Ultrasound-guided fine-needle aspiration of thyroid nodules: stratification of malignancy risk using follicular proliferation grading, clinical and ultrasonographic features

Abstract

Objective: To evaluate the diagnostic value of fine-needle aspiration (FNA) cytology and the additive contribution brought by clinical and ultrasound (US) features. Method: Cytological and histological diagnoses were compared in a series of 924 patients who underwent US-guided FNA before surgery. We additionally developed a grading system for follicular proliferation (FP) FNA diagnosis, and investigated its impact on the malignancy risk as well as the additive contribution of clinical and US features by means of decision tree analysis. Results: Excluding FP cases (nZ395), our data demonstrated that strictly benign or malignant FNA diagnoses exhibit great concordance with benign or malignant histological diagnoses (97.8% accuracy). Our grading system that was applied to the 395 FP cases revealed that grades 1, 2 and 3 were associated with a 7.7, 17.7 and 45.7% incidence of malignancy respectively. Decision tree analysis resulted in a classification model which involved FP grade, patient's age, serum thyroglobulin level, nodule size and nodule uniqueness. This model identified a subgroup of patients with grade 1 FP nodules who were older than 50 years, and who had a higher risk of malignancy (17.9%). In addition, high serum thyroglobulin levels were associated with a very high malignancy risk (75.0%) for patients with grade 3 FP nodules. Finally, among grade 2 FP patients, unique and large nodules were associated with a high malignancy risk of 36.1%. Conclusions: The integration of FP grade, clinical and US features allows the stratification of patients with FP cytology according to their risk of malignancy.

Prevalence of Cancer in Patients with Thyroid Nodules in the Island of Cyprus: Predictive Value of Ultrasound Features and Thyroid Autoimmune Status

“…This was mostly seen in cystic lesions where the specimen was low in cellularity. Furthermore, our high positive predictive value of 95.8% indicates that our technique was highly sensitive and accurate, comparable to similar studies from Korea [30], Denmark [31] and Belgium [32]. In our study, most cancers were papillary, and this is in accordance with other studies that showed an increased prevalence of this type of thyroid cancer [9,33,34].…”

Is Ultrasonography Useful in Predicting Thyroid Cancer in Children with Thyroid Nodules and Apparently Benign Cytopathologic Features?

“…assessed directly for adequacy by the cytopathologist, who performed a second pass when unsatisfactory specimens were obtained). Interestingly, in recent series studying the accuracy of US-guided FNAB, false negatives have occurred – but at a lower rate [22]. Consequently, the authors advocate the use of thyroid US to improve the initial diagnostic evaluation of thyroid nodules in adults.…”

“…BRAF mutations are rare in pediatric thyroid cancer [23]), a more standardized radiological report for thyroid nodules in children will certainly improve the diagnostic accuracy and comparability of studies [22,26]. Meanwhile, as molecular testing for mutations might improve FNAB diagnosis of malignancy [27,28], studies on the use of molecular markers for the diagnosis of pediatric thyroid cancers are needed.…”

Pre-operative diagnosis of thyroid cancer: Clinical, radiological and pathological correlation

“…FNA accuracy is reported to range between is 80 -90% 13 though the methodology for generating these predictive values vary from series to series. False negative benign results are reported to be between 1-3% in a number of research studies 21,22,25,31 . In contrast to these high accuracy rates, FNA results in our series were unhelpful in 53% of patients.…”

“…The vast majority of thyroid nodules are in women and historically nodules in men were believed to have a higher risk of malignancy. Even though recent international guidelines still include this risk factor, U n i v e r s i t y o f C a p e T o w n 11 many recent studies do not support the finding 21,22,23 . Some even demonstrate a higher incidence in women than men 24 .…”