Recent Experience With Preoperative Fine-Needle Aspiration Biopsy of Thyroid Nodules in a Community Hospital

Blansfield, Joseph; Sack, Martha J.; Kukora, John S.

doi:10.1001/archsurg.137.7.818

Cited by 44 publications

(36 citation statements)

References 9 publications

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“…Eleven U.S.-based thyroid FNA series were identified that met the inclusion criteria between 2002 and 2010 (9,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Of the studies that gave statistics for age and gender, average age was 51 years (46-56) with 14,551 (85%, range 75%-88%) women and 2508 (15%, range 12%-25%) men.…”

Section: Updated Meta-review Resultsmentioning

confidence: 99%

A Large Multicenter Correlation Study of Thyroid Nodule Cytopathology and Histopathology

Wang

Friedman

Kennedy

et al. 2011

Thyroid

320

257

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Background: Fine-needle aspiration (FNA) biopsies are the cornerstone of preoperative evaluation of thyroid nodules, but FNA diagnostic performance has varied across different studies. In the course of collecting thyroid FNA specimens for the development of a molecular diagnostic test, local cytology and both local and expert panel surgical pathology results were reviewed. Methods: Prospective FNAs were collected at 21 clinical sites. Banked FNAs were collected from two academic centers. Cytology and corresponding local and expert panel surgical pathology results were compared to each other and to a meta-review of 11 recently published U.S.-based thyroid FNA studies. Results: FNA diagnostic performance was comparable between the study specimens and the meta-review. Histopathology malignancy rates for prospective clinic FNAs were 34% for cytology indeterminate cases and 98% for cytology malignant cases, comparable to the figures found in the meta-review (34% and 97%, respectively). However, histopathology malignancy rates were higher for cytology benign cases in the prospective clinic FNA subcohort (11%) than in the meta-review (6%, with meta-review rates of 10% at community sites and 2% at academic centers, p < 0.0001). Resection rates for prospective clinic FNAs were also comparable to the meta-review for both cytology indeterminate cases (62% vs. 59%, respectively) and cytology malignant cases (82% vs. 81%, respectively). Surgical pathology categorical disagreement (benign vs. malignant diagnosis) was higher between local pathology and a consensus of the two expert panelists (11%) than between the two expert panelists both pre-(8%) and postconferral (3%). Conclusions: Although recent guidelines for FNA biopsy and interpretation have been published, the rates of false-positive and false-negative results remain a challenge. Two-thirds of cytology indeterminate cases were benign postoperatively and may decrease with the development of an accurate molecular diagnostic test. High disagreement rates between local and expert panel histopathology diagnosis suggests that central review for surgical diagnoses should be used when developing diagnostic tests based on resected thyroid specimens.

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Section: Updated Meta-review Resultsmentioning

confidence: 99%

A Large Multicenter Correlation Study of Thyroid Nodule Cytopathology and Histopathology

Wang

Friedman

Kennedy

et al. 2011

Thyroid

320

257

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“…However, this stresses the importance that nodule size cannot be the single determinant of which nodule to biopsy, and furthermore the need to biopsy more than one nodule in case of ‘high-risk’ features found in additional nodules on US, according to guidelines [11]. However, a false-negative rate of 2.3% is still acceptable when compared to other studies reporting a false-negative rate between 4 and 17% [3,5,16,17,18]. …”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Papillary Thyroid Microcarcinoma in Danish Patients: A Prospective Study of 854 Consecutive Patients with a Cold Thyroid Nodule Undergoing Fine-Needle Aspiration

et al. 2012

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We aimed to investigate the diagnostic accuracy of ultrasound (US)-guided fine-needle aspirates (FNAs) obtained from 854 consecutive Danish patients with a scintigraphically cold thyroid nodule in a borderline iodine-deficient area. Clinical, sonographic, and pathological findings in patients with a cold thyroid nodule undergoing US-guided FNA were prospectively registered. 408 patients underwent thyroid surgery, resulting in 50 cancers and in addition 37 patients had an incidental finding of papillary thyroid microcarcinomas. Based on the diagnostic FNA, we found sensitivity and specificity for malignancy of 73.9 and 99.2%, respectively. The positive and negative predictive values of a diagnostic FNA for malignancy were 89.5 and 97.7%. We identified 6 false-negative and 2 false-positive diagnoses. Solid versus cystic feature of the nodule, as well as >2 high-risk US features, were predictive for malignancy. Cancer incidence was 13% among females and 9% among males. The accuracy of a diagnostic set-up based on clinical examination, scintigraphy, US, and US-guided FNA was determined with a 48% rate of histopathological validation in the cohort. The overall thyroid cancer incidence has increased worldwide, but our results suggest that the most frequent occurring cancer is an incidental papillary thyroid microcarcinoma of which the clinical significance has yet to be established.

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“…In the literature, the reported incidences of falsepositive FNA and false-negative FNA range from 0 to 9% and from 1 to 7% respectively (1,15,(24)(25)(26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

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

Rorive

D’Haene²,

Fossion³

et al. 2010

European Journal of Endocrinology

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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.

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Recent Experience With Preoperative Fine-Needle Aspiration Biopsy of Thyroid Nodules in a Community Hospital

Cited by 44 publications

References 9 publications

A Large Multicenter Correlation Study of Thyroid Nodule Cytopathology and Histopathology

A Large Multicenter Correlation Study of Thyroid Nodule Cytopathology and Histopathology

High Prevalence of Papillary Thyroid Microcarcinoma in Danish Patients: A Prospective Study of 854 Consecutive Patients with a Cold Thyroid Nodule Undergoing Fine-Needle Aspiration

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

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