Diagnostic accuracy and importance of Fine Needle Aspiration Cytology in the prediction of malignancy in thyroid nodules
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Abstract
Objective: Since thyroid nodules have low malignant potential and thyroid cancers progress slowly, early diagnosis is important for a longer life expectancy. Fine needle aspiration (FNA) is a cost-effective method with an easy application, low complication rate and high diagnostic value. The aim of this study is to assess the diagnosis accuracy and prevalence of thyroid cancer by comparing the findings of FNA procedures performed in our center with definitive histopathology results of patients undergoing surgery after FNA and then comparing these results to the literature.
Materials and Methods: Cytology reports of 1040 patients who underwent thyroid FNA between January 2021 and October 2022 were retrospectively evaluated. Definitive histopathology results of 146 patients who underwent total or subtotal thyroidectomy were compared with preoperative FNA cytology results. Thyroid cytological results were classified according to the 2017 Bethesda system diagnostic categories.
Results: Cases with definitive histopathology results indicating malignancy accounted for 33.3% of non-diagnostic cases, 14.5% of benign, 18.5% of atypia or follicular lesion of undetermined significance (AUS)/FLUS, 33.3% of follicular neoplasm or suspected follicular neoplasm, 75.0% of suspected malignancy and 100% of malignant preoperative FNAC results. For malignant cases, FNA had a sensitivity of 47.5%, specificity of 98.1%, false-positive rate of 20.8%, false-negative rate of 17.2%, positive predictive value of 79.1%, negative predictive value of 82.8% and accuracy rate of 72.8%.
Conclusion: In this study, the prevalence of thyroid cancer exceeded the cancer rates predicted by the 2017 Bethesda classification. Thyroid cancer may be predicted by the follow-up of patients with solitary or multiple nodules without a surgical indication, and a repeat FNA when necessary.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Accepted 2023-10-15
Published 2023-10-16
References
Steele SR, Martin MJ, Mullenix PS, Azarow KS, Andersen CA. The significance of incidental thyroid abnormalities identified during carotid duplex ultrasonography. Arch Surg [Internet]. 2005 Oct [cited 2023 Apr 3];140(10):981–5. Available from: https://pubmed.ncbi.nlm.nih.gov/16230549/ DOI: https://doi.org/10.1001/archsurg.140.10.981
Hagag P, Strauss S, Weiss M. Role of ultrasound-guided fine-needle aspiration biopsy in evaluation of nonpalpable thyroid nodules. Thyroid [Internet]. 1998 [cited 2023 Apr 3];8(11):989–95. Available from: https://pubmed.ncbi.nlm.nih.gov/9848711/ DOI: https://doi.org/10.1089/thy.1998.8.989
Nam-Goong IS, Kim HY, Gong G, Lee HK, Hong SJ, Kim WB, et al. Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clin Endocrinol (Oxf) [Internet]. 2004 Jan [cited 2023 Apr 3];60(1):21–8. Available from: https://pubmed.ncbi.nlm.nih.gov/14678283/ DOI: https://doi.org/10.1046/j.1365-2265.2003.01912.x
Leenhardt L, Hejblum G, Franc B, Du Pasquier Fediaevsky L, Delbot T, Le Guillouzic D, et al. Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules. J Clin Endocrinol Metab [Internet]. 1999 [cited 2023 Apr 3];84(1):24–8. Available from: https://pubmed.ncbi.nlm.nih.gov/9920057/ DOI: https://doi.org/10.1210/jcem.84.1.5418
Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab [Internet]. 2002 [cited 2023 Apr 3];87(5):1941–6. Available from: https://pubmed.ncbi.nlm.nih.gov/11994321/ DOI: https://doi.org/10.1210/jcem.87.5.8504
Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol [Internet]. 2017 May 1 [cited 2023 Apr 9];14(5):587–95. Available from: https://pubmed.ncbi.nlm.nih.gov/28372962/ DOI: https://doi.org/10.1016/j.jacr.2017.01.046
Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid [Internet]. 2017 Nov 1 [cited 2023 Apr 3];27(11):1341–6. Available from: https://pubmed.ncbi.nlm.nih.gov/29091573/ DOI: https://doi.org/10.1089/thy.2017.0500
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid [Internet]. 2016 Jan 1 [cited 2023 Apr 18];26(1):1–133. Available from: https://pubmed.ncbi.nlm.nih.gov/26462967/ DOI: https://doi.org/10.1089/thy.2015.0020
Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med [Internet]. 1997 [cited 2023 Apr 22];126(3):226–31. Available from: https://pubmed.ncbi.nlm.nih.gov/9027275/ DOI: https://doi.org/10.7326/0003-4819-126-3-199702010-00009
Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest [Internet]. 2009 Aug [cited 2023 Apr 22];39(8):699–706. Available from: https://pubmed.ncbi.nlm.nih.gov/19601965/ DOI: https://doi.org/10.1111/j.1365-2362.2009.02162.x
Bagga PK, Mahajan NC. Fine needle aspiration cytology of thyroid swellings: how useful and accurate is it? Indian J Cancer [Internet]. 2010 Oct [cited 2023 Apr 22];47(4):437–42. Available from: https://pubmed.ncbi.nlm.nih.gov/21131759/ DOI: https://doi.org/10.4103/0019-509X.73564
Muratli A, Erdogan N, Sevim S, Unal I, Akyuz S. Diagnostic efficacy and importance of fine-needle aspiration cytology of thyroid nodules. J Cytol [Internet]. 2014 [cited 2023 May 7];31(2):73–8. Available from: https://pubmed.ncbi.nlm.nih.gov/25210233/ DOI: https://doi.org/10.4103/0970-9371.138666
Leennhardt L, Bernier MO, Boin-Pineau MH, Conte Devolx B, Maréchaud R, Niccoli-Sire P, et al. Advances in diagnostic practices affect thyroid cancer incidence in France. Eur J Endocrinol [Internet]. 2004 Feb [cited 2023 Apr 22];150(2):133–9. Available from: https://pubmed.ncbi.nlm.nih.gov/14763910/ DOI: https://doi.org/10.1530/eje.0.1500133
Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab [Internet]. 2006 [cited 2023 Apr 3];91(11):4295–301. Available from: https://pubmed.ncbi.nlm.nih.gov/16868053/ DOI: https://doi.org/10.1210/jc.2006-0527
Haymart MR, Repplinger DJ, Leverson GE, Elson DF, Sippel RS, Jaume JC, et al. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab [Internet]. 2008 [cited 2023 Apr 3];93(3):809–14. Available from: https://pubmed.ncbi.nlm.nih.gov/18160464/ DOI: https://doi.org/10.1210/jc.2007-2215
Mcleod DSA, Cooper DS, Ladenson PW, Ain KB, Brierley JD, Fein HG, et al. Prognosis of differentiated thyroid cancer in relation to serum thyrotropin and thyroglobulin antibody status at time of diagnosis. Thyroid [Internet]. 2014 Jan 1 [cited 2023 Apr 3];24(1):35–42. Available from: https://pubmed.ncbi.nlm.nih.gov/23731273/ DOI: https://doi.org/10.1089/thy.2013.0062
Marqusee E, Benson CB, Frates MC, Doubilet PM, Larsen PR, Cibas ES, et al. Usefulness of ultrasonography in the management of nodular thyroid disease. Ann Intern Med [Internet]. 2000 Nov 7 [cited 2023 Apr 22];133(9):696–700. Available from: https://pubmed.ncbi.nlm.nih.gov/11074902/ DOI: https://doi.org/10.7326/0003-4819-133-9-200011070-00011
Cusick EL, MacIntosh CA, Krukowski ZH, Williams VMM, Ewen SWB, Matheson NA. Management of isolated thyroid swellings: a prospective six year study of fine needle aspiration cytology in diagnosis. BMJ [Internet]. 1990 [cited 2023 May 7];301(6747):318–21. Available from: https://pubmed.ncbi.nlm.nih.gov/2203493/ DOI: https://doi.org/10.1136/bmj.301.6747.318
Role of fine needle aspiration cytology in the diagnosis of palpable thyroid lesions - PubMed [Internet]. [cited 2023 May 7]. Available from: https://pubmed.ncbi.nlm.nih.gov/12785159/
Ko HM, Jhu IK, Yang SH, Lee JH, Nam JH, Juhng SW, et al. Clinicopathologic analysis of fine needle aspiration cytology of the thyroid. A review of 1,613 cases and correlation with histopathologic diagnoses. Acta Cytol [Internet]. 2003 [cited 2023 May 7];47(5):727–32. Available from: https://pubmed.ncbi.nlm.nih.gov/14526669/ DOI: https://doi.org/10.1159/000326596
The diagnostic value of fine needle aspiration cytology in thyroid swellings in a university hospital, Yemen - PubMed [Internet]. [cited 2023 May 7]. Available from: https://pubmed.ncbi.nlm.nih.gov/12847625/
Accuracy and consistency of fine-needle aspiration biopsy in the diagnosis and management of solitary thyroid nodules - PubMed [Internet]. [cited 2023 May 7]. Available from: https://pubmed.ncbi.nlm.nih.gov/15984379/
Fine needle aspiration cytology of thyroid nodule: diagnostic accuracy and pitfalls - PubMed [Internet]. [cited 2023 May 7]. Available from: https://pubmed.ncbi.nlm.nih.gov/17591005/
Haberal AN, Toru S, Özen O, Arat Z, Bilezikçi B. Diagnostic pitfalls in the evaluation of fine needle aspiration cytology of the thyroid: correlation with histopathology in 260 cases. Cytopathology [Internet]. 2009 Apr [cited 2023 May 7];20(2):103–8. Available from: https://pubmed.ncbi.nlm.nih.gov/18713250/ DOI: https://doi.org/10.1111/j.1365-2303.2008.00594.x