The atypical thyroid fine‐needle aspiration: Past, present, and future

Bongiovanni, Massimo; Krane, Jeffrey F.; Cibas, Edmund S.; Faquin, William C.

doi:10.1002/cncy.20178

Cited by 111 publications

(112 citation statements)

References 56 publications

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“…The literature strongly suggests that the ROM for AUS/FLUS lesions is significantly higher than postulated by the Bethesda Classification creators (20,24,(28)(29)(30). Additionally, some literature suggests that the ROM in AUS/FLUS may not be significantly lower than FN/SFN (21,29). Bongiovanni and cols.…”

Section: Current Management Of Cytologically Benign Thyroid Fna Biopsiesmentioning

confidence: 98%

“…The Bethesda system created three indeterminate categories: atypia or follicu-multicenter clinical trials investigating immunohistochemical markers are lacking (34). Thus, most cytopathologists view immunohistochemistry as having a very limited role in thyroid cytology (29).…”

Section: Application Of Immunohistochemistry To Fna Cytologymentioning

confidence: 99%

“…The available clinical validity data are limited to retrospective analyses of methodologies from academic laboratories (38,39), and no data are available to assess the analytical or clinical validity of commercially available DNA mutation panels. BRAF mutations are uncommon in Bethesda categories III and IV (37,38), and RET/PTC and PAX8/PPARG translocations are rare in all cytologically indeterminate categories (29,34,38). BRAF Molecular diagnostic of thyroid nodules Veracyte Afirma gene expression Classifier (geC)…”

Section: Dna Mutation/rearrangement Testingmentioning

confidence: 99%

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Molecular markers in the diagnosis of thyroid nodules

Ward

Kloos²

2013

Arq Bras Endocrinol Metab

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SUMMARYAn indeterminate thyroid nodule cytology result occurs about every sixth fine-needle aspiration. These indeterminate nodules harbor a 24% risk of malignancy (ROM); too high to ignore, but driving surgery where most nodules are benign. Molecular diagnostics have emerged to ideally avoid surgery when appropriate, and to trigger the correct therapeutic surgery when indicated, as opposed to an incomplete diagnostic surgery. No current molecular test offers both high sensitivity and high specificity. A molecular diagnostic test with high sensitivity (e.g. Afirma Gene Expression Classifier sensitivity 90%) offers a high Negative Predictive Value when the ROM is relatively low, such as < 30%. Only such tests can "rule-out" cancer. In this setting, a molecularly benign result suggests the same ROM as that of operated cytologically benign nodules (~6%). Thus, clinical observation can replace diagnostic surgery; increasing quality of life and decreasing medical costs. However, its low specificity cannot "rule-in" cancer as a suspicious result has a Positive Predictive Value (PPV) of ~40%, perhaps too low to routinely reflex to definitive cancer surgery. Conversely, high specificity tests (BRAF, RAS, PPAR/PAX-8, RET/PTC, PTEN) offer high PPV results, and only these tests can "rule-in" cancer. Here a positive molecular result warrants definitive therapeutic surgery. However, their low sensitivity cannot "rule-out" cancer and a negative molecular result cannot dissuade diagnostic surgery; limiting their cost-effectiveness. Whether or not there is a useful and cost-effective role to sequentially combine these approaches, or to modify existing approaches, is under investigation. Arq Bras Endocrinol Metab. 2013;57(2):89-97 Keywords Biopsy, fine-needle; DNA mutational analysis; gene expression; genomics; molecular diagnostic techniques SUMáRioResultados indeterminados na citologia de um nódulo tireoidiano ocorrem em cerca de um a cada seis punções aspirativas por agulha fina. Esses nódulos indeterminados apresentam risco de malignidade (RM) de cerca de 24%, um valor alto demais para ser ignorado e que leva à cirurgia em casos em que a maioria dos nódulos é benigna. O diagnóstico molecular é uma forma ideal de se evitar a cirurgia quando apropriado e de se levar ao correto procedimento cirúrgico terapêutico quando indicado, em oposição à cirurgia diagnóstica incompleta. Atualmente, não existem testes moleculares com alta sensibilidade e especificidade. Um teste molecular de alta sensibilidade (por exemplo, a sensibilidade do teste Afirma Gene Expression Classifier é de 90%) tem um alto Valor Preditivo Negativo quando o RM é relativamente baixo, por exemplo, < 30%. Apenas esses testes podem "excluir" o câncer. Nesse contexto, um resultado molecular benigno sugere o mesmo RM de nódulos com resultado benigno na citologia e operados (~6%). Assim, a observação clínica pode substituir a cirurgia diagnóstica, aumentando a qualidade de vida e diminuindo os custos médicos. Entretanto, a baixa especificidade não pode "incluir" o cân...

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Section: Current Management Of Cytologically Benign Thyroid Fna Biopsiesmentioning

confidence: 98%

Section: Application Of Immunohistochemistry To Fna Cytologymentioning

confidence: 99%

Section: Dna Mutation/rearrangement Testingmentioning

confidence: 99%

See 1 more Smart Citation

Molecular markers in the diagnosis of thyroid nodules

Ward

Kloos²

2013

Arq Bras Endocrinol Metab

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“…However several international studies and reviews have been published in this regard. (6,13,15,(20)(21)(22)(23)(24)(25)(26)(27) This study was performed to study the diagnostic utility of TBSRTC for reporting the rate of thyroid malignancies.…”

Section: Introductionmentioning

confidence: 99%

The Bethesda System for Reporting Thyroid Cytopathology : A Five-Year Retrospective Review of One Center Experience

Mufti¹,

Molah²

2012

IJHS

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Abstract:Fine-needle aspiration (FNA) of the thyroid gland is a widely accepted and accurate method for triaging patients with thyroid nodules. Thyroid FNA suffers from a reporting confusion due to multiplicity of category terminologies. To address this, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was recently introduced for unifying the terminology and morphologic criteria along with the corresponding risk of malignancy.Objective: The aim of this study was to report the diagnostic utility of TBSRTC at our institution and report the malignancy risk for FNA of thyroid lesions among Saudi patients using this system at KAUH (King Abdulaziz University Hospital), Jeddah, Saudi Arabia. Materials and methods: A retrospective study identifying 250 thyroid FNAs performed among Saudi patients between Jan 2005-Dec 2010 was undertaken. Cytology specimen data was collected through a computerized search of our cytopathology archives. Results: Among the 250 thyroid FNAs, 84 were followed by surgical resection. The overall surgical yield of malignancy was 23.8%. The malignancy rate for the 6 categories was as follows: non diagnostic: 20%, benign: 3.1%, atypia of undetermined significance: 50%, suspicious for follicular neoplasm: 20%, suspicious for malignancy: 80%, malignant: 100%. Conclusion:Retrospective classification of FNAs of thyroid lesions among Saudi patients using TBSRTC at KAAUH, Jeddah, Saudi Arabia, validates the diagnostic reproducibility of this system and yields similar results for risk of malignancy as reported by others. However the associated rates found for non diagnostic (20%) raise the possibility of malignancy risk in this category and validate the past observations that sample inadequacy is a common cause of false negative thyroid FNAs.

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“…The category of FLUS, although not perfect, brings some relevant information, which helps physicians to find the optimal management. According to published reports, diagnosis of FLUS constitutes about 1% up to nearly 20% of all cytological outcomes (10,11,12,13,14,15,16,17,18,19,20,21). In our material, such diagnosis is made in 3.8% of patients subjected to FNAB and constitutes above 57% of outcomes in the case of follicular lesions.…”

Section: Discussionmentioning

confidence: 60%

Low malignancy risk of thyroid follicular lesion of undetermined significance in patients from post-endemic areas

Słowińska-Klencka¹,

Wozniak²,

Wojtaszek³

et al. 2013

European Journal of Endocrinology

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Objective: New classification of the thyroid fine-needle aspiration biopsy (FNAB) results tries to stratify the risk of malignancy of thyroid follicular lesions using 'follicular lesion of undetermined significance' (FLUS) subcategory. Clinical significance of this category in the endemic (or post-endemic) areas has not been clearly established. Design: The aim of the study was to determine the risk of malignancy for FLUS as well as to evaluate ultrasound (US) malignancy risk features (MRF) in such nodules in comparison with 'suspicious for neoplasm' (SFN) and 'benign lesions' (BL). Methods: The US images and cytological diagnoses of 589 thyroid follicular lesions were analysed from January 2010 to July 2012. Cytological follow-up was assessed in 110 cases and surgical one in 100 cases. Results: FLUS was diagnosed in 340 cases (3.8% of all cytological diagnoses and 57% of thyroid follicular lesions). Altogether, clinical and/or surgical follow-up revealed thyroid cancer in 3.2% patients with FLUS nodules. Repeat FNAB led to more specific diagnosis in 74.4% of FLUS (3.5%, papillary cancers or their suspicion; 2.3%, SFN; 68.6%, BL). The histopathological examination showed thyroid cancer in 6.4% cases of FLUS and 7.0% of SFN and follicular adenoma in 8.5% of FLUS and 11.6% of SFN (NS, FLUS vs SFN). FLUS showed MRF of intermediate values between BL and SFN; SFN more often than FLUS showed at least two MRF (53 vs 30%, P!0.0001). Conclusions: The risk of cancer in FLUS in areas with recently corrected iodine supply is low. In such areas, repeated biopsy leads to more precise cytological diagnosis in about 3/4 cases.

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The atypical thyroid fine‐needle aspiration: Past, present, and future

Cited by 111 publications

References 56 publications

Molecular markers in the diagnosis of thyroid nodules

Molecular markers in the diagnosis of thyroid nodules

The Bethesda System for Reporting Thyroid Cytopathology : A Five-Year Retrospective Review of One Center Experience

Low malignancy risk of thyroid follicular lesion of undetermined significance in patients from post-endemic areas

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