1
|
Puga FM, Ferreira IP, Brandão JR, Fonseca L, Couto de Carvalho A, Freitas C. Comparison of Cytological Adequacy between 23- and 25-Gauge in Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules: A Single-Center Prospective Study. Acta Cytol 2024; 68:121-127. [PMID: 38599193 DOI: 10.1159/000538290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/08/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Approximately 15% of fine-needle aspiration (FNA) of thyroid nodules are considered nondiagnostic. Several factors are potentially involved, including clinical and nodule features but also the gauge (G) of the needle used. However, few studies have compared the cytological adequacy obtained with different gauge needles and the data are controversial. We aimed to evaluate cytological adequacy results using 23- or 25-G needles. METHODS This study is an observational and prospective study of thyroid nodules submitted to ultrasound-guided FNA. The procedure was performed randomly using 23- or 25-G needles. The samples were reported by different cytopathologists who were blinded to the information of the gauge of the needle used. Statistical analysis was performed to compare cytological adequacy of FNA between the two groups. RESULTS A total of 177 thyroid nodules were included - 98 (55.4%) using 23-G and 79 (44.6%) using 25-G needles. The 23-G group presented a higher rate of cytological adequacy (69.4% [68/98] vs. 46.8% [37/79], p = 0.002). No differences were found between the two groups regarding patient or nodule characteristics. On logistic regression, 23-G needles correlated with better cytological adequacy (unadjusted OR 2.57 [95% CI: 1.39-4.77]), even after adjusting for nodule dimension, location, and type of cytology (slides +/- additional liquid-based cytology) (adjusted OR 2.44 [95% CI: 1.23-4.84]). CONCLUSION The gauge of the needle used was found to be an independent predictor of cytological adequacy, with 23-G needles providing more adequate samples. Further investigation is needed to confirm our results in order to stablish the optimal diagnosis technique.
Collapse
Affiliation(s)
- Francisca Marques Puga
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Inês Poças Ferreira
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - José Ricardo Brandão
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Liliana Fonseca
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - André Couto de Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Cláudia Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| |
Collapse
|
2
|
Issa PP, McCarthy C, Hussein M, Albuck AL, Emad E, Shama M, Moroz K, Toraih E, Kandil E. Assessing Adequacy: A Meta-Analysis of Rapid Onsite Evaluation of Thyroid Nodules. J Surg Res 2024; 296:523-531. [PMID: 38330678 DOI: 10.1016/j.jss.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 12/27/2023] [Accepted: 01/07/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Fine-needle aspiration (FNA) is the standard form of preoperative evaluation of thyroid nodule cytological status. A significant number FNAs are classified as inadequate for interpretation, requiring a repeat FNA which is potentially avoidable, costly, and delays treatment. To address these concerns and maximize first-time FNA adequacy, rapid onsite evaluation (ROSE) of FNA specimens was introduced. Our study aims to determine the impact of ROSE on FNA adequacy. METHODS PubMed, Embase, and Web of Science were searched for primary articles assessing the adequacy of ROSE in thyroid nodules. RESULTS A total of 17 studies were included for a total of 24,649 thyroid nodes. Thirteen thousand two hundred fifteen (53.6%) thyroid nodules were assessed utilizing ROSE and 11,434 (46.4%) were not. Pooled adequacy increased significantly from 76% without ROSE to 92% with rose (P = 0.001). Use of ROSE increased the odds of adequate FNA by 22% (risk ratio (RR) = 1.22, 95% confidence interval (CI) = 1.12-1.32). At institutions with less than 85% effective diagnostic adequacy without ROSE, the risk for diagnostic adequacy increased by 28% with ROSE implementation (RR = 1.28, 95% CI = 1.20-1.37). In contrast, in studies reported from institutions with an effective diagnostic rate greater than 85% without the use of ROSE, the diagnostic adequacy only increased by 5% with ROSE implementation (RR = 1.05, 95% CI = 1.03-1.06). CONCLUSIONS The use of ROSE during first-time FNA of thyroid nodules can significantly improve adequacy, especially at institutions with baseline high inadequacy rates. Implementation of ROSE can reduce repeat FNAs and its associated consequences.
Collapse
Affiliation(s)
- Peter P Issa
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana; Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana
| | | | - Mohammad Hussein
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Aaron L Albuck
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana
| | - Essam Emad
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mohamed Shama
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Krzysztof Moroz
- Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Eman Toraih
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana; Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
| |
Collapse
|
3
|
Rechter M, Saraph S, Cohen H, Ronen O. Nondiagnostic Test Result Rates Following Thyroid Extra-Fine-Needle Aspiration. Am J Clin Pathol 2023; 159:98-102. [PMID: 36469111 DOI: 10.1093/ajcp/aqac136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/06/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The first Bethesda classification category of thyroid fine-needle aspiration biopsy (FNAB) is nondiagnostic (ND), which indicates that the specimen's cellularity is inadequate for evaluation. This work investigated the effect of needle diameter size on ND rates by comparing diagnostic outcomes of FNAB samples collected with 23-, 25-, and 27-gauge needles. METHODS This was a retrospective analysis of samples collected from patients undergoing FNAB between 2018 and 2021. It was conducted in an otolaryngology department in a university teaching hospital. RESULTS Of the 699 aspirations, 144, 335, and 220 were performed using 23-, 25-, and 27-gauge needles, respectively. ND rates increased significantly when using 27-gauge compared with 23- to 25-gauge needles (P = .002), and a significantly lower ND rate was found for the 25-gauge needle compared with the 27-gauge needle (P = .001). Furthermore, increased nodule size was associated with reduced ND rate (odds ratio, 0.801; 95% confidence interval, 0.691-0.929). CONCLUSIONS The 25-gauge needles are superior to 27-gauge needles in reducing ND rates of thyroid nodule FNAB specimens. Future prospective studies should be performed to confirm these findings.
Collapse
Affiliation(s)
- Michael Rechter
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Sivan Saraph
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Hector Cohen
- Department of Pathology, Galilee Medical Center, Nahariya, Israeland
| | - Ohad Ronen
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
| |
Collapse
|
4
|
Torregrossa L, Poma AM, Macerola E, Rago T, Vignali P, Romani R, Proietti A, Di Stefano I, Scuotri G, Ugolini C, Basolo A, Antonelli A, Materazzi G, Santini F, Basolo F. The Italian Consensus for the Classification and Reporting of Thyroid Cytology: Cytohistologic and molecular correlations on 37,371 nodules from a single institution. Cancer Cytopathol 2022; 130:899-912. [PMID: 35789118 PMCID: PMC9796474 DOI: 10.1002/cncy.22618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC) includes six diagnostic categories (TIR 1/1C, TIR 2, TIR 3A, TIR 3B, TIR 4, and TIR 5), each indicating a different risk of malignancy. The objective of this monocentric retrospective study was to evaluate the distribution of the ICCRTC classes at the authors' institution and assess their cytohistologic correlations. METHODS The authors retrospectively collected 37,371 consecutive cytologic reports of thyroid nodules and described the clinical-pathologic features of the different cytologic categories. The cytologic diagnoses also were compared with histologic outcomes in a subset of patients. RESULTS The cytologic classes were distributed as follows: nondiagnostic, 15.6%; benign, 66.5%; low-risk indeterminate, 10% (TIR 3A); high-risk indeterminate, 3.5% (TIR 3B); suspicious, 1.7%; and malignant, 2.6%. According to histology, the risk of malignancy was very high in the nondiagnostic category (29.8%), with young male patients more exposed to malignancy, and it was relatively high among benign (7.8%) and indeterminate nodules (32.5% in TIR 3A; 52.1% in TIR 3B), mainly because of the high prevalence of follicular architecture in malignant tumors. On histology, the malignancy rates were 92.4% and 99.3% for the suspicious and malignant categories, respectively; aggressive variants of papillary thyroid carcinoma were mostly diagnosed in these categories. CONCLUSIONS In this series, nondiagnostic nodules showed high prevalence and, surprisingly, high malignancy rates. Malignant tumors with follicular architecture represented a diagnostic pitfall in benign and indeterminate nodules. The suspicious and malignant categories had high specificity for malignancy. Importantly, the ICCRTC had high reliability for identifying preoperatively aggressive histotypes of thyroid carcinoma.
Collapse
Affiliation(s)
- Liborio Torregrossa
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Anello Marcello Poma
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Elisabetta Macerola
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Teresa Rago
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Paola Vignali
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Rossana Romani
- Section of PathologyUniversity Hospital of PisaPisaItaly
| | | | - Iosè Di Stefano
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | | | - Clara Ugolini
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Alessio Basolo
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Alessandro Antonelli
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Ferruccio Santini
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| |
Collapse
|
5
|
Oh J, Yoo TY, Saal TM, Tsay L, Faquin WC, Carlson JC, Deschler DG, Pai SI, Weissleder R. Multiplexed single-cell analysis of FNA allows accurate diagnosis of salivary gland tumors. Cancer Cytopathol 2022; 130:581-594. [PMID: 35666645 PMCID: PMC9542730 DOI: 10.1002/cncy.22594] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/06/2022] [Accepted: 04/23/2022] [Indexed: 11/24/2022]
Abstract
Diagnosing salivary gland tumors (SGTs) through fine-needle aspiration (FNA) biopsies is challenging due to the overlapping cytomorphologic features between benign and malignant tumors. The authors developed an innovative, multiplexed cycling technology for the rapid analyses of single cells obtained from FNA that can facilitate the molecular analyses and diagnosis of SGTs. Antibodies against 29 protein markers associated with 7 SGT subtypes were validated and chemically modified via custom linker-bio-orthogonal probes (FAST). Single-cell homogenates and FNA samples were profiled by FAST cyclic imaging and computational analysis. A prediction model was generated using a training set of 151,926 cells from primary SGTs (N = 26) and validated on a separate cohort (N = 30). Companion biomarker testing, such as neurotrophic tyrosine receptor kinase (NTRK), was also assessed with the FAST technology. The FAST molecular diagnostic assay was able to distinguish between benign and malignant SGTs with an accuracy of 0.86 for single-cell homogenate samples and 0.88 for FNA samples. Profiling of multiple markers as compared to a single marker increased the diagnostic accuracy (0.82 as compared to 0.65-0.74, respectively), independent of the cell number sampled. NTRK expression was also assessed by the FAST assay, highlighting the potential therapeutic application of this technology. Application of the novel multiplexed single-cell technology facilitates rapid biomarker testing from FNA samples at low cost. The customizable and modular FAST-FNA approach has relevance to multiple pathologies and organ systems where cytologic samples are often scarce and/or indeterminate resulting in improved diagnostic workflows and timely therapeutic clinical decision-making.
Collapse
Affiliation(s)
- Juhyun Oh
- Center for Systems BiologyMassachusetts General HospitalBostonMassachusetts
- Department of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Tae Yeon Yoo
- Department of Systems BiologyHarvard Medical SchoolBostonMassachusetts
| | - Talia M. Saal
- Center for Systems BiologyMassachusetts General HospitalBostonMassachusetts
| | - Lisa Tsay
- Center for Systems BiologyMassachusetts General HospitalBostonMassachusetts
| | - William C. Faquin
- Department of PathologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Jonathan C.T. Carlson
- Center for Systems BiologyMassachusetts General HospitalBostonMassachusetts
- Mass General Cancer CenterMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Daniel G. Deschler
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusetts
- Department of Otology and LaryngologyHarvard Medical SchoolBostonMassachusetts
| | - Sara I. Pai
- Center for Systems BiologyMassachusetts General HospitalBostonMassachusetts
- Mass General Cancer CenterMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
- Department of SurgeryMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Ralph Weissleder
- Center for Systems BiologyMassachusetts General HospitalBostonMassachusetts
- Department of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
- Department of Systems BiologyHarvard Medical SchoolBostonMassachusetts
- Mass General Cancer CenterMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
| |
Collapse
|
6
|
Wang J, Wang J, Quan J, Liu J, Tian L, Dong C. Relationship between serum NDRG3 and papillary thyroid carcinoma. Front Endocrinol (Lausanne) 2022; 13:1091462. [PMID: 36619553 PMCID: PMC9811643 DOI: 10.3389/fendo.2022.1091462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In recent years, papillary thyroid carcinoma is considered to be one of the fastest increaseing cancer. NDRG family member 3 (NDRG3) has been proposed as a molecular marker of tumor, and is expected to be used in clinic. METHODS Enzyme-linked immunosorbent assay was used to detect the serum NDRG3 expression in 81 papillary thyroid carcinoma cases, 75 benign thyroid nodules cases and 77 healthy control cases, respectively. Electrochemiluminescence method was applied to measure the levels of triiodothyronine, tetraiodothyronine, thyrotropin, thyroglobulin antibody and thyroid peroxidase antibody. Immunohistochemical staining was used to detect the expression of NDRG3 in papillary thyroid carcinoma, benign thyroid nodules and normal tissues adjacent to cancer. RESULTS The expression of serum triiodothyronine, tetraiodothyronine, thyrotropin, thyroglobulin antibody and thyroid peroxidase antibody and NDRG3 were significantly different among benign thyroid nodules, papillary thyroid carcinoma cases and healthy control groups (P <0.001). Only the expression of serum NDRG3 was significantly different between benign thyroid nodules and papillary thyroid carcinoma groups (P <0.001). Immunohistochemistry showed that NDRG3 was expressed in all three groups, the lowest in papillary thyroid carcinoma, the second in benign thyroid nodules, and the highest in normal tissues adjacent to cancer. Logistic regression analysis showed that serum NDRG3 was an independent protective factor for papillary thyroid carcinoma (OR =0.964, 95%CI =0.953 to 0.974, P <0.001). The ROC curve of non-papillary thyroid carcinoma diagnosed by serum NDRG3 showed the optimal cut-off value of 481.38 pg/ml, sensitivity of 72.4%, specificity of 90.1%, and the maximum area under the curve (AUC =0.902, 95%CI =0.863 to 0.940, P <0.001). The ROC curve of benign thyroid nodules diagnosed by serum NDRG3 showed the optimal critical value of 459.28 pg/ml, sensitivity of 81.3%, and specificity of 74.1% (AUC =0.863, 95%CI =0.808 to 0.919, P <0.001). The expression level of serum NDRG3 was significantly correlated with extrathyroid extensionand (P =0.007) and lymphatic metastasis of papillary thyroid carcinoma (P =0.019). CONCLUSIONS The decrease of NDRG3 expression can not only differential diagnosis benign thyroid nodules and papillary thyroid carcinoma, but also serve as a molecular marker for the diagnosis of papillary thyroid carcinoma.
Collapse
Affiliation(s)
- Jiahao Wang
- The First Clinical College of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Jun Wang
- Department of Thyroid and Breast Surgery, Gansu Cancer Hospital, Lanzhou, Gansu, China
| | - Jinxing Quan
- Department of Endocrinology in Gansu Provincial People’s Hospital and The First Clinical College of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
- *Correspondence: Jinxing Quan,
| | - Juxiang Liu
- Department of Endocrinology in Gansu Provincial People’s Hospital and The First Clinical College of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Limin Tian
- Department of Endocrinology in Gansu Provincial People’s Hospital and The First Clinical College of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Changhong Dong
- Radiotherapy Department of Gansu Maternal and Child Health Hospital, Lanzhou, Gansu, China
| |
Collapse
|
7
|
Sengul I, Sengul D. DELICATE NEEDLE WITH THE FINEST GAUGE FOR A BUTTERFLY GLAND, THE THYROID:IS IT WORTH MENTIONING? SANAMED 2021. [DOI: 10.24125/sanamed.v16i2.515] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|