy efficacy of small thyroid nodules in the area of recently normalized iodine supply

Liquid‐based FNAC of the thyroid

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