1
|
Chakrabarty N, Mahajan A, Basu S, D’Cruz AK. Comprehensive Review of the Imaging Recommendations for Diagnosis, Staging, and Management of Thyroid Carcinoma. J Clin Med 2024; 13:2904. [PMID: 38792444 PMCID: PMC11122658 DOI: 10.3390/jcm13102904] [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: 04/18/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Thyroid cancer is the most common head and neck cancer (HNC) in the world. In this article, we comprehensively cover baseline, posttreatment, and follow-up imaging recommendations for thyroid carcinomas along with the eighth edition of the tumor, node, metastasis (TNM) staging system proposed by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). We include characterization and risk stratification of thyroid nodules on ultrasound (US) proposed by various international bodies. Management guidelines (depending upon the type of thyroid carcinoma) based on the international consensus recommendations (mainly by the American Thyroid Association) are also extensively covered in this article, including the role of a radioiodine scan. The management of recurrent disease is also briefly elucidated in this article. In addition, we cover the risk factors and etiopathogenesis of thyroid carcinoma along with the non-imaging diagnostic workup essential for thyroid carcinoma management, including the significance of genetic mutations. US is the diagnostic imaging modality of choice, with US-guided fine needle aspiration (FNA) being the procedure of choice for tissue diagnosis. The roles of computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) in thyroid carcinoma staging are also specified. Through this article, we aim to provide a comprehensive reference guide for the radiologists and the clinicians in the pursuit of optimal care for patients with thyroid carcinoma.
Collapse
Affiliation(s)
- Nivedita Chakrabarty
- Department of Radiodiagnosis, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India;
| | - Abhishek Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, 65 Pembroke Place, Liverpool L7 8YA, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India;
| | - Anil K. D’Cruz
- Apollo Hospitals, Navi Mumbai 400614, Maharashtra, India;
- Foundation of Head Neck Oncology, Mumbai 400012, Maharashtra, India
- Union International Cancer Control (UICC), 1202 Geneva, Switzerland
| |
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
|
Toong LY, Ghauth S. Surgeon-performed ultrasound-guided head and neck procedures during COVID-19 pandemic. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [PMCID: PMC9166173 DOI: 10.1186/s43163-022-00258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background The ultrasonographic procedure is a common diagnostic and therapeutic method in daily medical practice. Surgeon-performed ultrasound (SUS) has been gaining popularity, especially during this COVID-19 pandemic. Methods Two ENT surgeons performed US-guided diagnostic or therapeutic procedures in the outpatient clinic. A successful SUS is defined as the diagnostic procedure's ability to facilitate the final histopathological diagnosis that can guide the subsequent treatment and disease resolution following the therapeutic procedure without the need for more invasive open surgical intervention. Results Out of 10 participants, 6 are males, and 4 are females. There were no complications noted. All subjects had successful tissue sampling or intervention on the first attempt for diagnostic and therapeutic SUS. Conclusions With COVID-19, there has been a significant shift in ordinary medical practice. SUS is proven to be a safe and effective method to facilitate the management of head and neck pathologies.
Collapse
|
4
|
Yildirim E, Akbas P, Erdogan KO, Bektas S, Gumuskaya PO, Er AM, Paltura C. The comparison of the histopathological results of the thyroid fine-needle aspiration biopsies in the 795 patients with thyroidectomy. Diagn Cytopathol 2021; 49:671-676. [PMID: 33560593 DOI: 10.1002/dc.24718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND We aimed to evaluate the effectiveness of preoperative fine-needle aspiration biopsies (FNAB) by the postthyroidectomy pathology results. METHOD Seven hundred and ninety-five patients with FNAB and following thyroid operations which have been performed between April 2008 and December 2019 were included in this study. By comparing the results of the FNAB and final pathologies, the specificity, sensitivity, FNR, false positivity ratio (FPR), accuracy and also the effect of nodule diameter on these have been evaluated. In Bethesda III subgroup according to FNAB, we investigated the malignancy rates and in whom this risk has been increased more. RESULTS In our study, the sensitivity of FNAB is 73.40%, the specificity is 95.33%, the accuracy is 91.81%, FNR is 26.60% and FPR is 4.67%. In the patients with nodules ≥4 cm and < 4 cm respectively, we calculated the sensitivity 20.0% vs 79.76%, specificity 95.73% vs 95.19%, accuracy 89.82% vs 92.78%, FNR 80.0% vs 20.24%, FPR 4.27% vs 4.8%. CONCLUSION Thyroid FNAB is an easy procedure with a high specificity and sensitivity. Nevertheless, when the nodule diameter was ≥4 cm, increased FNR and decreased sensitivity should be kept in mind while evaluating the patients.
Collapse
Affiliation(s)
- Emine Yildirim
- Department of General Surgery, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Pelin Akbas
- Department of Pathology, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Kivilcim Orhun Erdogan
- Department of General Surgery, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Sibel Bektas
- Department of Pathology, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Perihan Ozkan Gumuskaya
- Department of İnternal Medicine, University of Health Sciences Turkey, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ahmet Muzaffer Er
- Department of General Surgery, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Ceki Paltura
- Department of Otolaryngology, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
5
|
Donmez M, Aydin H, Kose E, Kahramangil B, Erten O, Gokceimam M, Akbulut S, Jin J, Krishnamurthy V, Shin J, Siperstein A, Berber E. Standardization of thyroid fine needle aspiration procedure and outcomes within an endocrine surgery department. Gland Surg 2021; 10:567-573. [PMID: 33708540 DOI: 10.21037/gs-20-630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Fine needle aspiration (FNA) biopsy is an essential procedure for thyroid nodules. Although, the efficacy of surgeon-performed thyroid FNA biopsies has been demonstrated in the literature, there are insufficient data regarding how to establish an efficient program with a low insufficiency rate within a group practice. Methods An endocrine surgery thyroid FNA biopsy program was established in 2000 by one surgeon, with training of additional partners during fellowship and upon recruitment. The results within 18 years were analyzed. The FNA biopsies were performed by endocrine surgeons under ultrasound guidance without on-site pathologist review. Results A total of 5,469 FNA biopsies were performed by 7 surgeons. The total number of FNA biopsies performed by each surgeon varied between 291-1,378. FNA biopsies were performed in 2 passes using 22-gauge needles under constant suction. The overall insufficiency rate was 4.3%, with individual surgeon rates ranging between 2.7% and 7.2%. The insufficiency rate for the whole team ranged between 3.3% and 5% when examined in 5-year blocks. Conclusions This study shows that an establishment of a highly efficient thyroid FNA biopsy program within a group practice is possible with a structured endocrine surgical training and adoption of a standard technique.
Collapse
Affiliation(s)
- Mustafa Donmez
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Husnu Aydin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Emin Kose
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Bora Kahramangil
- Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Ozgun Erten
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Mehmet Gokceimam
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Serkan Akbulut
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Judy Jin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joyce Shin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Allan Siperstein
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
6
|
Dhingra JK. Ultrasound-Guided Fine-Needle Biopsy of First 1000 Consecutive Thyroid Nodules: Single-Surgeon Experience. OTO Open 2020; 4:2473974X20929008. [PMID: 32537553 PMCID: PMC7268147 DOI: 10.1177/2473974x20929008] [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: 03/24/2020] [Accepted: 04/23/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To study the feasibility, safety, and learning curve of ultrasound-guided fine-needle biopsy (USGFNB) performed by a newly trained otolaryngologist in a community office in a setting. Study Design Collect USGFNB data of all thyroid nodules in a prospective manner. Setting A dedicated ultrasound clinic in a large community-based practice, operated by a single surgeon with the purpose of providing office-based point-of-care diagnostic ultrasonography and USGFNB. Subjects and Methods Data on the first 1000 unselected consecutive thyroid nodules that underwent USGFNB over a 3-year period were analyzed. Chi-square analysis was used to assess the statistical significance of characteristics of diagnostic vs nondiagnostic nodules. A multivariate regression analysis was conducted to determine nodule characteristics predictive of adequate sampling. Diagnostic yield and time efficiency data were plotted over a 3-year period to study the learning curve for the USGFNB procedure performed by an operator with no previous experience. Results A total of 1000 nodules in 734 patients including 142 males and 592 females (age range, 17-87 years) were studied. Of the patients, 188 of 734 had more than 1 nodule biopsied, with a maximum of 4 nodules biopsied in 1 setting. The procedure was successfully completed in all patients, with no major complications. A steep learning curve was observed, and adequate samples were obtained in 91.9% of the patients on the first attempt. The cystic nature of the nodule was the biggest predictor of a nondiagnostic yield. Conclusions Otolaryngologist-performed USGFNB of the thyroid is safe, effective, and desirable.
Collapse
Affiliation(s)
- Jagdish K Dhingra
- Department of Otolaryngology-Head and Neck Surgery Tufts Medical Center, ENT Specialists, Inc, Brockton, Massachusetts, USA
| |
Collapse
|
7
|
Wang J, Zhu Y, Song Y, Xu G, Yu H, Wang T, Zhang B. Determining whether surgeons perform thyroid fine-needle aspiration as well as radiologists: an analysis of the adequacy and efficiency of ultrasound-guided fine-needle aspiration performed by newly trained head and neck surgeons and radiologists. Gland Surg 2020; 9:711-720. [PMID: 32775261 DOI: 10.21037/gs.2020.03.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Ultrasound-guided fine-needle aspiration (FNA) cytology is a crucial diagnostic technique used to assess thyroid nodules. In the past, ultrasound-guided FNA was performed mainly by radiologists. However, many surgeons are increasingly being trained for this procedure now. In this study, we aimed to compare the adequacy and efficiency of ultrasound-guided FNA performed by newly trained head and neck surgeons with experienced radiologists in a single institution. We also assessed the malignancy rates in nondiagnostic nodules and the differences between benign and malignant nodules. Methods This is a retrospective study. The data from patients who underwent ultrasound-guided FNA performed by surgeons or radiologists in two consecutive years were collected. Medical records, cytology results, and surgical pathology results were analyzed. Results During the study period, a total of 2,405 ultrasound-guided FNAs were performed on 2,163 patients. The head and neck surgeons and radiologists performed 1,132 and 1,273 ultrasound-guided FNA procedures, respectively. The nondiagnostic rate was 14.49% for surgeons and 15.40% for radiologists (P=0.533). There were no differences in patient age, gender, nodule size, and other sonographic characteristics between the groups of patients who were treated by radiologists versus surgeons. The median waiting time from biopsy appointment to performing ultrasound-guided FNA was 0 days for head and neck surgeons, and 6 days for radiologists (P<0.001). Of the 40 patients who had a repeat FNA or surgery, 19 (47.50%) had a malignancy. Preoperative information about age, gender, operator, and characteristics of nodules did not predict the outcome of nodules with Bethesda category I. Conclusions The adequacy of ultrasound-guided FNAs performed by head and neck surgeons is similar to that of skilled radiologists, while surgeons are more efficient than radiologists. Nondiagnostic FNA reports should not be considered benign, and repeat FNA or selective surgical treatment is recommended.
Collapse
Affiliation(s)
- Jiaxin Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yanli Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yuntao Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Guohui Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Hao Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Tianxiao Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Bin Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| |
Collapse
|
8
|
The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
Collapse
|
9
|
Zhu Y, Song Y, Xu G, Fan Z, Ren W. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC): A report of 2,781 cases in a Chinese population. Chin J Cancer Res 2020; 32:140-148. [PMID: 32410792 PMCID: PMC7219100 DOI: 10.21147/j.issn.1000-9604.2020.02.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective To evaluate the diagnostic utility of The Bethesda System for Reporting Thyroid Cytology (TBSRTC) at Peking University Cancer Hospital, the incidence of noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), and the impact of reclassification on cytopathological outcomes. Methods We performed a retrospective study of thyroid fine-needle aspiration (FNA) cases between April 2014 and March 2019. The FNA results were classified according to TBSRTC. Post-surgery histological findings were followed up. Results A total of 2,781 thyroid FNAs were performed. The incidences of the 6 diagnostic categories (DCs I-VI) were 14.8%, 17.1%, 15.8%, 2.3%, 11.6% and 38.5%, respectively. A total of 1,122 patients (40.3%) had corresponding histological results. NIFTP accounted for 0.4% of papillary thyroid carcinoma (PTC) cases, and there was no significant difference in the risk of malignancy (ROM) for each TBSRTC DC between "NIFTP=carcinoma (Ca)" and "NIFTP≠Ca". When "NIFTP=Ca", the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of TBSRTC were 98.0%, 84.0%, 99.4%, 58.3%, and 97.5%, respectively. When "NIFTP≠Ca", the sensitivity, specificity, PPV, NPV and accuracy of the TBSRTC were 98.1%, 81.5%, 99.3%, 61.1%, and 97.5%, respectively. Conclusions TBSRTC is effective in the preoperative diagnosis of thyroid nodules in Peking University Cancer Hospital. The impact of the reclassification of NIFTP on cytopathological outcomes is limited because of its low incidence, and the revised ROMs are not suitable for Asian patients.
Collapse
Affiliation(s)
| | | | | | - Zhihui Fan
- Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | | |
Collapse
|
10
|
Horvath L, Kraft M. Evaluation of ultrasound and fine-needle aspiration in the assessment of head and neck lesions. Eur Arch Otorhinolaryngol 2019; 276:2903-2911. [DOI: 10.1007/s00405-019-05552-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/06/2019] [Indexed: 12/17/2022]
|
11
|
Jiang D, Zang Y, Jiang D, Zhang X, Zhao C. Value of rapid on-site evaluation for ultrasound-guided thyroid fine needle aspiration. J Int Med Res 2018; 47:626-634. [PMID: 30463462 PMCID: PMC6381502 DOI: 10.1177/0300060518807060] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective Application of rapid on-site evaluation (ROSE) for thyroid fine needle aspiration (FNA) is controversial. Therefore, ROSE has not been universally applied. This study aimed to evaluate the value of ROSE for ultrasound-guided thyroid FNA. Methods A total of 997 patients with 1103 suspicious thyroid nodules had ultrasound-guided FNA performed from January 2016 to February 2018. There were 513 nodules with ROSE and 590 nodules without ROSE. The cytological nondiagnostic rate, needle passes, and procedural times of thyroid FNA with or without ROSE were compared. The nondiagnostic rates of subsets of suspicious thyroid nodules were further compared. Results There was no significant effect of ROSE on the nondiagnostic rate of FNA. However, FNA with ROSE significantly reduced the numbers of sub-centimeter, mixed solid-cystic, macrocalcified, and hypervascular nodules. There was a significantly smaller number of needle passes and less procedural times with ROSE than without ROSE. There was no significant difference in the complication rate of FNA with and without ROSE. Conclusion ROSE for thyroid FNA reduces the number of needle passes and procedural times. ROSE has a higher clinical application value in subsets of thyroid nodules, which tend to be difficult to diagnose with FNA.
Collapse
Affiliation(s)
- Danni Jiang
- 1 Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yichen Zang
- 1 Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dandan Jiang
- 2 Department of Breast Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojuan Zhang
- 1 Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng Zhao
- 1 Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
12
|
Kahramangil B, Kose E, Donmez M, Aydin H, El-Dabh D, Krishnamurthy V, Jin J, Shin JJM, Siperstein A, Berber E. Efficacy of surgeon-performed, ultrasound-guided lymph node fine needle aspiration in patients with thyroid pathologic conditions. Surgery 2018; 164:657-664. [PMID: 30072253 DOI: 10.1016/j.surg.2018.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although the concept of surgeon-performed fine needle aspiration of thyroid nodules is established, experience with surgeon-performed lymph node fine needle aspiration is scant. We aimed to study the efficacy of surgeon-performed lymph node fine needle aspiration in patients with thyroid pathologic conditions. METHODS This is an institutional review board-approved study of patients with thyroid pathologic conditions who underwent surgeon-performed lymph node fine needle aspiration between 2002 and 2017. Efficacy and utility were analyzed. RESULTS A total of 201 patients with benign nodular goiter (n = 30) and thyroid cancer (n = 200) underwent 230 lymph node fine needle aspirations (89 during preoperative workup, 141 at postoperative follow-up). Insufficient aspiration rate was 6% and indeterminate cytologic results 3%. In 91% of patients with suspicious lymph nodes, definite diagnosis could be obtained by fine needle aspiration; 51% (n = 118) of fine needle aspirations indicated metastasis from thyroid cancer and 40% (n = 91) benign findings. Sensitivity and specificity of lymph node fine needle aspiration in diagnosing nodal metastasis were 92% and 89%, respectively. Cytologic testing and thyroglobulin washout indicated 95% concordance. On logistic regression, spherical shape, microcalcifications, cystic appearance, and loss of hilum on ultrasound independently predicted lymph node metastasis. CONCLUSION Our data indicate that an adequate surgeon-performed lymph node fine needle aspiration is highly accurate in diagnosing nodal status in thyroid pathologic conditions. We recommend adoption of this technique, when feasible, to develop an efficient, comprehensive thyroid practice.
Collapse
Affiliation(s)
- Bora Kahramangil
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | - Emin Kose
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | - Mustafa Donmez
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | - Husnu Aydin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | - Daniel El-Dabh
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Judy Jin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Allan Siperstein
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
13
|
Song JSA, Dmytriw AA, Yu E, Forghani R, Rotstein L, Goldstein D, Poon CS. Investigation of thyroid nodules: A practical algorithm and review of guidelines. Head Neck 2018; 40:1861-1873. [PMID: 29607563 DOI: 10.1002/hed.25160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/28/2017] [Accepted: 02/14/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND High resolution ultrasound has led to early detection of subclinical tumors and drastic increase in incidence of thyroid malignancy. To achieve a balance in appropriate investigation without perpetuating an overdiagnosis phenomenon, a concise set of evidence-based recommendations to stratify risk is required. METHODS We sought to assemble an evidence-based diagnostic algorithm and accompanying pictorial review for workup of thyroid nodules that summarizes the most recent guidelines. In addition, we conducted a literature search and analysis of our imaging databases. RESULTS Although many imaging features of benign and malignant nodules can be nonspecific, others, such as microcalcifications, lymphadenopathy, and peripheral invasion, are highly suggestive of malignancy. The predictive values of salient imaging characteristics are presented. CONCLUSION Evidence-based guidelines are available such that a cost-effective algorithm for thyroid nodule workup can be devised. Conservative management with a focus on periodic monitoring is the working clinical consensus on the approach to thyroid nodules.
Collapse
Affiliation(s)
- Jin Soo A Song
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Adam A Dmytriw
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Yu
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Reza Forghani
- Department of Radiology, Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | - Lorne Rotstein
- Department of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Goldstein
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Colin S Poon
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
14
|
Ahn D, Jeong JY. Reply to: Partial Verification Distorts Estimates of Sensitivity in Diagnostic Accuracy Studies for Fine-Needle Aspiration Cytology. Ann Surg Oncol 2017; 24:637-638. [PMID: 29071659 DOI: 10.1245/s10434-017-6154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Ji Yun Jeong
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
15
|
Gill AS, Amdur R, Joshi AS. Importance of FNA Technique for Decreasing Non-diagnostic Rates in Thyroid Nodules. Head Neck Pathol 2017; 12:160-165. [PMID: 28819755 PMCID: PMC5953868 DOI: 10.1007/s12105-017-0844-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/31/2017] [Indexed: 01/26/2023]
Abstract
To identify potential interventions that may lower the high non-diagnostic rates associated with ultrasound guided (US) fine needle aspiration (FNA) biopsy of the thyroid nodule. A case series of 164 thyroid nodule US-guided FNA was identified retrospectively. The following variables were analyzed in regards to diagnostic and non-diagnostic sampling: patient age, gender, size of nodule, biopsy technique (capillary vs. aspiration), needle gauge (23 vs. 25), and physician experience. The FNA diagnosis, and final pathology, when applicable, was recorded for each sample using the Bethesda criteria. Data was analyzed using the Fisher's exact test or the chi square test. After multivariate logistic regression, capillary action was independently associated with lower non-diagnostic rates (p = 0.01), while increasing patient age was associated with higher non-diagnostic rates (p = 0.018). Physician experience (p = 0.014) was not independently associated with lower non-diagnostic rates. Nodules that were "cystic >50%" were significantly more likely to yield a non-diagnostic result (p < 0.0001). After taking into account confounding variables, including physician experience, our data reveals a statistically significant decrease in non-diagnostic rates with the use of capillary action vs. aspiration technique in US-guided FNA. A major focus in healthcare today is providing cost-effective and minimally invasive care to the patient. In the setting of a rising incidence of thyroid disease, we believe our study demonstrates the need for a prospective analysis of the relationship between technique and non-diagnostic rates.
Collapse
Affiliation(s)
- Amarbir S Gill
- Division of Otolaryngology - Head and Neck Surgery, The University of California, Davis, 2521 Stockton Blvd. #7200, Sacramento, CA, 95817, USA.
| | - Richard Amdur
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University, Washington, DC, USA
| | - Arjun S Joshi
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University, Washington, DC, USA
| |
Collapse
|
16
|
Manning AM, Yang H, Falciglia M, Mark JR, Steward DL. Thyroid Ultrasound-Guided Fine-Needle Aspiration Cytology Results: Observed Increase in Indeterminate Rate over the Past Decade. Otolaryngol Head Neck Surg 2017; 156:611-615. [PMID: 28118554 DOI: 10.1177/0194599816688190] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives To evaluate changes in distribution of reported thyroid nodule fine-needle aspiration (FNA) cytopathology results since implementation of the Bethesda classification and revised 2015 American Thyroid Association (ATA) guidelines for selecting nodules for biopsy. Study Design Retrospective review. Setting Tertiary academic medical center. Subjects and Methods Evaluation of ultrasound (US)-guided thyroid FNA by a single surgeon using 2015 ATA nodule selection criteria and Bethesda reporting on 211 thyroid nodules in a 1-year period (2015). Comparison is made to an earlier sample wherein any nodule >1 cm underwent US FNA with cytology reported prior to Bethesda consensus (2006). Results The current cohort involved mostly women (79%); nodules ranged from 1 to 7 cm (mean ± SEM, 2.4 ± 0.07 cm). Mean ± SEM age was 53.5 ± 1.1 years. Bethesda reporting yielded 6% nondiagnostic, 57% benign, 3% malignant, and 34% indeterminate (27% atypia of undetermined significance [AUS]/follicular lesion of undetermined significance [FLUS], 4% follicular neoplasm [FN]/Hürthle neoplasm [HN], and 2% suspicious for malignancy [SFM]). The malignancy rate in indeterminate nodules was 26% (18% AUS/FLUS, 33% FN/HN, and 80% SFM). Age, sex, or nodule size did not correlate with indeterminate cytology. The comparator sample of 447 nodules had significantly different distribution, with 7% nondiagnostic, 80% benign, 5% malignant, and 8% indeterminate ( P < .00001). Conclusion We observed a significantly increased proportion of indeterminate cytology and corresponding decrease in benign nodules compared with an earlier sample, predominately from an increase in AUS/FLUS. Multiple factors are likely involved, including selection of sonographically suspicious nodules for biopsy based upon 2015 ATA guidelines coupled with cytopathological interpretation by a new generation of cytopathologists trained in the era of Bethesda reporting; further study is required to make a definitive conclusion.
Collapse
Affiliation(s)
- Amy M Manning
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, USA
| | - Huaitao Yang
- 2 Department of Pathology and Laboratory Medicine. University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, USA
| | - Mercedes Falciglia
- 3 Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine. University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan R Mark
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, USA
| | - David L Steward
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, USA.,3 Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine. University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
17
|
Patel R, R. Skandarajah A, Gorelik A, Shears MJ, Tasevski R, Miller JA. One-stop thyroid nodule clinic with same-day fine-needle aspiration cytology improves efficiency of care. ANZ J Surg 2016; 88:354-358. [DOI: 10.1111/ans.13833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/07/2016] [Accepted: 09/25/2016] [Indexed: 01/26/2023]
Affiliation(s)
- Rajeshbhai Patel
- Endocrine Surgery Unit; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Anita R. Skandarajah
- Endocrine Surgery Unit; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | - Alexandra Gorelik
- Melbourne Epicentre; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Matthew J. Shears
- Endocrine Surgery Unit; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Robert Tasevski
- Endocrine Surgery Unit; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | - Julie A. Miller
- Endocrine Surgery Unit; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| |
Collapse
|
18
|
Graciano AJ, Fischer CA, Chone CT, Bublitz GS, Sonagli M, Filho CAR. Efficacy of ultrasound‐guided fine‐needle aspiration performed by surgeons newly trained in thyroid ultrasound. Head Neck 2016; 39:439-442. [DOI: 10.1002/hed.24603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 01/09/2023] Open
Affiliation(s)
- Agnaldo J. Graciano
- Department of Otolaryngology Head and Neck SurgeryCampinas State UniversityCampinas Brazil
- Department of Surgery, Division of Otolaryngology Head and Neck SurgeryHospital Sao JoseJoinville Brazil
| | - Carlos A. Fischer
- Department of Surgery, Division of Otolaryngology Head and Neck SurgeryHospital Sao JoseJoinville Brazil
| | - Carlos T. Chone
- Department of Otolaryngology Head and Neck SurgeryCampinas State UniversityCampinas Brazil
| | - Giuliano S. Bublitz
- Department of Surgery, Division of Otolaryngology Head and Neck SurgeryHospital Sao JoseJoinville Brazil
| | - Marina Sonagli
- Department of Surgery, Division of Otolaryngology Head and Neck SurgeryHospital Sao JoseJoinville Brazil
| | - Cezar A. Rodrigues Filho
- Department of Surgery, Division of Otolaryngology Head and Neck SurgeryHospital Sao JoseJoinville Brazil
| |
Collapse
|
19
|
Bozkurt H, İrkörücü O, Aziret M, Reyhan E, Okuyan MK. Comparison of 1869 thyroid ultrasound-guided fine-needle aspiration biopsies between general surgeons and interventional radiologists. Ann Med Surg (Lond) 2016; 10:92-102. [PMID: 27594994 PMCID: PMC4995479 DOI: 10.1016/j.amsu.2016.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/15/2016] [Accepted: 07/16/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Thyroid nodules are commonly encountered problems in clinical practice. For patients who have a thyroid nodule, the fine-needle aspiration biopsy (FNAB) is the most important test, as it is the most reliable diagnostic method for distinguishing between benign thyroid nodules and cancerous nodules. FNAB is able to be performed either via an ultrasound (USG) or alone and is the first choice when it comes to diagnosing thyroid nodules, given that it is cheap, safe and provides accurate results. OBJECTIVE In this study-a retrospective analysis of FNAB via USG - our aim is to evaluate the multiple variables related to FNAB procedures, including the experience of the person performing the biopsy, the age and gender of the patient, the number of nodules, the size of the nodule(s) and the number of lams recorded from the cytopathology report on non-diagnostic rates, conducted at an invasive radiology clinic and at a general surgery clinic. MATERIALS AND METHODS A total of 1062 patients involving 1869 nodules, examined using FNAB via USG, were reviewed retrospectively from records dated between November 2011 and July 2014 and from pathology reports taken from the ANEAH General Surgery clinic and Interventional Radiology clinic. Cytopathology results were classified according to the 2007 Bethesda System for Reporting. Gender, age, number of nodules, diameter of the nodules, biopsied nodules, location of the nodules, number of lams, symptoms and the date of biopsies were the parameters used to examine the factors involved in non-diagnostic cytopathology invasive radiology. These parameters were inspected at both of the clinics (ANEAH General Surgery clinic and Interventional Radiology clinic). In analyzing the results, the statistical significance level was set at 0.05, where in cases that the p value was under 0.05 (p < 0.05), it was determined that no significant relationship existed. In this study, data were analyzed using SPSS 20 software. RESULTS Of the nodules reviewed, 1620 were found on females and 249 on males. The age of the patients ranged from 10 to 87 years, with the mean age being 50 years. In the general surgery clinic, 470 nodules of 341 patients were aspirated, and in the interventional radiological clinic, 1399 nodules of 721 patients were aspirated. In the literature review conducted to compare statistical assessments of FNAB via USG, no significant difference was found between the ANEAH General Surgery clinic and the Invasive Radiology clinic (p > 0.05). In the invasive radiology clinic, non-diagnostic rates decreased with the increase in experience of the person who conducted the biopsy (p = 0.001). CONCLUSION The results from both of the clinic's rates of non-diagnostic FNAB, performed via USG, were found to be acceptable. Our study also demonstrates that USG-guided FNAB can be performed with a low non-diagnostic rate as experience grows.
Collapse
Affiliation(s)
- Hilmi Bozkurt
- Health Sciences University Adana Numune Training and Research Hospital, Department of General Surgery, Adana, Turkey
| | - Oktay İrkörücü
- Health Sciences University Adana Numune Training and Research Hospital, Department of General Surgery, Adana, Turkey
| | - Mehmet Aziret
- Sakarya University Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
| | - Enver Reyhan
- Health Sciences University Adana Numune Training and Research Hospital, Department of General Surgery, Adana, Turkey
| | - Mehmet Kemal Okuyan
- Health Sciences University Adana Numune Training and Research Hospital, Department of Interventional Radiology, Adana, Turkey
| |
Collapse
|
20
|
Stang MT, Shah SA, Sosa JA. Management of the Central and Lateral Neck in Patients with Differentiated Thyroid Cancer. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Bestepe N, Ozdemir D, Tam AA, Dellal FD, Kilicarslan A, Parlak O, Ersoy R, Cakir B. Malignancy risk and false-negative rate of fine needle aspiration cytology in thyroid nodules ≥4.0 cm. Surgery 2016; 160:405-12. [PMID: 27157121 DOI: 10.1016/j.surg.2016.03.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/16/2016] [Accepted: 03/26/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to evaluate malignancy rate and to determine false negativity of fine needle aspiration biopsy (FNAB) in thyroid nodules ≥4.0 cm. METHODS The medical records of patients who underwent thyroidectomy between January 2007 and December 2014 were reviewed. Demographic and clinical data as well as preoperative ultrasonography findings were analyzed. The nodules in these patients were grouped as ≥4.0 cm and <4.0 cm according to ultrasonography measurements. Nodules <4.0 cm were further divided into 1.0-3.9 cm and <1.0 cm. Histopathologically malignant nodules with preoperative benign cytology were defined as having false-negative FNAB. RESULTS There were 1,008 nodules that measured ≥4.0 cm, 4,013 nodules that measured 1.0-3.9 cm, and 540 that measured nodules <1.0 cm. Based on histopathologic findings, 8.5%, 10.2%, and 25.6% of nodules ≥4.0 cm, 1.0-3.9 cm, and <1.0 cm were malignant, respectively (P < .001). There was no significant difference between 1.0-3.9-cm and ≥4.0-cm nodules with respect to malignancy (P = .108). False-negativity rates were 4.7% in nodules ≥4.0 cm, 2.2% in nodules measuring 1.0-3.9 cm, and 4.8% in <1.0-cm nodules. Nodules measuring <1.0 cm and ≥4.0 cm had similar false-negativity rates (P = .93), while 1.0-3.9-cm nodules had statistically lower false-negativity rates than those found in the other two groups (P = .03 and P < .001, respectively). CONCLUSION Of the nodules that were operatively excised, nodules ≥4.0 cm had a similar risk of malignancy as nodules 1.0-3.9 cm. The rate of false-negative FNAB in nodules ≥4.0 cm was twice as high as in nodules 1.0-3.9 cm; however, we do not think it is high enough to recommend a routine operation when cytology results are benign.
Collapse
Affiliation(s)
- Nagihan Bestepe
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey.
| | - Didem Ozdemir
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Abbas Ali Tam
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Fatma Dilek Dellal
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Aydan Kilicarslan
- Department of Pathology, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Omer Parlak
- Department of General Surgery, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| |
Collapse
|
22
|
Fernandes VT, De Santis RJ, Enepekides DJ, Higgins KM. Surgeon-performed ultrasound guided fine-needle aspirate biopsy with report of learning curve; a consecutive case-series study. J Otolaryngol Head Neck Surg 2015; 44:42. [PMID: 26510834 PMCID: PMC4625451 DOI: 10.1186/s40463-015-0099-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
Background Fine-needle aspiration biopsy has become the standard of care for the evaluation of thyroid nodules. More recently, the use of ultrasound guided fine-needle aspiration biopsy (UG-FNAB) has improved adequacy of sampling. Now there has been improved access to UG-FNAB as ultrasound technology has become more accessible. Here we review the adequacy rate and learning curve of a single surgeon starting at the adoption of UG-FNAB into surgical practice. Methods UG-FNABs performed at Sunnybrook Health Sciences Centre from 2010 to 2015 were reviewed retrospectively. Nodule characteristics were recorded along with cytopathology and final pathology reports. Chi-square analysis, followed by the reporting of odds ratios with confidence intervals, were used to assess the statistical significance and frequencies, respectively, of nodule characteristics amongst both diagnostic and non-diagnostic samples. A multiple regression analysis was conducted to determine if any nodule characteristic were predictive of adequacy of UG-FNABs. The learning curve was assessed by calculating the eventual adequacy rates across each year, and its statistical significance was measured using Fischer’s Exact Test. Results In total 423 biopsies were reviewed in 289 patients. The average nodule size was 23.05 mm. When examining if each patient eventually received a diagnostic UG-FNAB, regardless of the number attempts, adequacy was seen to increase from 70.8 % in 2010 to, 81.0 % in 2011, 90.3 % in 2012, 85.7 % in 2013, 89.7 % in 2014, and 94.3 % in 2015 (Fischer’s Exact Test, p = 0.049). Cystic (χ2 = 19.70, p <0.001) nodules were found to yield higher rates of non-diagnostic samples, and their absence are predictive of obtaining an adequate biopsy as seen in a multiple regression analysis (p < 0.001) Adequacy of repeat biopsies following an initial non-diagnostic sample was 75.0 %. Conclusions Surgeons are capable of performing UG-FNAB with a learning curve noted to achieve standard adequacy rates. Cystic nodules are shown to yield more non-diagnostic samples in the surgeon’s office.
Collapse
Affiliation(s)
- Vinay T Fernandes
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada.
| | - Robert J De Santis
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada.
| | - Danny J Enepekides
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada
| | - Kevin M Higgins
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada.
| |
Collapse
|
23
|
Fernandes VT, Magarey MJR, Kamdar DP, Freeman JL. Surgeon performed ultrasound-guided fine-needle aspirates of the thyroid: 1067 biopsies and learning curve in a teaching center. Head Neck 2015; 38 Suppl 1:E1281-4. [PMID: 26316053 DOI: 10.1002/hed.24212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 06/12/2015] [Accepted: 07/11/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Surgeon performed ultrasound-guided fine-needle aspirates (UG-FNAs) reduce delay in diagnosis and allow for surgeon surveillance. We present the first report on a learning curve and impact of head and neck surgical trainees on adequacy rates. METHODS Thyroid UG-FNA biopsies from 2009 to 2013 were reviewed retrospectively. Specimen adequacy, cytologic diagnosis, and surgical pathology were used to calculate adequacy and accuracy. RESULTS One thousand sixty-seven biopsies were examined in 723 individuals. The adequacy rate from adoption into practice improved from 71% to 78% to 85% over 300 cases. When UG-FNA was subsequently taught to trainees, adequacy rates varied among trainees (p < .037), and there were higher nondiagnostic rates earlier in training (p = .04). Adequacy was not related to size or palpability, but cystic lesions yielded more inadequate specimens (p < .001). CONCLUSION Surgeon performed UG-FNA biopsy can be performed adequately in an outpatient setting. Adequacy rates reach acceptable levels after 300 cases, whereas trainee involvement impacts adequacy rates. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1281-E1284, 2016.
Collapse
Affiliation(s)
- Vinay T Fernandes
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Dev P Kamdar
- Hofstra North Shore - LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Jeremy L Freeman
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Canada
| |
Collapse
|
24
|
Ucler R, Usluogulları CA, Tam AA, Ozdemir D, Balkan F, Yalcın S, Kıyak G, Ersoy PE, Guler G, Ersoy R, Cakır B. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules three centimeters or larger in size. Diagn Cytopathol 2015; 43:622-8. [PMID: 25914194 DOI: 10.1002/dc.23289] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/05/2015] [Accepted: 03/30/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Whether under ultrasonography (US) guidance or not, fine-needle aspiration biopsy (FNAB) has some limitations, particularly in larger nodules. In this study, we aimed to evaluate the diagnostic value of US-guided fine-needle aspiration biopsy (US-FNAB) in thyroid nodules equal to or larger than 3 cm. MATERIALS AND METHODS Data of 267 patients operated for nodular goiter in the period of January 2006 and March 2012 were reviewed retrospectively. The study group (40 males, 104 females; mean age 42.3 ± 12.3, between 17 and 71) consisted of patients with nodules with a diameter of 3 cm or larger. Patients with nodules less than 3 cm in diameter were considered as the control group (27 males, 96 females; mean age 44.4 ± 11.9, between 18 and 71). RESULTS For nodules smaller than 3 cm, US-FNAB had an accuracy rate of 60% and a false negativity rate of 21.9%. In nodules equal to or larger than 3 cm, the accuracy rate of US-FNAB was 80%, with a false negativity rate of 6.7%. Malignancy was observed in 16% of the study group and 42.3% of the control group. CONCLUSION This study showed that increased nodule diameter is not associated with limitations in the diagnostic value of US-FNAB. We also found that the malignancy rate was smaller for larger nodules. This finding reflects the importance of accurate and rational diagnostic work-up and clinical management for detecting malignancy and surgical decision-making.
Collapse
Affiliation(s)
- Rıfkı Ucler
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Celil Alper Usluogulları
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Abbas Ali Tam
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Didem Ozdemir
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Fevzi Balkan
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Samet Yalcın
- Department of General Surgery, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Gulten Kıyak
- Department of General Surgery, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Pamir Eren Ersoy
- Department of General Surgery, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Gulnur Guler
- Department of Pathology, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Bekir Cakır
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
25
|
Yeh MW, Bauer AJ, Bernet VA, Ferris RL, Loevner LA, Mandel SJ, Orloff LA, Randolph GW, Steward DL. American Thyroid Association statement on preoperative imaging for thyroid cancer surgery. Thyroid 2015; 25:3-14. [PMID: 25188202 PMCID: PMC5248547 DOI: 10.1089/thy.2014.0096] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The success of surgery for thyroid cancer hinges on thorough and accurate preoperative imaging, which enables complete clearance of the primary tumor and affected lymph node compartments. This working group was charged by the Surgical Affairs Committee of the American Thyroid Association to examine the available literature and to review the most appropriate imaging studies for the planning of initial and revision surgery for thyroid cancer. SUMMARY Ultrasound remains the most important imaging modality in the evaluation of thyroid cancer, and should be used routinely to assess both the primary tumor and all associated cervical lymph node basins preoperatively. Positive lymph nodes may be distinguished from normal nodes based upon size, shape, echogenicity, hypervascularity, loss of hilar architecture, and the presence of calcifications. Ultrasound-guided fine-needle aspiration of suspicious lymph nodes may be useful in guiding the extent of surgery. Cross-sectional imaging (computed tomography with contrast or magnetic resonance imaging) may be considered in select circumstances to better characterize tumor invasion and bulky, inferiorly located, or posteriorly located lymph nodes, or when ultrasound expertise is not available. The above recommendations are applicable to both initial and revision surgery. Functional imaging with positron emission tomography (PET) or PET-CT may be helpful in cases of recurrent cancer with positive tumor markers and negative anatomic imaging.
Collapse
Affiliation(s)
- Michael W. Yeh
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Andrew J. Bauer
- Division of Endocrinology and Diabetes: The Thyroid Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Victor A. Bernet
- Division of Endocrinology, Mayo School of Medicine, Jacksonville, Florida
| | - Robert L. Ferris
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Laurie A. Loevner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lisa A. Orloff
- University of California, San Francisco, San Francisco, California
| | - Gregory W. Randolph
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital, Boston, Massachusetts
| | | |
Collapse
|
26
|
Isaac A, Jeffery CC, Seikaly H, Al-Marzouki H, Harris JR, O'Connell DA. Predictors of non-diagnostic cytology in surgeon-performed ultrasound guided fine needle aspiration of thyroid nodules. J Otolaryngol Head Neck Surg 2014; 43:48. [PMID: 25466726 PMCID: PMC4260212 DOI: 10.1186/s40463-014-0048-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fine needle aspiration (FNA) is the standard of care for the diagnostic work-up of thyroid nodules but despite its proven utility, the non-diagnostic rate for thyroid FNA ranges from 6-36%. A non-diagnostic FNA is problematic for the clinician and patient because it can result in repeated procedures, multiple physician visits, and a delay in definitive treatment. Surgeon-performed FNA has been shown to be safe, cost-effective, as accurate as those performed by other clinicians, and has the added benefit of decreasing wait times to surgery. Several studies have examined rates and factors that may be predictive of a non-diagnostic cytology in non-surgeon FNA, but none have evaluated this in surgeon-performed thyroid FNA. If these factors are unique in surgeon-performed vs. non-surgeon performed thyroid FNA, then patients may be more appropriately triaged to FNA by alternate clinicians. OBJECTIVES The purpose of this study was to determine the rate and factors predictive of a non-diagnostic FNA in surgeon performed ultrasound-guided FNA of thyroid nodules. METHODS We conducted a retrospective review of all adult patients who underwent thyroid FNA by a staff, fellow, or resident Otolaryngologist at the University of Alberta between January 2011 and June 2013. Factors analyzed included patient factors, thyroid characteristics, nodule characteristics, and surgeon level of training and experience. Univariate and multivariate binary logistic regression analysis were performed. RESULTS 131 patients (180 nodules) were reviewed. The non-diagnostic rate was 23%. Nodules with predominant cystic component, those less than 1 cm, and resident-performed FNA were associated with non-diagnostic cytology (p = 0.001, p = 0.02, p = 0.04 respectively). A cystic nodule was the only independent predictor of non-diagnostic FNA on multivariate analysis (OR = 4.441, 95% CI [1.785-11.045], p = 0.001). CONCLUSIONS The rate of non-diagnostic thyroid FNA performed by a surgeon with ultrasound guidance is similar to other clinicians. A cystic nodule is a strong independent predictor of non-diagnostic cytology. Non-cystic nodules may particularly benefit from surgeon-performed thyroid FNA due to the high diagnostic rate and potential for earlier definitive management.
Collapse
Affiliation(s)
- Andre Isaac
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, #603-10649 Saskatchewan Drive, Edmonton, AB T6E 6S8 Canada
| | - Caroline C Jeffery
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, #603-10649 Saskatchewan Drive, Edmonton, AB T6E 6S8 Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, #603-10649 Saskatchewan Drive, Edmonton, AB T6E 6S8 Canada
| | - Hani Al-Marzouki
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, #603-10649 Saskatchewan Drive, Edmonton, AB T6E 6S8 Canada
| | - Jeffrey R Harris
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, #603-10649 Saskatchewan Drive, Edmonton, AB T6E 6S8 Canada
| | - Daniel A O'Connell
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, #603-10649 Saskatchewan Drive, Edmonton, AB T6E 6S8 Canada
| |
Collapse
|
27
|
Ganguly A, Burnside G, Nixon P. A systematic review of ultrasound-guided FNA of lesions in the head and neck--focusing on operator, sample inadequacy and presence of on-spot cytology service. Br J Radiol 2014; 87:20130571. [PMID: 25247346 PMCID: PMC4243210 DOI: 10.1259/bjr.20130571] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 08/05/2014] [Accepted: 09/22/2014] [Indexed: 11/05/2022] Open
Abstract
The objective of this review is to perform a systematic review of ultrasound-guided fine-needle aspiration (FNA) services for head and neck lesions with assessment of inadequacy rates and related variables such as the presence of immediate cytological assessment. A computer-based systematic search of articles in English language was performed using MEDLINE (1950 to date) from National Health Service evidence healthcare database and PubMed. Full texts of all relevant articles were obtained and scrutinized independently by two authors according to the stated inclusion and exclusion criteria. The primary search identified 932 articles, but only 78 met all the study criteria. The overall inadequacy rate was 9.3%, 16 studies had on-site evaluation by a cytopathologist/specialist clinician with a rate of 6.0%. In seven studies, a cytotechnician was available to either assess the sample or prepare the slides with an average inadequacy rate of 11.4%. In 1 study, the assessment was unclear, but the inadequacy rate for the remaining 54 studies, without immediate assessment, was 10.3%. The rate for the cytopathologist/specialist clinicians was significantly different to no on-site assessment but this was not found for assessment by cytotechnicians. The review suggests that the best results are obtained with a cytopathologist-led FNA service, where the pathologist reviews the specimen immediately, in relation to the clinical context, thereby deciding on adequacy and need for further biopsies. A systematic review looking at ultrasound-guided FNA of head and neck lesions has not been published previously.
Collapse
Affiliation(s)
- A Ganguly
- 1 Department of Radiology, Warrington and Halton Hospitals NHS Foundation Trust, Cheshire, UK
| | | | | |
Collapse
|
28
|
Ahn D, Kim H, Sohn JH, Choi JH, Na KJ. Surgeon-performed ultrasound-guided fine-needle aspiration cytology of head and neck mass lesions: sampling adequacy and diagnostic accuracy. Ann Surg Oncol 2014; 22:1360-5. [PMID: 25297899 DOI: 10.1245/s10434-014-4119-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies of surgeon-performed ultrasound-guided fine-needle aspiration cytology (US-FNAC) have been limited largely to thyroid nodules. This study evaluated the sampling adequacy and diagnostic accuracy of surgeon-performed US-FNAC for a large range of head and neck mass lesions, including lesions of the thyroid, salivary glands, and lymph nodes. METHODS The study included 617 cases of US-FNAC performed by a single surgeon between 2009 and 2013. Their medical histories and ultrasound (US) findings were retrospectively reviewed. Sample adequacy was analyzed according to the surgeon's experience, anatomic tumor location, and US tumor characteristics. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of FNAC were calculated after correlation with the surgical histopathologic results. RESULTS The overall adequacy rate for surgeon-performed US-FNAC was 91.9 % (567/617). Inadequate specimens were obtained from 9.7 % (29/282) of the thyroid glands, 6.1 % of the salivary glands (6/98), and 6.3 % (15/237) of the lymph nodes. The effect of the surgeon's experience plateaued (inadequate sampling rate, 6-8 %) after 100 US-FNAC procedures. Inadequate sampling was associated with tumor characteristics such as cystic change and rim calcification. Overall, US-FNAC showed a sensitivity of 88.2 %, a specificity of 98.2 %, a PPV of 98.5 %, an NPV of 85.7 %, and a diagnostic accuracy of 91.6 %. CONCLUSION With proper training and experience managing at least 100 US-FNAC cases, surgeons can ensure a low inadequate sampling rate and good diagnostic accuracy for a range of head and neck mass lesions.
Collapse
Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Daegu, Korea,
| | | | | | | | | |
Collapse
|
29
|
Tsao GJ, Orloff LA. Clinician-Performed Thyroid Ultrasound-Guided Fine-Needle Aspiration. Otolaryngol Clin North Am 2014; 47:509-18. [DOI: 10.1016/j.otc.2014.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
30
|
Lo WC, Cheng PW, Wang CT, Yeh ST, Liao LJ. Pain levels associated with ultrasound-guided fine-needle aspiration biopsy for neck masses. Head Neck 2013; 36:252-6. [DOI: 10.1002/hed.23303] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Wu-Chia Lo
- Department of Otolaryngology; Far Eastern Memorial Hospital; Taipei Taiwan
- Oriental Institute of Technology; Taipei Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology; Far Eastern Memorial Hospital; Taipei Taiwan
- Oriental Institute of Technology; Taipei Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology; Far Eastern Memorial Hospital; Taipei Taiwan
- Oriental Institute of Technology; Taipei Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
| | - Shu-Tin Yeh
- Endocrine and Metabolism; Department of Internal Medicine; Far Eastern Memorial Hospital; Taipei Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology; Far Eastern Memorial Hospital; Taipei Taiwan
- Oriental Institute of Technology; Taipei Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
| |
Collapse
|
31
|
Karadeniz Cakmak G, Emre AU, Tascilar O, Gultekin FA, Ozdamar SO, Comert M. Diagnostic adequacy of surgeon-performed ultrasound-guided fine needle aspiration biopsy of thyroid nodules. J Surg Oncol 2012; 107:206-10. [PMID: 22766655 DOI: 10.1002/jso.23212] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 06/11/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Surgeon-performed ultrasonography (US) of thyroid nodules might serve as a potential therapeutic guide to designate accurate surgical or clinical intervention. OBJECTIVE To evaluate the diagnostic adequacy of surgeon-performed ultrasonography guided fine needle aspiration biopsy (FNAB) of thyroid nodules, the factors responsible for diagnostic adequacy and the impact of surgeon-performed US on treatment approach. METHODS Retrospective review of a single surgeon performed 621 US-guided FNABs without on-site cytological specimen assessment. Outside US findings were compared to the surgeon-performed US. Measured variables and outcomes for the study included diagnostic adequacy rates and the effects of detected differences between US reports on treatment variability. RESULTS Diagnostic adequacy rate of surgeon-performed US-guided FNAB was determined to be 94.52% without on-site specimen evaluation by cytologist. Non-diagnostic specimens occurred in 34 of 621 (5.48%) nodules. The differences detected between the outside US and surgeon-performed US altered invasive treatment algorithm in 30 (5.47%) patients. FNAB was avoided for 15 (2.7%) patients. Total thyroidectomy became the preferred surgical option in 15 (2.7%) patients after the discovery of additional nodules in the contralateral lobe. CONCLUSION Surgeon-performed US offers clear clinical benefits in terms of diagnostic yield of FNAB with providing valuable additional data that might alter surgical treatment approach.
Collapse
Affiliation(s)
- Guldeniz Karadeniz Cakmak
- Department of Surgery, The School of Medicine, Zonguldak Karaelmas University, Kozlu-Zonguldak, Turkey.
| | | | | | | | | | | |
Collapse
|
32
|
Bohacek L, Milas M, Mitchell J, Siperstein A, Berber E. Diagnostic accuracy of surgeon-performed ultrasound-guided fine-needle aspiration of thyroid nodules. Ann Surg Oncol 2011; 19:45-51. [PMID: 21633868 DOI: 10.1245/s10434-011-1807-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is scant data concerning surgeon-performed thyroid fine-needle aspiration (FNA), and controversy regarding its accuracy in larger nodules. This study aimed to specifically assess accuracy of surgeon-performed ultrasound (US)-guided FNA on a per-nodule basis, with a subanalysis of nodule size. METHODS Data of 1,000 surgeon-performed US-guided thyroid FNAs at a single institution from 2000 to 2010 were prospectively collected. Standard clinical information, FNA results using the Bethesda criteria, and final histology were recorded. RESULTS Fine-needle aspiration results were reported as: cancer (7%), suspicious for cancer (2%), suspicious for follicular neoplasm (17%), atypia of unknown significance (AUS) (1%), benign (67%), and insufficient (6%). Of nodules with FNA results of cancer, suspicious for cancer, suspicious for follicular neoplasm, and atypia of unknown significance, 94% were operated on, with malignancy rates of 97%, 58%, 21%, and 12%, respectively. Of nodules with benign FNA, 26% underwent surgery for associated symptoms, concerning features, or other remote pathology. A total of 56% were followed, and 18% were lost to follow-up. Of nodules with insufficient FNA, 46% had repeat FNA (yielding a diagnosis in 81%), 23% underwent surgery, 21% with hypocellular features were followed, and 9% were lost to follow-up. In size subanalysis, there was no statistically significant difference in risk of malignancy or increased rate of falsely negative FNA with increasing nodule size. CONCLUSIONS The Bethesda system appropriately stratified lesions for risk of malignancy, and repeat FNA had high diagnostic yield in lesions with inadequate FNA. The results suggest no trend toward larger lesions harboring thyroid malignancy nor an increased likelihood of false-negative benign FNA.
Collapse
Affiliation(s)
- Linda Bohacek
- Division of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | |
Collapse
|
33
|
Gursoy A, Anil C, Erismis B, Ayturk S. Fine-needle aspiration biopsy of thyroid nodules: comparison of diagnostic performance of experienced and inexperienced physicians. Endocr Pract 2011; 16:986-91. [PMID: 20570813 DOI: 10.4158/ep10077.or] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether a difference exists in terms of obtaining adequate cytologic samples from ultrasound-guided fine-needle aspiration cytology (US-FNAC) between experienced and inexperienced physicians in a tertiary referral center. METHODS In a prospective design, all patients with thyroid nodules of at least 10 mm in diameter were referred for US-FNAC tissue sampling as a part of their diagnostic work-up. Between May 2006 and September 2009, 997 euthyroid patients with 1,320 thyroid nodules were referred for US-FNAC by the attending endocrinologist (experienced physician) or 1 of 2 endocrinology fellows (inexperienced physicians). RESULTS Of the 1,320 nodules, 713 biopsy specimens were obtained by the experienced physician and 607 were obtained by the inexperienced physicians. Nodule size was significantly larger in the endocrinologist's group of patients than in the fellows' group of patients (17 mm versus 14 mm, respectively; P<.001). The inadequacy rate of the US-FNAC procedures performed by the experienced physician (22 of 713 thyroid nodules or 3.1%) was significantly lower than for those performed by the inexperienced physicians (102 of 607 thyroid nodules or 16.8%) (P<.001). CONCLUSION We conclude that, with increasing operator experience, the number of inadequate cytologic specimens generated by US-FNAC procedures is substantially reduced. This limits both direct and indirect costs and also minimizes the risks of possibly unnecessary surgical procedures.
Collapse
Affiliation(s)
- Alptekin Gursoy
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Ankara, Turkey
| | | | | | | |
Collapse
|
34
|
Surgeon-performed ultrasound in patients referred for thyroid disease improves patient care by minimizing performance of unnecessary procedures and optimizing surgical treatment. World J Surg 2010; 34:1164-70. [PMID: 20135315 DOI: 10.1007/s00268-010-0402-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Ultrasonography has become an indispensable tool in the evaluation of thyroid nodular disease, and most patients will have had a thyroid ultrasound prior to initial surgical evaluation. This study examines the added benefit of office-based, surgeon-performed ultrasonography in patients referred for thyroid disease. METHODS All patients referred to a single endocrine surgeon for evaluation of thyroid disease over a 2-year period were reviewed. Outside ultrasonographic findings were compared to the surgeon-performed ultrasound that was used to formulate treatment decisions. RESULTS Of 286 consecutive patients referred for surgical evaluation of thyroid disease, 261 had an outside ultrasound available for comparison. There were 239 women and 47 men. Mean age was 54.7 +/- 16.6. In 46 patients (17.6%), differences between the two ultrasounds were significant enough to alter treatment plans. For 18 patients no distinct nodule was identified and biopsy was avoided. Nine of these patients had ultrasound characteristics of Hashimoto's disease. In five patients the nodule was significantly smaller than reported and biopsy was not warranted. Twelve patients had nonpalpable, enlarged lymph nodes not previously identified; these were biopsied. Three were positive for metastatic thyroid cancer, which prompted the addition of neck dissection to the operative procedure. In 8 of 132 patients undergoing thyroidectomy, the surgical procedure was significantly altered by the ultrasound findings. CONCLUSIONS This study demonstrates a clear advantage for patients who undergo a surgeon-performed ultrasound. For many, unnecessary procedures were prevented. For others, substantial modifications to the extent of surgery were made when new ultrasonographic findings were identified during the preoperative investigation.
Collapse
|
35
|
Abstract
The use of ultrasound for thyroid cancer has evolved dramatically over the last few decades. Since the late 1960s, ultrasound has become essential in the examination of the thyroid gland with the increased availability of high-frequency linear array transducers and computer-enhanced imaging capabilities of modern day portable ultrasound equipment in a clinic- or office-based setting. As a noninvasive, rapid, and easily reproducible imaging study, ultrasound has been demonstrated to have a broadened utility beyond the simple confirmation of thyroid nodules and their sizes. Recently, office-based ultrasound has become an integral part of clinical practice, where it has demonstrated overwhelming benefits to patients being evaluated and treated for thyroid cancer. Ultrasound has become useful in the qualitative characterization of thyroid nodules based on benign or malignant features. On the basis of such classifications and the relative risk for thyroid malignancy, the need for ultrasound-guided fine-needle aspiration, preoperative and intraoperative staging, lymph node mapping, and the extent of surgery can subsequently be determined. Furthermore, ultrasound has additional value in the surveillance of patients treated for thyroid cancer.
Collapse
Affiliation(s)
- John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, 1475 NW 12th Avenue (M-875), Miami, Florida 33136, USA.
| | | |
Collapse
|
36
|
Robitschek J, Straub M, Wirtz E, Klem C, Sniezek J. Diagnostic efficacy of surgeon-performed ultrasound-guided fine needle aspiration: A randomized controlled trial. Otolaryngol Head Neck Surg 2010; 142:306-9. [DOI: 10.1016/j.otohns.2009.11.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 10/24/2009] [Accepted: 11/10/2009] [Indexed: 10/19/2022]
Abstract
Objective: To evaluate the clinical efficacy of surgeon-performed, office-based head and neck ultrasound in facilitating diagnostic fine needle aspiration (FNA) of lesions in the head and neck. Study Design: A randomized controlled trial of ultrasound-guided FNA versus traditional palpation-guided technique for palpable masses in the head and neck. Setting: An office-based study performed in a military academic medical center. Subjects and Methods: Eighty-one adults older than 18 years of age with a palpable head and neck mass (less than 3 cm in largest diameter) were randomized to ultrasound-guided or traditional palpation-guided FNA of a head and neck mass. Measured variables and outcomes for the study included tissue adequacy rates, tissue type, and operator variability. Results: Following three passes using either palpation or ultrasound guidance, a comparative tissue adequacy rate of 84 percent for ultrasound guidance versus 58 percent for standard palpation was established ( P < 0.014). With regard to tissue type, a statistically significant comparative diagnostic advantage for ultrasound guidance was observed in thyroid tissue while remaining statistically insignificant for lymphatic and salivary tissues. No statistical significance was found when comparing the ability of otolaryngology residents versus attending otolaryngologists to obtain ultrasound-guided diagnostic samples. Conclusion: Office-based surgeon-performed ultrasound-guided FNA of palpable lesions in the head and neck yields a statistically significant higher diagnostic rate compared to standard palpation technique. Our institutional experience supports the utility of surgeon-performed ultrasound as a core competency in clinical practice.
Collapse
Affiliation(s)
- Jon Robitschek
- Department of Otolaryngology, Tripler Army Medical Center, Honolulu, HI
| | - Mary Straub
- Department of Otolaryngology, Tripler Army Medical Center, Honolulu, HI
| | - Eric Wirtz
- Department of Otolaryngology, Tripler Army Medical Center, Honolulu, HI
| | - Christopher Klem
- Department of Otolaryngology, Tripler Army Medical Center, Honolulu, HI
| | - Joseph Sniezek
- Department of Otolaryngology, Tripler Army Medical Center, Honolulu, HI
| |
Collapse
|
37
|
Abstract
PURPOSE OF REVIEW This article reviews the recent developments in neck ultrasound for thyroid cancer published in the last 18 months, with emphasis on the emerging role of surgeon-performed ultrasound in clinical endocrine practice. RECENT FINDINGS Ultrasound has evolved beyond the simple differentiation of solid and cystic thyroid nodules and their measurement. Although no single ultrasound feature has the highest accuracy in distinguishing between benign and malignant thyroid lesions, the combination of several ultrasound characteristics (e.g. hypoechogenicity, irregular borders and microcalcifications) within such thyroid nodules may have a stronger correlation for thyroid cancer. Based on these ultrasound features and risk for thyroid malignancy, the need for ultrasound-guided fine needle aspiration, preoperative staging, lymph node mapping and extent of surgery can subsequently be determined and performed. Furthermore, ultrasound has an additional value intraoperatively and in the postoperative surveillance of patients treated for thyroid cancer. Surgeon-performed ultrasound has recently become indispensible in clinical practice where endocrine surgeons have integrated this versatile imaging modality in the evaluation and treatment of patients with thyroid cancer. SUMMARY Ultrasound is an essential modality in the evaluation of thyroid malignancy. Surgeon-performed ultrasound has proved invaluable in the preoperative, intraoperative and postoperative setting. Future developments in ultrasound may lead to further improvement in the diagnostic accuracy of this modality.
Collapse
|
38
|
Role of operator experience in ultrasound-guided fine-needle aspiration biopsy of the thyroid. Radiol Med 2010; 115:612-8. [PMID: 20177981 DOI: 10.1007/s11547-010-0528-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 06/12/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Thyroid nodules are commonly encountered in clinical practice, and ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the gold standard in diagnosing the pathological nature of undetermined thyroid nodules. The aim of this study was to evaluate whether operator experience influences the diagnostic accuracy of US-guided FNAB. MATERIALS AND METHODS A total of 700 consecutive US-guided FNAB done by a single radiologist between 2000 and 2007 were retrospectively analysed. The same freehand technique and capillary-action technique with 22- or 25-gauge needles was used for all nodules, All specimens were prepared and fixed without the cytologist on site and were subsequently analysed by two expert cytologists. The procedures were chronologically divided into seven groups and classified as diagnostic or nondiagnostic. RESULTS The rate of nondiagnostic procedures for each group was 32% in group 1, 13% in group 2, 17% in group 3, 11% in group 4, 10% in group 5, 5% in group 6 and 8% in group 7. No major complications were recorded. CONCLUSIONS The rate of nondiagnostic US-guided FNAB is heavily dependent on the operator's experience. We estimated that at least 200 procedures need to be performed in order to achieve the levels of diagnostic accuracy reported in the literature. We therefore suggest specific training before operators routinely perform this procedure in clinical practice.
Collapse
|
39
|
Pinchot SN, Al-Wagih H, Schaefer S, Sippel R, Chen H. Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. ACTA ACUST UNITED AC 2009; 144:649-55. [PMID: 19620545 DOI: 10.1001/archsurg.2009.116] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS All thyroid nodules 4 cm or larger should be surgically removed regardless of fine-needle aspiration biopsy (FNAB) results because of an unacceptably high rate of false-negative preoperative biopsy results in these large nodules. DESIGN Retrospective cohort study. SETTING Single-institution, tertiary academic referral center. PATIENTS A retrospective analysis was performed on all patients who underwent surgery for a thyroid nodule 4 cm or larger from May 1, 1994, through January 31, 2007. MAIN OUTCOME MEASURES Preoperative FNAB results were correlated with final surgical pathologic results. The FNAB results were reported as nondiagnostic, benign, inconclusive (follicular neoplasm), or malignant, whereas the final surgical pathologic data were reported as benign or malignant. RESULTS Of 155 patients who underwent a thyroidectomy for a nodule 4 cm or larger, 21 patients (13.5%) had a clinically significant thyroid carcinoma within the nodule on final pathologic analysis. Preoperative cytologic testing of the mass was performed on 97 patients, and the results read as benign for 52, inconclusive for 23, nondiagnostic for 11, and malignant for 11. In lesions 4 cm or larger, 26 of 52 FNAB results reported as benign (50.0%) turned out to be either neoplastic (22) or malignant (4) on final pathologic analysis. Among patients with nondiagnostic FNAB results, the risk of malignant neoplasms was 27.3%. CONCLUSIONS In patients with thyroid nodules 4 cm or larger, the FNAB results are highly inaccurate, misclassifying half of all patients with reportedly benign lesions. Furthermore, those patients with a nondiagnostic FNAB result display a high risk of differentiated thyroid carcinoma. Therefore, we recommend that diagnostic lobectomy be strongly considered in patients with thyroid nodules 4 cm or larger regardless of FNAB cytologic test results.
Collapse
Affiliation(s)
- Scott N Pinchot
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI 53792, USA
| | | | | | | | | |
Collapse
|