Fine-Needle Aspiration Biopsy as a Preoperative Procedure in Patients with Malignancy in Solitary and Multiple Thyroid Nodules

Abstract

BackgroundFine-needle aspiration biopsy (FNAB) is a recognized technique for the basic, preoperative cytological diagnosis of thyroid nodules.Aim of the StudyTo analyze the accuracy of FNAB in the diagnosis of thyroid cancer in patients with solitary and multiple thyroid nodules and to compare the demographic, clinical and pathological characteristics of patients with thyroid carcinoma in solitary and multiple tumors.Materials and MethodsThe case records of 2,403 patients with solitary and multiple thyroid tumors treated consecutively between 2008 and 2013 were analyzed retrospectively. We selected 1,645 for further analysis. A solitary thyroid nodule was observed in 493 patients, and multiple nodules were detected in 1,152 patients. Further classification of the patients in these two groups was performed on the basis of the FNAB results, type of surgery performed and histopathology. TC was histopathologically confirmed in 166 patients, and benign disease was found in 1,479. The TC patients were assigned to the study group, and those with benign thyroid disease were placed into the control group. The study group was divided into two subgroups according to the presence of cancer in a single thyroid nodule or in multiple nodules. Malignancy in a solitary thyroid nodule was diagnosed in 98 (59.0%) patients, and cancer in multiple nodules was diagnosed in 68 (41.0%). Comparative analyses of the demographic, clinical and histopathological characteristics were performed for both subgroups. The following statistical analyses were performed: comparative characteristic of subgroups, ROC analysis for study group and subgroup of patients, and multivariable logistic regression analysis for study group.ResultsThe rate of prediction of TC by FNAB was three times higher in the patients with a solitary thyroid nodule compared with those with multiple thyroid nodules and it was statistically significant (p<0.001). The rate of total thyroid resection and lack of necessity for reoperation were also significantly higher in the TC patients with a solitary nodule. The histopathological results showed that significantly more patients with a solitary nodule had advanced-stage TC (stage III or IV) and tumor progression (pT3 or pT4) (p = 0.002 for both). ROC analysis demonstrated that the overall accuracy of FNAB as a predictor of thyroid cancer presence was high, especially for the subgroup of patients with a solitary thyroid nodule (AUC = 0.958, p<0.0001). Multivariable logistic regression analysis confirmed that a positive FNAB result was the sole predictor of the performance of total resection in the TC study group (p<0.0001), while a negative FNAB result and the presence of a papillary cancer type were independent predictors of the risk of reoperation (p<0.0001 and p = 0.002, respectively).ConclusionsFNAB often produces false-negative results in patients with multiple malignant thyroid tumors, which results in reoperation in many cases. False-negative FNAB results are rare in patients with a solitary tumor. Because of the low predict...

Dual malignancy in a thyroid; papillary thyroid carcinoma and small lymphocytic lymphoma; a report of a case with a cyto‐histologic correlation

“…1,2 Typically, cytology smears show papillary configuration, characteristic nuclear features like nuclear grooves and pseudoinclusions, or even psammoma bodies, which if present, are highly suggestive of this diagnosis. Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy and can be readily diagnosed by cytology, thus fine needle aspiration (FNA) is the initial diagnostic procedure of choice.…”

“…Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy and can be readily diagnosed by cytology, thus fine needle aspiration (FNA) is the initial diagnostic procedure of choice. 2 Biphenotypic thyroid carcinomas, conversely, are not uncommon with anaplastic thyroid carcinoma arising in association with papillary or follicular thyroid carcinoma being the most common example. 1,3 Multiple thyroid malignancies is a rare situation, and accurate diagnosis by FNA has reportedly high false-negative rate reaching up to 69%.…”

“…Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy and can be readily diagnosed by cytology, thus fine needle aspiration (FNA) is the initial diagnostic procedure of choice. 1,2 Typically, cytology smears show papillary configuration, characteristic nuclear features like nuclear grooves and pseudoinclusions, or even psammoma bodies, which if present, are highly suggestive of this diagnosis. 1,3 Multiple thyroid malignancies is a rare situation, and accurate diagnosis by FNA has reportedly high false-negative rate reaching up to 69%.…”

“…1,3 Multiple thyroid malignancies is a rare situation, and accurate diagnosis by FNA has reportedly high false-negative rate reaching up to 69%. 2 Biphenotypic thyroid carcinomas, conversely, are not uncommon with anaplastic thyroid carcinoma arising in association with papillary or follicular thyroid carcinoma being the most common example. 4 Primary thyroid lymphomas are also rare, usually of the non-Hodgkin's Bcell phenotype.…”

Thyroid Cancer: A Retrospective Analysis

“…However, FNAB has shown less accuracy in the evaluation of multinodular thyroid gland as 2 out of 4 cases with multiple nodular thyroid mass were initially diagnosed as colloid goitre. Kaliszewski et al 28 have shown in their study that the rate of prediction of thyroid cancer by FNAB in the patients with solitary thyroid nodule was three times higher than that in the patients with multiple nodule. This is important as in cases with negative FNAB result, the surgeon may perform a less radical procedure which will require another surgery for complete removal of the remaining thyroid gland.…”