Fine needle aspiration and the Bethesda system: Correlation with histopathology in 1,228 surgical patients

Linhares, Samantha M.; Handelsman, Rachel S.; Picado, Omar; Farrá, Josefina C.; Lew, John I.

doi:10.1016/j.surg.2021.05.016

Cited by 6 publications

(7 citation statements)

References 29 publications

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“…After all, one of the reasons for having indeterminate diagnoses is to limit the false‐positive and false‐negative rates. In our current study, we recorded no false‐positive cases but had a false‐negative rate of 10.9%, which is comparable to other recent studies 20,21 . Like with indeterminate diagnoses, the calculation of false‐negative rates by having the resected population in the denominator overestimates the ROM of the benign category.…”

Section: Discussionsupporting

confidence: 86%

“…In our current study, we recorded no false-positive cases but had a false-negative rate of 10.9%, which is comparable to other recent studies. 20,21 Like with indeterminate diagnoses, the calculation of false-negative rates by having the resected population in the denominator overestimates the ROM of the benign category. The true ROM is most likely closer to the expected ROM of 0%-3%.…”

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confidence: 99%

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Molecular‐derived risk of malignancy and the related positive call rate of indeterminate thyroid cytology diagnoses as quality metrics for individual cytopathologists

Ohori,

Cuda,

Bastacky

et al. 2023

Cancer Cytopathology

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BackgroundIndeterminate thyroid cytopathology diagnoses represent differing degrees of risk that are corroborated by follow‐up studies. However, traditional cytologic–histologic correlation may overestimate the risk of malignancy (ROM) because only a subset of cases undergo resection. Alternatively, some molecular tests provide probability of malignancy data to calculate the molecular‐derived risk of malignancy (MDROM) and the positive call rate (PCR). The authors investigated MDROMs and PCRs of indeterminate diagnoses for individual cytopathologists as quality metrics.MethodsThis study was approved by the Department of Pathology Quality Improvement Program. Thyroid cytopathology diagnoses and ThyroSeq v3 results were retrieved for each cytopathologist for a 2‐year period with at least 3 years of follow‐up for the atypia of undetermined significance (AUS), follicular neoplasia (FN), and follicular neoplasia, oncocytic‐type (ONC) cytopathologic diagnoses. MDROMs and PCRs were compared with reference ROMs and cytologic–histologic correlation outcomes.ResultsThe overall MDROMs (and ranges for cytopathologists) for the AUS, FN, and ONC categories were 13.4% (range, 5.8%–20.8%), 28.1% (range, 22.1%–36.7%), and 27.0% (range, 19.5%–41.5%), respectively, and most individual cytopathologists' MDROMs were within reference ROM ranges. However, PCRs more effectively parsed the differences in cytopathologists' ROM performance. Although the overall PCRs were not significantly different across cytopathologists (p = .06), the AUS PCRs were quite different (p = .002). By cytologic–histologic correlation, six of 55 resected cases (10.9%) were falsely negative, and there were no false‐positive cases.ConclusionsMDROMs and PCRs evaluate concordance with reference ROMs and with one another and provide individual feedback, which potentially facilitates quality improvement.

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Section: Discussionsupporting

confidence: 86%

mentioning

confidence: 99%

Molecular‐derived risk of malignancy and the related positive call rate of indeterminate thyroid cytology diagnoses as quality metrics for individual cytopathologists

Ohori,

Cuda,

Bastacky

et al. 2023

Cancer Cytopathology

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“…To avoid unnecessary surgery for thyroid nodules with indeterminate cytology, clinical and sonographic features and investigations such as repeated FNA or molecular testing are used to estimate the malignancy risk (4). Unlike the implied malignancy risk (5-15%) of Bethesda class III thyroid nodules in the general population, the malignancy risk increases up to 50-60% in surgically resected populations (5)(6)(7). Bethesda class III is a heterogeneous category that contains follicular cells exhibiting either architectural abnormalities or nuclear atypia (3).…”

Section: Introductionmentioning

confidence: 99%

Malignancy Rate of Bethesda Class III Thyroid Nodules Based on the Presence of Chronic Lymphocytic Thyroiditis in Surgical Patients

2021

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BackgroundHashimoto’s thyroiditis (HT), also known as chronic lymphocytic thyroiditis (CLT), may interfere with the accurate cytological diagnosis of thyroid nodules. Recently, HT has been considered a premalignant condition for thyroid cancer development. The diagnosis of atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) thyroid nodules is challenging and evidence for the malignancy risk of AUS/FLUS thyroid nodules coexisting with CLT is scarce. Therefore, we assessed the malignancy risk of AUS/FLUS thyroid nodules according to the presence of background CLT.MethodsThis study included 357 surgically resected thyroid nodules with AUS/FLUS cytology. Cases with concomitant malignant nodules were excluded. CLT was defined based on the pathologic report after thyroid surgery.ResultsAmong 357 tumors, 130 tumors (36%) were confirmed to have coexisting CLT, and 170 tumors (48%) were determined to be malignant after thyroidectomy. Malignancy rates were similar in both groups (48% in each) regardless of background CLT (62/130 with CLT vs. 108/227 without CLT). In the group with CLT, thyroiditis was more frequent in the final pathology (12% with CLT vs. 1% without CLT, P = 0.003). In multivariate analysis, positive BRAFV600E mutation, highly suspicious sonographic features (K-TIRADS 5), and smaller thyroid nodules were significant factors for thyroid malignancies.ConclusionThe malignancy rate of thyroid nodules with AUS/FLUS cytology was comparable irrespective of the presence of underlying CLT.

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“…Hence, it is crucial to identify factors that could affect the diagnostic value of TFNAB since it is evident that comprehension of such factors could enhance accuracy, refine patient management, and reduce unnecessary repetitive procedures 4,5 . Various studies have sought demographic, clinical, and sonography features that could impact the diagnostic performance of TFNAB 6–8 . Despite these efforts, the relationship between these factors and the diagnostic outcome of TFNAB remains incompletely understood, and the results are often inconsistent.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 Various studies have sought demographic, clinical, and sonography features that could impact the diagnostic performance of TFNAB. [6][7][8] Despite these efforts, the relationship between these factors and the diagnostic outcome of TFNAB remains incompletely understood, and the results are often inconsistent.…”

Section: Introductionmentioning

confidence: 99%

Examining the impact of several factors including COVID‐19 on thyroid fine‐needle aspiration biopsy

Deniz,

Dindar

2023

Diagnostic Cytopathology

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ObjectiveThe study explores various factors, including coronavirus disease 2019 (COVID‐19) history and vaccination status, that influence the classification value of ultrasonography‐guided thyroid fine needle aspiration biopsy (TFNAB) by comparing non‐diagnostic (Bethesda‐I) and diagnostic (Bethesda II–VI) results.MethodsWe conducted a retrospective observational study in a high‐volume tertiary care center involving patients who underwent TFNAB from November 2022 to April 2023. The study retrospectively analyzed the cytopathology of 482 thyroid nodules. Patients were categorized into non‐diagnostic (n = 136) and Diagnostic groups (n = 346) based on TFNAB. A comprehensive set of parameters was examined, including demographic, anthropometric and clinical data, thyroid ultrasonography findings, COVID‐19 history and immunization status.ResultsThe mean age was 55.1 ± 12.1 years in the non‐diagnostic group and 53.5 ± 13 years in the Diagnostic group (p = .223). 75.7% (n = 103) of the non‐Diagnostic group and 82.9% (n = 287) of the Diagnostic group were male (p = .070). The mean nodule longitudinal diameter of the Diagnostic group was significantly higher than that of the non‐diagnostic group (p = .015). The TIRADS score of the nodules showed a statistical difference between the groups (p = .048). The groups had no significant differences regarding other ultrasonographic parameters and COVID‐19‐related variables.ConclusionIt can be assumed that when the longitudinal diameter of the thyroid nodule is small and in TIRADS categories other than the TIRADS3 category, TFNAB is less likely to be diagnostic. However, future research may be needed to confirm these findings and uncover any long‐term effects of COVID‐19 or vaccines on thyroid nodule diagnostics.

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Fine needle aspiration and the Bethesda system: Correlation with histopathology in 1,228 surgical patients

Cited by 6 publications

References 29 publications

Molecular‐derived risk of malignancy and the related positive call rate of indeterminate thyroid cytology diagnoses as quality metrics for individual cytopathologists

Molecular‐derived risk of malignancy and the related positive call rate of indeterminate thyroid cytology diagnoses as quality metrics for individual cytopathologists

Malignancy Rate of Bethesda Class III Thyroid Nodules Based on the Presence of Chronic Lymphocytic Thyroiditis in Surgical Patients

Examining the impact of several factors including COVID‐19 on thyroid fine‐needle aspiration biopsy

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