Ultrasonographically guided thyroid biopsy: a review with emphasis on technique.

We describe our technique for ultrasonographically guided fine-needle aspiration biopsy of the thyroid that achieves a high rate of diagnostic specimens. Indications for ultrasonographically guided fine-needle aspiration biopsy included a difficult-to-palpate thyroid nodule and previously unsuccessful palpation-guided fine-needle aspiration. Ultrasonographically guided fine-needle aspiration biopsy was performed on 316 thyroid nodules in 306 patients. Adequate cytologic specimens were obtained in 97.2% of the nodules in which biopsy was performed, with a 2.8% rate of inadequate cellularity. Two helpful aspects of this technique that were thought to improve the overall diagnostic yield were the use of color and power Doppler "vascular mapping" of the nodule just before biopsy and on-site cytologic control.     

Pediatric medullary carcinoma of the thyroid with point mutation of RET proto-oncogene associated with multiple endocrine neoplasia and initially diagnosed by fine-needle aspiration biopsy

A 7-year-old girl presented with a thyroid mass, elevated serum levels of calcitonin and carcinoembryonic antigen, as well as multiple mucosal nodules in the upper lip and tongue. Cytologic material obtained by fine-needle aspiration biopsy from the thyroid mass was diagnosed as medullary carcinoma and confirmed by immunohistochemical studies in the cell-block sections. Subsequent histopathologic examination showed involvement of both thyroid lobes by medullary carcinoma, and electron microscopic studies further confirmed the diagnosis. Molecular studies showed a point mutation in amino acid 918 in exon 16 of the RET proto-oncogene. Biopsies from the upper lip and tongue showed mucosal neuromas. Fine-needle aspiration biopsy is frequently used in the initial evaluation of thyroid nodules. This case illustrates the value of fine-needle aspiration biopsy as a safe and accurate diagnostic modality in the workup of pediatric thyroid nodules. Fine-needle aspiration biopsy should always be considered for the investigation of thyroid nodules in pediatric patients.     

甲状腺结节超声引导下细针抽吸活检的诊断价值及研究进展

甲状腺结节已成为一种是多种常见甲状腺疾病的共同表现,如何正确地早期诊断对临床治疗方案的选择以及预后均具有重要的影响。随着超声医学技术的不断发展,超声引导下细针抽吸活检技术是近年来逐渐发展起来的一项新技术,将二维超声与细针抽吸活检相结合,具有创伤小且安全有效的特点,逐渐成为鉴别甲状腺结节良恶性的重要方法。该文就二维超声、细针抽吸活检以及超声弹性成像在甲状腺结节的应用进行综述。     

Fine-needle aspiration biopsy of thyroid nodules. A cost-effective diagnostic plan

Fine-needle aspiration biopsy is a safe and accurate method for diagnosing thyroid nodules. Personnel who have experience with the aspiration technique and with the cytologic classification of specimens are crucial to accurate results. One important advantage of using fine-needle biopsy to initially screen patients with nodules is that it can save substantially on healthcare resources.     

Thyroid nodules

Palpable thyroid nodules occur in 4 to 7 percent of the population, but nodules found incidentally on ultrasonography suggest a prevalence of 19 to 67 percent. The majority of thyroid nodules are asymptomatic. Because about 5 percent of all palpable nodules are found to be malignant, the main objective of evaluating thyroid nodules is to exclude malignancy. Laboratory evaluation, including a thyroid-stimulating hormone test, can help differentiate a thyrotoxic nodule from an euthyroid nodule. In euthyroid patients with a nodule, fine-needle aspiration should be performed, and radionuclide scanning should be reserved for patients with indeterminate cytology or thyrotoxicosis. Insufficient specimens from fine-needle aspiration decrease when ultrasound guidance is used. Surgery is the primary treatment for malignant lesions, and the extent of surgery depends on the extent and type of disease. Ablation by postoperative radioactive iodine is done for high-risk patients--identified as those with metastatic or residual disease. While suppressive therapy with thyroxine is frequently used postoperatively for malignant lesions, its use for management of benign solitary thyroid nodules remains controversial.     

浅析超声引导下细针穿刺活检和超声联合弹性成像诊断甲状腺结节(TN)的临床价值

目的:探讨超声引导下细针穿刺活检和超声联合弹性成像诊断甲状腺结节的临床价值。方法:选取38例于2017年5月至2019年5月来我院影像科进行诊疗的疑为甲状腺结节患者为研究对象,所有患者于术前均行超声引导下细针穿刺活检与超声联合弹性成像检查,以手术病理结果为金标准,比较两种检查方式的诊断准确率。结果:超声联合弹性成像的诊断准确率为93.33%,较超声引导下细针穿刺活检的82.22%明显更高,两种检查方式比较存在显著差异(P<0.05)。结论:针对甲状腺结节的临床诊断,超声引导下细针穿刺活检与超声联合弹性成像各具优势,进行联合检测可提高临床检测的准确率,值得在临床当中推广应用。     

Fine-needle aspiration biopsy of thyroid nodules. A diagnostic method that minimizes the need for surgery

Fine-needle aspiration biopsy is the most accurate and cost-effective method of evaluating thyroid nodules. When an experienced endocrinologist and cytopathologist are available, aspiration biopsy is the diagnostic procedure of choice. In our experience at Straub Clinic and Hospital, Honolulu, it has more than halved the number of operations for suspected thyroid cancer.     

Imaging,genetic testing,and biomarker assessment of follicular cell-derived thyroid cancer

Abstract

Thyroid carcinoma is the most common endocrine malignancy worldwide, and its incidence continues to increase. As such the approach to a recently identified thyroid nodule is important to understand. The relevant imaging, examination, and need for fine-needle aspiration biopsy (FNA) are discussed. In approximately 25% of nodules, the diagnosis cannot be established with FNA-based cytology, and surgical excision is necessary for definitive diagnosis. Recent advances in genetic and molecular testing may increase the diagnostic accuracy of FNA in managing thyroid nodules.     

A high-resolution melting protocol for rapid and accurate differential diagnosis of thyroid nodules

A large majority of thyroid nodules are benign, and only 5% have malignant features on cytological examination. Unfortunately, fine-needle aspiration is inconclusive in approximately 30% of all thyroid biopsies, because the cytological features are indeterminate (suspicious for malignancy but not completely diagnostic or nondiagnostic). Wide panels of somatic mutations have been identified in thyroid cancers, and detection of genetic alterations in fine-needle aspirate has been demonstrated to improve diagnostic accuracy. Nevertheless, the relatively high number of genetic targets to be investigated, in comparison with the low percentage of malignant samples, makes the usual diagnostic protocol both time-consuming and expensive. We developed a reliable and sensitive protocol based on high-resolution melting analysis for the rapid screening of mutations of KRAS, HRAS, NRAS, and BRAF oncogenes in thyroid fine-needle aspirations. The entire procedure can be completed in approximately 48 hours, with a dramatic reduction in costs. The proposed protocol was applied to the analysis of 260 consecutive fine-needle aspiration biopsy (FNAB) samples. In 35 of 252 samples, 36 sequence variants were detected for BRAF (17 samples), NRAS (6 samples), HRAS (3 samples), KRAS codon 12 (9 samples), and KRAS codon 61 (1 sample).     

Ultrasound‐Guided Fine‐Needle Aspiration Versus Fine‐Needle Capillary Sampling Biopsy of Thyroid Nodules

OBJECTIVE: Both fine-needle aspiration (FNA) and fine-needle capillary (FNC) sampling of palpable thyroid nodules have been advocated. The appropriate technique for biopsy of nonpalpable nodules now sampled under ultrasound guidance has not been assessed. The objective of this study was to determine cytologic adequacy rates of ultrasound-guided FNA and FNC sampling. METHODS: Ultrasound-guided fine-needle biopsy was performed on 180 thyroid nodules. Nodules were measured and characterized (mixed cystic-solid or solid) on diagnostic sonography. The technique used for biopsy (FNA versus FNC sampling) alternated sequentially per patient. Four 25-gauge fine-needle samples were obtained from each nodule. The sampling adequacy and cytopathologic diagnoses were recorded. The significance of differences in cytologic adequacy rates between techniques was then assessed with a repeated measures logistic regression model. RESULTS: Fine-needle aspiration and FNC sampling biopsies were performed in 88 and 92 nodules, respectively. Fine-needle aspiration was diagnostic (ie, satisfactory) in 78 (89%) of 88 nodules and nondiagnostic (less than optimal or unsatisfactory) in 10 (11%) of 88 nodules; FNC sampling was diagnostic in 80 (87%) of 92 nodules and nondiagnostic in 12 (13%) of 92 nodules. Fine-needle aspiration sampling was diagnostic in 38 (86%) of 44 solid nodules and 40 (91%) of 44 mixed cystic-solid nodules; FNC sampling was diagnostic in 48 (81%) of 59 solid nodules and 32 (97%) of 33 mixed cystic-solid nodules. These percentages were not significantly different. CONCLUSIONS: Ultrasound-guided FNA and FNC sampling result in comparable diagnostic cytologic adequacy rates. Equivalent diagnostic yields and the technical ease of capillary sampling may prompt adoption of FNC sampling at high-volume endocrine/radiology practices.     

Fine-needle aspiration biopsy of the thyroid. Superior diagnostic tool

Fine-needle aspiration biopsy of thyroid nodules is an easily performed office procedure that has the highest sensitivity and specificity and the lowest cost of all evaluation methods. Interpretation requires an experienced cytologist or endocrinologist, or both. Patient acceptance has been high. With use of fine-needle aspiration biopsy, many unnecessary operations have been avoided.     

A Case Challenge: Differentiating Thyroid Nodules for Malignancy and Management

An increase in the identification of thyroid nodules (TNs) leads to a subsequent increase in benign nodules being misdiagnosed as malignant. The American Thyroid Association has recognized that most TNs are benign and has developed clinical guidelines to guide clinical decision making for the reduction of excessive thyroidectomy. Evaluation and treatment of TNs is recommended for all nodules identified through palpation and incidentally through advanced imaging. The goal of evaluation is to initiate accurate monitoring and management recommendations based on malignancy risk determined by patient history, physical examination, ultrasound imaging, and fine-needle aspiration biopsy when indicated.     

Thyroid nodules

Thyroid nodules are common entities, clinically important primarily because of their malignant potential. Serum thyrotropin and thyroid ultrasonography are pivotal in evaluating thyroid nodules. Fine-needle aspiration biopsy is the most accurate tool for diagnosing malignancy and selecting candidates for surgery. An approach to the initial evaluation and management of single nodules, functioning nodules, multinodular glands, incidental nodules, and cysts is discussed, as are therapeutic interventions for benign nodules. Thyroid cancer discovered during pregnancy is also discussed.     

Needle tract seeding of papillary thyroid carcinoma after fine-needle capillary biopsy: A case report

BACKGROUNDFine-needle biopsy is an accurate and cost-efficient tool for the assessment of thyroid nodules. It includes two primary methods: Fine-needle capillary biopsy (FNCB) and fine-needle aspiration biopsy. Needle tract seeding (NTS) is a rare complication of thyroid fine-needle biopsy mainly caused by fine-needle aspiration biopsy rather than FNCB. Here, we present an extremely rare case of a papillary thyroid carcinoma (PTC) patient with FNCB-derived NTS. CASE SUMMARYWe report a 32-year-old woman with PTC who showed subcutaneous NTS 1 year after FNCB and thyroidectomy. NTS was diagnosed based on clinical manifestations, biochemistry indices, and imaging (computed tomography and ultrasound). Pathological identification of PTC metastases consistent with the puncture path is the gold standard for diagnosis. Surgical resection was the main method used to treat the disease. After surgery, thyroid function tests and ultrasound scans were performed every 3-6 mo. To date, no evidence of tumor recurrence has been observed.CONCLUSIONFNCB is a safe procedure as NTS is rare, and can be easily removed surgically with no recurrence. Accordingly, NTS should not limit the usefulness of FNCB.     

Radiological and surgical management of thyroid neoplasms.

Recent advances in the radiological diagnosis in thyroid neoplasms have been achieved by high-resolution ultrasonography and color-Doppler, and the ultrasound-guided fine-needle aspiration biopsy and ultrasound-guided percutaneous ethanol injection therapy have been developed on the basis of these modalities. Ultrasonography and ultrasound-guided fine-needle aspiration biopsy have made minimally invasive thyroid surgery possible. The surgical procedures are classified into three main categories according to the approach, and each approach has its own advantages and disadvantages. Surgeons have to select the most suitable approach from one of these categories of approaches for each patient with a thyroid neoplasm.     

Ultrasound guided fine-needle aspiration cytology of?breast lesions

Breast biopsy consists in the collection of cells or tissue fragments from a breast lesion and their analysis by a pathologist. There are several types of breast biopsy defined on the basis of the type of needle used: fine-needle aspiration and biopsy performed with a spring-based needle. This article focuses on fine-needle aspiration performed under sonographic guidance.It is used mainly to assess cysts that appear to contain vegetations or blood or that are associated with symptoms; lesions and solid nodules that are not unequivocally benign; and axillary lymph nodes that appear suspicious on physical examination and/or sonography.In addition to distinguishing between benign and malignant lesions, ultrasound guided fine-needle aspiration also plays an important role in tumor grading and in immunocytochemical identifying specific tumor markers. This article describes the technique used and the possible causes of false negative and false positive findings. Despite its limitations, fine-needle aspiration has become a fundamental tool for the identification and preoperative management of malignant breast lesions.     

The role of large-needle aspiration biopsy in the preoperative selection of palpable thyroid nodules: a summary of principal data.

This report summarizes clinical and pathologic data showing the role of preoperative large-needle aspiration biopsy (LNAB) histology for a better evaluation of the palpable thyroid nodules that were non-diagnostic or microfollicular at fine-needle aspiration (FNA) cytology. LNAB performed on 261 nodules with non-diagnostic cytology showed findings which were adequate for diagnosis in 130 (49.8%) and inadequate in 131 (50.2%) cases. Two hundred sixty nodules that were diagnosed as microfollicular at FNA were also examined by LNAB; inadequate specimens were obtained in 17% of cases; pure microfollicular structure was confirmed by aspiration needle biopsy in 35% of the nodules and LNAB showed the remaining 48% to contain a macrofollicular component suggesting a benign hyperplastic lesion. Seventeen nodules that were found to be microfollicular at FNA and micromacrofollicular at LNAB were excised and the postoperative result was benign in all cases. Twenty-five nodules diagnosed as microfollicular on both FNA and LNAB were excised and the postoperative diagnoses were benign (20 nodules) or malignant (five nodules). These data indicate that LNAB histology can be used for the preoperative selection of the palpable thyroid nodules that were non-diagnostic or microfollicular at FNA cytology.     

Color Doppler sonography: Anatomic and physiologic assessment of the thyroid

The purpose of this study was to assess the potential application of color Doppler sonography in thyroid imaging. Thyroid nodules and other thyroid pathology detected by color Doppler ultrasound and nuclear scintigraphy were compared in 115 patients. The majority of “cold” nodules demonstrated a peripheral rim of color flow and no internal color flow with color Doppler sonography. A large number of “hot” nodules demonstrated internal color flow. Color Doppler sonography was helpful in delineating nodules in otherwise inhomogeneous glands. We determined that color Doppler cannot reliably distinguish benign from malignant thyroid nodules; fine-needle aspiration biopsy remains the most accurate method in differentiating benign and malignant lesions. We suggest that color Doppler sonography plays only a limited role in the evaluation of nodular thyroid disease at this time. The color Doppler appearance of other thyroid disorders (including toxic multinodular goiter, Graves' disease, and thyroiditis) is discussed. © 1995 John Wiley & Sons, Inc.     

Radioiodine imaging in the primary care of thyroid disease

There are few indications for ordering a RAIU or a thyroid scan in a primary care setting. In suspected hyperthyroidism, a sensitive thyrotropin assay should be the initial test ordered. If the thyrotropin level is low or suppressed, and the diagnosis of thyroiditis vs Graves' hyperthyroidism is not clear, a RAIU test is appropriate. In the case of a euthyroid nodular goiter, fine-needle aspiration is the most accurate initial test to evaluate for malignancy. The primary indication for a scan in the case of a euthyroid nodular goiter is a low or suppressed thyrotropin level, because malignancy is rare in a hot nodule. If thyroid cancer or congenital hypothyroidism is encountered, referral to an endocrinologist is probably the most expedient and cost-effective way to proceed.     

Risk for malignancy of thyroid nodules as assessed by sonographic criteria: the need for biopsy.

OBJECTIVE: To correlate sonographic and color Doppler characteristics of thyroid nodules with the results of sonographically guided fine-needle aspiration biopsy to establish the relative importance of these features in predicting risk for malignancy. METHODS: We retrospectively analyzed the sonographic features of 34 malignant and 36 benign thyroid nodules with respect to size, echogenicity, echo structure, shape, border, calcification, and internal vascularity. Individual features and combinations of features were analyzed for their correlation with benign or malignant disease. A comparative analysis of several authors' previously proposed methods for distinguishing between benign and malignant nodules using sonographic criteria was also performed to determine their sensitivity and specificity in predicting nodule disease within our study data. RESULTS: Nodule size ranged from 0.8 to 4.6 cm in greatest dimension (mean, 1.96 cm; SD, 0.877 cm). The prevalence of malignancy in our study population was estimated to be nearly 5.33%. Intragroup comparison of sonographic features among benign and malignant nodules resulted in identification of intrinsic calcification as the only statistically significant predictor of malignancy (35.3% sensitive and 94.4% specific; P < .005). Presence of a "snowstorm" pattern of calcification was 100% specific for malignancy. Echogenicity, echo structure, shape, border classification, and grade of internal vascularity did not show any significant difference between benign and malignant nodules in this study. Various combinations of features previously suggested to be significant predictors of malignancy were also analyzed and shown to have very little sensitivity or specificity in predicting benign or malignant disease among nodules in our study population. CONCLUSIONS: This study indicates that the presence of intrinsic microcalcification is the only statistically reliable criterion on which to base increased suspicion for malignancy in thyroid nodules. Our results indicate the need for biopsy in determining further workup. All nodules that show the presence of intrinsic microcalcification should undergo biopsy, particularly if calcifications have a snowstorm appearance on sonography.