联合BRAFV600E基因检测在甲状腺结节穿刺细胞学诊断为BethesdaⅢ类中的辅助诊断作用北大核心CSCD

目的分析甲状腺结节穿刺细胞学(fine-needle aspiration,FNA)诊断为意义不明确的细胞非典型病变或意义不明确的滤泡性病变(atypia of undetermined significance or follicular lesion of undetermined significance,AUS/FLUS)这一分类的恶性概率,探讨联合应用BRAFV600E基因检测在该分类中良恶性结节的诊断价值。方法回顾性分析郑州大学附属肿瘤医院2018年10月至2019年11月共114例行甲状腺结节FNA检查并行手术治疗的患者,其中男20例,女94例,年龄16~76岁,以手术病理结果作为甲状腺结节性质诊断的金标准,评估细胞学结果为AUS/FLUS的恶性发生率,并应用配对χ2检验(McNemer检验)和诊断试验评价方法分析术前FNA联合应用BRAFV600E基因检测对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的鉴别诊断效能。采用SPSS 22.0软件进行统计学分析。结果PTC患者中,BRAFV600E基因突变率为84.76%(89/105)。在FNA结果为AUS/FLUS这一分类中,PTC所占比例为57.14%(12/21)。BRAFV600E基因突变在AUS/FLUS这一分类中诊断PTC的特异度、敏感度、阳性预测值和阴性预测值分别为:9/9、5/12、5/5和9/16。BRAFV600E基因突变能够提高该细胞学分类患者的PTC检出率(OR=0.438,95%CI=0.251~0.763,P=0.016)。结论术前FNA联合BRAFV600E基因突变检测能显著提高细胞学诊断为AUS/FLUS的甲状腺结节的恶性检出率。     

甲状腺结节细针穿刺细胞学检查评估

目的 探讨甲状腺细针穿刺细胞学(fine-needle aspiration,FNA)检查的临床价值.方法 回顾性分析中国医学科学院肿瘤医院2005年10月至2011年1月行甲状腺细针穿刺的474例连续病例资料.B超引导下穿刺218例(46.0％),触诊穿刺256例(54.0％).细胞学诊断结果分为六级:无法诊断、良性、不典型细胞、滤泡样肿瘤、可疑恶性及恶性.将其中157例手术患者术前细胞学诊断结果与术后组织病理学诊断结果进行比较.结果 157例手术治疗患者中91例为恶性,术前FNA诊断为无法诊断2/7、良性16.7％ (9/54)、不典型细胞3/9、滤泡样肿瘤1/3、可疑恶性83.3％( 35/42)、恶性97.6％ (41/42).甲状腺细针穿刺鉴别甲状腺结节良恶性的敏感度为85.4％,特异度为86.9％.阳性预测值90.5％.结论甲状腺细针穿刺细胞学诊断能够为甲状腺疾病提供较为准确的术前诊断.六级诊断方法有助于临床治疗方案的选择.     

桥本甲状腺炎合并甲状腺乳头状癌外科诊治(附51例临床分析)

目的:探讨桥本甲状腺炎(HT)合并甲状腺乳头状癌(PTC)患者的临床诊断、治疗及预后。方法:回顾性分析2001-02-2008-10,经我科收治HT合并PTC患者51例临床资料。结果:28例患者术前行甲状腺相关抗体检查,甲状腺球蛋白抗体(TG-Ab)升高5例,甲状腺过氧化物酶抗体(TPO-Ab)增高15例;术前B超均发现甲状腺存在实质性肿块,发现伴有钙化灶22例,占43.14%,提示恶性者5例;3例外院行甲状腺细针穿刺细胞学检查(FNA),其中提示可疑癌细胞2例,高度怀疑恶性者1例。所有患者均行手术治疗,术后均进行随访,随访时间为8～100个月,失访2例,随访病例均未出现复发及转移发生,无瘤生存至今。结论:HT伴有甲状腺结节者应警惕恶性可能,术前结合TG-Ab、TPO-Ab、B超检查、FNA综合分析有助于HT合并PTC的诊断,手术治疗是针对HT合并PTC的有效治疗方法,其手术原则可依照PTC的治疗原则。手术治疗疗效好,预后好。     

甲状腺癌相关基因的研究进展

随着诊断技术的发展,甲状腺癌的发病率在世界范围内上升,成为最常见的内分泌肿瘤。通常,根据原发肿瘤的组织学特点可以将甲状腺癌分为甲状腺乳头状癌(papillary thyroid carcinoma,PTC)、甲状腺滤泡状癌(follicular thyroid carcinoma,FTC)、甲状腺髓样癌(medullary thyroid carcinoma,MTC)、低分化甲状腺癌及未分化甲状腺癌(anaplastic thyroid carcinoma,ATC),研究证实甲状腺癌的病理分型与其预后关系密切。在甲状腺肿瘤组织中发现多种基因(如IG20/MADD、RET、BRAF等)和分子(如基质金属蛋白酶)参与肿瘤的发生,分子水平研究成为诊断和治疗的新方向,基于分子病理生理学的新型靶向治疗方法已进入临床研究阶段,为难以手术根治的甲状腺癌的治疗带来希望。     

分化型甲状腺癌颈淋巴结清扫术

分化型甲状腺癌(differentiated thyroid cancer,DTC)起源于甲状腺滤泡上皮细胞,占甲状腺癌的90％以上,主要包括甲状腺乳头状癌(papillary thyroid carcinoma,PTC)和甲状腺滤泡状癌(follicular thyroid carcinoma,FTC),少数为Hurthle细胞或嗜酸性细胞肿瘤.颈部淋巴结转移是PTC主要的生物学特性之一,约20％ ～90％ PTC诊断时病理证实颈部淋巴结转移,转移部位最常见为同侧颈Ⅵ区淋巴结.甲状腺癌患者的颈部淋巴结转移,是复发率增高、存活率降低的危险因素.低分化型甲状腺癌也属于分化型甲状腺癌范畴,此类型肿瘤的临床生物学特点为高侵袭性、易转移、预后差.     

超声诊断对甲状腺乳头状腺癌中央区清扫的临床指导意义

目的:探讨超声诊断对甲状腺乳头状腺癌(特别是甲状腺微小灶癌)是否行中央区淋巴结清扫的临床指导意义。方法:分析2012-09-2013-12期间在我科(同一术者、同一标准)进行甲状腺乳头状腺癌行中央区淋巴结清扫手术的临床资料121例,评价术前超声对甲状腺微小灶癌和非微小灶癌中央区淋巴结转移的诊断价值。结果:121例患者中甲状腺微小灶癌(原发病灶d≤1.0cm)62例,其颈中央区淋巴结超声诊断的准确率为74.2%(46/62),漏诊率为61.9%(13/21),误诊率为7.3%(3/41),灵敏度为38.1%(8/21)、特异度为92.7%(38/41),阳性预测值为72.7%(8/11),阴性预测值为74.5%(38/51),Kappa值为0.3485(<0.4),表示在PTMC中术前超声与术后病理诊断一致性较差;非微小灶癌(原发病灶d>1.0cm)患者59例,其术前超声中央区淋巴结诊断的准确率为55.9%(33/59),漏诊率为58.3%(21/36),误诊率为21.7%(5/23),灵敏度为41.7%(15/36),特异度为78.3%(18/23),阳性预测值75.0%(15/20),阴性预测值为46.2%(18/39),Kappa值为0.1757(<0.4),表示超声诊断与术后病理诊断一致性仍较差。结论:甲状腺微小灶癌术前中央区淋巴结超声诊断提示可疑阳性的,需常规行颈中央区淋巴结清扫。对于中央区淋巴结超声提示阴性的,可结合患者高危因素决定是否行预防性颈中央区淋巴结清扫。非微小灶型甲状腺乳头状腺癌中央区淋巴结超声检查无论是否提示有无异常淋巴结,均应行颈中央区淋巴结清扫。     

超声引导下细针抽吸细胞学检查对甲状腺结节的诊断价值

目的　探讨不同医师操作下,超声引导下细针抽吸细胞学检查（fine needle aspiration cytology,FNAC）对不同大小甲状腺结节的诊断价值。方法　回顾性分析109 例患者122个结节的FNAC结果与手术组织病理学结果。结果　17个结节（13.9%）未获得满意的细胞学诊断结果,余105个结节FNAC与组织学结果的符合率85.7%。诊断敏感性78.6%,特异性93.9%,阳性预测值93.6%,阴性预测值79.3%。≤1 cm与＞1 cm组只有阴性预测值差异有统计学意义。≤1 cm与＞1 cm组、良恶性结节间、不同医师操作下FNAC取材不满意率均无统计学差异。结论　FNAC能有效鉴别不同大小甲状腺结节良恶性。     

超声引导下细针穿刺活检结合甲状腺影像报告和数据系统诊断甲状腺结节的临床价值

目的探讨超声引导下细针穿刺活检(US-FNAB)结合甲状腺影像报告和数据系统(TI-RADS)分类对甲状腺结节的诊断价值。方法回顾性分析经外科手术切除的490例患者的598个甲状腺结节的临床资料,所有结节均行TI-RADS分类和US-FNAB,以手术病理结果为金标准,计算FNAB、TI-RADS及两者联合诊断的敏感度、特异度、符合率、阴性预测值及阳性预测值,并绘制受试者工作特征(ROC)曲线,采用Z检验比较ROC曲线下面积(AUC)。结果 TI-RADS分类法诊断的敏感度、特异度、符合率分别为83.9%、82.0%、83.4%,而FNAB结果的TBSRTC分类法为99.0%、46.7%、89.6%。TBSRTCⅡ类的结节总体恶性率为7.8%,其中TI-RADS 4b、4c、5类结节的恶性率为50.0%;Ⅴ、Ⅵ类结节的总体恶性率分别为84.7%、95.3%,其中TI-RADS 4a类结节恶性率分别为58.2%、85.3%;Ⅰ、Ⅲ类结节总体恶性率分别为31.6%、31.8%,其中TI-RADS 4a类结节恶性率分别为10.0%、4.6%;而4b、4c或5类的结节分别为55.6%、82.6%。两者联合应用的敏感度、特异度分别为99.8%、82.3%。结论 FNAB与TI-RADS分类的联合使用,可以更及时地检测甲状腺癌,并有助于FNAB后选择最佳的治疗策略。     

使用两种不同的穿刺针对甲状腺细针穿刺标本满意率的影响

目的 比较使用带芯针或者空芯针对甲状腺细针穿刺细胞学检查(fine-needle aspiration cytology, FNAC)标本满意率的影响。方法 回顾性收集2019年1月～2021年7月阜阳市人民医院完成的甲状腺FNAC患者1614例1773个甲状腺结节临床资料,根据穿刺时使用针具不同分成空芯针组(n=837)和带芯针组(n=936),主要指标为标本满意率,次要指标为恶性诊断率及标本不满意原因。结果 两种针标本满意率比较,空芯针组标本满意率高于带芯针组(χ²=16.456,P<0.05)。标本不满意原因分析,带芯针标本中“血液污染遮蔽滤泡细胞”及“滤泡细胞少于最少诊断需要”原因高于空芯针(χ²=7.476、20.298,P<0.05)。两种针标本恶性诊断率比较差异无统计学意义(χ²=1.861,P>0.05)。结论 对于经验丰富的穿刺操作者,使用带芯针无法提升标本满意率,同时显著增加患者的穿刺费用。     

超声造影在鉴别伴有钙化的甲状腺结节良恶性中的价值

目的 评价超声造影在鉴别伴有钙化的甲状腺结节良恶性中的价值.方法 对2009年2月至2012年9月期间的179例伴有钙化的甲状腺结节患者经浅静脉注入造影剂微泡行超声造影检查,观察结节的造影剂灌注过程,并采用TomTec软件进行量化分析,获得造影定量参数,患者术后均经病理证实,以评估其灵敏性、特异性、阳性预测值、阴性预测值和诊断符合率.结果 良性结节110例,其中结节性甲状腺肿中46例伴粗大钙化和16例伴微钙化;腺瘤中28例粗大钙化和1例微钙化;桥本甲状腺炎中13例伴粗大钙化和4例伴微钙化,2例缝线肉芽肿均伴微钙化.恶性结节69例,其中乳头状癌中60例伴微钙化和8例伴粗大钙化,1例髓样癌伴微钙化.恶性结节主要表现为不均匀弱增强,峰值强度(51.38±14.33) dB,低于良性结节(92.37±33.36)dB,而良性结节为等增强或高增强,二者差异有统计学意义(t=14.33,P＜0.05),但是造影定量参数中始增时间与达峰时间良恶性结节相比差异无统计学意义.超声造影诊断伴有钙化的甲状腺结节良恶性的灵敏性、特异性、阳性预测值、阴性预测值、诊断符合率分别为92.75％、90.91％、86.49％、95.24％、91.62％.结论 超声造影对伴有钙化的甲状腺结节有较高的鉴别诊断价值.     

Repeated fine-needle aspiration cytology for the diagnosis and follow-up of thyroid nodules

IntroductionThe recently-proposed Bethesda reporting system has offered clinical recommendations for each category of reported thyroid cytology, including repeated fine-needle aspiration (FNA) for non-diagnostic and atypia/follicular lesions of undetermined significance, but there are no sound indications for repeated examination after an initial benign exam.ObjectiveTo investigate the clinical validity of repeated FNA in the management of patients with thyroid nodules.MethodThe present study evaluated 412 consecutive patients who had repeated aspiration biopsies of thyroid nodules after an initial non-diagnostic, atypia/follicular lesion of undetermined significance, or benign cytology.ResultsThe majority of patients were female (93.5%) ranging from 13 to 83 years. Non-diagnostic cytology was the most common indication for a repeated examination in 237 patients (57.5%), followed by benign (36.8%), and A/FLUS (5.6%) cytology. A repeated examination altered the initial diagnosis in 70.5% and 78.3% of the non-diagnostic and A/FLUS patients, respectively, whereas only 28.9% of patients with a benign cytology presented with a different diagnosis on a sequential FNA.ConclusionsRepeat FNA is a valuable procedure in cases with initial non-diagnostic or A/FLUS cytology, but its routine use for patients with an initial benign examination appears to not increase the expected likelihood of a malignant finding.     

Usage and Diagnostic Yield of Fine-Needle Aspiration Cytology and Core Needle Biopsy in Thyroid Nodules: A Systematic Review and Meta-Analysis of Literature Published by Korean Authors

ObjectivesThe usefulness of core needle biopsy (CNB) for the diagnosis of thyroid nodules remains controversial, and preferences vary across hospitals. The purpose of this study was to assess the actual use of CNB in Korea and to analyze the advantages and disadvantages of CNB through a systematic review and meta-analysis of papers published by Korean authors.MethodsA meta-analysis of full-text publications published in English presenting data from Korea retrieved from the Embase literature database was performed.ResultsCNB led to a significantly lower proportion of non-diagnostic results than fine-needle aspiration (FNA). However, the frequency of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) did not decrease as a result of performing CNB in nodules with initial AUS/FLUS results, while it increased in consecutive cases. A subcategory analysis of AUS/FLUS showed that the increased frequency of AUS/FLUS findings on CNB was due to more frequent diagnoses of architectural atypia and follicular neoplasm, which resulted in a higher frequency of inconclusive findings in consecutive cases compared to FNA. Hospitals favoring CNB had a higher proportion of AUS/FLUS diagnoses. Although the complication rate did not differ significantly between CNB and FNA, serious complications of CNB did occur.ConclusionA reduced frequency of non-diagnostic results may be a definite advantage of CNB over FNA. However, the increased frequency of diagnoses of architectural atypia and follicular neoplasm should be considered when selecting CNB as a diagnostic tool.     

Retrospective evaluation of frozen section use for thyroid nodules with a prior fine needle aspiration diagnosis of Bethesda II–VI: The Weill Cornell Medical College experience

ObjectiveTo evaluate the Weill Cornell Medical College (WCMC)/New York Presbyterian Hospital (NYPH) experience with intraoperative frozen (IOF) section in the management of thyroid nodules with a fine needle aspiration (FNA) diagnosis of Bethesda II–VI and to analyze the cost and pathology benefit it provides.MethodsThe surgical and cytopathology files at WCMC/NYPH were searched within the time period of January 2008 to May 2013. A total of 435 thyroid specimens were identified for which both an FNA and subsequent IOF section was performed. The FNA was correlated with the locations of the resected nodule and the nodule frozen for intraoperative diagnosis. The results of the FNA were compared to the IOF section diagnosis and final diagnosis (FD).ResultsAmong 435 cases, the FNA diagnosis was Bethesda II: 149 cases, Bethesda III: 170 cases, Bethesda IV: 91 cases, Bethesda V: 19 cases, and Bethesda VI: 6 cases. There were a total of 83 carcinomas identified on FD, which included 69 papillary thyroid carcinomas (PTCs), 12 follicular carcinomas, and 2 poorly differentiated carcinomas. The preoperative FNA diagnosis for these carcinomas was as follows: Bethesda II, 11/149 (7.4%), Bethesda III, 24/170 (14%), Bethesda IV, 26/91 (29%), Bethesda V, 16/19 (84%), and Bethesda VI, 6/6 (100%). IOF section contributed to the diagnosis of malignancy in 16/429 (4%) cases: 1/149 (0.7%) Bethesda II, 5/170 (3%) Bethesda III, 2/91 (1.1%) Bethesda IV, and 8/19 (42%) Bethesda V. The diagnosis of malignancy was confirmed in the 6 Bethesda VI cases by IOF section. There were no false positives on IOF section. IOF had a sensitivity and specificity of 26% and 100%, respectively.ConclusionThe role of IOF section is limited in the evaluation of thyroid nodules. IOF section is most useful for nodules with an FNA diagnosis of Bethesda V lesions. The diagnosis of follicular variant of PTC remains difficult on frozen section.     

Utilizing the McGill Thyroid Nodule Score to compare between hemithyroidectomy cases who required completion thyroidectomy and cases of hemithyroidectomy alone

ObjectivesThis study aims to evaluate whether the McGill Thyroid Nodule Score (MTNS) accurately helps to decide the extent of surgery (hemithyroidectomy versus total thyroidectomy) based on the malignancy risk and to assess whether its use lowers the rate of completion thyroidectomy in cases of indeterminate thyroid nodules.MethodsWe performed a retrospective cohort study comparing MTNS results of patients undergoing hemithyroidectomy in King Abdulaziz Medical City, NGHA, Jeddah from the period of January 2013 to December 2017. We divided the cases into hemithyroidectomy who required completion and hemithyroidectomy who did not need completion surgery. The pre-operative indeterminate FNA biopsy subgroup comprised of Bethesda type III (atypia of undetermined significance/follicular lesion of undetermined significance) and Bethesda type IV (follicular neoplasm/suspicious for a follicular neoplasm/Hurthle cell neoplasm). Post-operative histopathology was divided into benign or malignant groups.ResultsOf the 501 patient charts reviewed, 111 (22.2%) had an indeterminate FNA biopsy. 97 (87.4%) patients were females and 14 (12.6%) were males. In the hemithyroidectomy group, the pre-operative mean of the MTNS was 6.65, while in the completion thyroidectomy the mean was 11.47. The median MTNS was 7 (32% risk of malignancy) for the hemithyroidectomy group and 11 (63% risk of malignancy) for the completion thyroidectomy group (p < 0.001).ConclusionsBased on the MTNS the risk of malignancy in cases of hemithyroidectomy who required completion surgery was significantly higher than those who underwent hemithyroidectomy only. The MTNS can be of value to thyroid surgeon in the pre-operative decision-making when dealing with an indeterminate thyroid nodule on FNA biopsy.     

Role of fine needle aspiration and frozen section in determining the extent of thyroidectomy

The routine use of fine needle aspiration (FNA) and frozen section (FS) in the management of a thyroid nodule is controversial and needs to be evaluated on an institution to institution basis. Our aim was to determine the role of FNA and FS in determining the extent of thyroidectomy. We performed a comparative study of FNA and FS examination of all patients presenting with nodular thyroid disease between September 2002 and December 2005. Data were collected on a proforma by reviewing FNA, FS and histopathological reports. Data were analyzed on SPSS 11. Sensitivity, specificity, accuracy, positive predictive value and negative predictive values were calculated. We included 44 patients with preoperative FNA, intraoperative FS examination and final histopathology reports available. We excluded patients with local invasion and distant metastases. Final histopathological report was taken as gold standard. FNA reported 8 benign, 7 papillary carcinoma, 22 follicular neoplasm, 1 medullary and 6 suspicious lesions. On final pathology there were 16 benign and 28 malignant cases. Thus a total of 20 carcinomas were missed by FNA. When routine FS was done, a total of ten patients who had malignancy were missed. Both FNA and FS have high specificity for diagnosis of thyroid cancer but lacked sensitivity at our instituition. This is mainly because of high false negative results.     

The cytological and clinical value of the thyroid "follicular lesion"

BACKGROUND: The main limitation of fine-needle aspiration (FNA) is its limited distinction between neoplastic and benign lesions. We summarize our experience with thyroid nodules that were defined as follicular lesions by comparing the clinical and cytological features of the thyroid follicular lesions that were examined histologically to define the most reliable criteria of malignancy. METHODS: The medical records of all patients who underwent thyroid aspiration at Rabin Medical Center from 1999 to 2000 were reviewed for a diagnosis of follicular lesion that warranted surgery (N = 58). The cytology and pathology reports of the patients who met these criteria were reviewed and compared with the original reports. RESULTS: The incidence of malignancy in follicular lesions of the thyroid is about 26%. There was a significant correlation between a histologic diagnosis of carcinoma and the cytologic findings of nuclear grooves (P =.041), solid arrangement (P =.019), hypercellularity (P =.01), and hypercellularity to colloid amount ratio (P =.016). Nodular size was predictive of malignancy. No correlation was found between patient age or gender and tendency toward malignancy. CONCLUSIONS: The combination of cytological characteristics and the size of the nodule aspirate are predictive values of malignancy. We believe that every follicular lesion should be excised to obtain a definitive histological diagnosis based on capsular or vascular invasion.     

A single-center multidisciplinary study analyzing thyroid nodule risk stratification by comparing the thyroid imaging reporting and data system (TI-RADS) and American thyroid association (ATA) risk of malignancy for thyroid nodules

ObjectivesThe thyroid imaging reporting and data system (TI-RADS) and 2015 American Thyroid Association (ATA) guidelines are two well-known risk stratification systems for classifying thyroid nodules based on cancer risk. This study aims to evaluate the diagnostic efficacy of these two systems in predicting malignancy in patients undergoing thyroid surgery.MethodsWe studied data on 120 individuals who were scheduled to undergo surgery for benign or malignant nodular diseases of the thyroid gland between October 2017 and October 2019. The TI-RADS category and ultrasound pattern based on ATA guidelines were assigned to dominant thyroid nodule categories by two experienced radiologists blinded to patients’ previous thyroid ultrasonography and fine-needle aspiration biopsy results. A pathologist with experience in thyroid diseases blinded to patients’ sonographic and clinical data reviewed the thyroidectomy specimens.ResultsA total of 120 patients, 88 women and 32 men, were included in our study. Final histopathological results were as follows: 50% (n=60) papillary thyroid carcinoma, 36.6% (n=44) benign nodular thyroid diseases, 4.1% (n=5) follicular adenoma, 2.5% (n=3) hurtle cell adenoma, 1.7% (n=2) follicular thyroid carcinoma, 1.7% (n=2) medullary thyroid carcinoma, 1.7% (n=2) hurtle cell carcinoma, and 1.7% (n=2) follicular tumor of uncertain malignancy potential. The sensitivity, specificity, positive predictive value, and negative predictive value for TI-RADS were 80%, 56%, 72%, and 67%, respectively, and that for ATA were 80%, 64%, 76%, and 69%, respectively.ConclusionThe TI-RADS and ATA showed similar rates of sensitivity, specificity, NPV, and PPV. Our observed risk of malignancy was higher than expected for the ACR TI-RADS 3–5 categories and the very low, low, and intermediate suspicion risk strata in the ATA guidelines. We found no difference between observed and expected malignancy risk for the ACR TI-RADS 2’s and ATA's high suspicion categories.     

Fine-needle aspiration cytology in the diagnosis of salivary gland lesions. The role of the Milan system for reporting cytopathology

BackgroundFine needle aspiration cytology (FNAC) is an established technique in the management of salivary gland lesions. The Milan System for reporting salivary gland cytopathology (MSRSGC) intents to standardize diagnostic categories. Current studies are trying to evaluate the diagnostic approach of this system.MethodsFNAC of salivary gland lesions were retrieved over an 11-year period. 185 FNAC specimens from 182 patients were reviewed blindly and classified according to the criteria established by the MSRSGC. 136 (74.7%) patients had follow-up of their processes.ResultsThe total number of diagnostic categories and risk of malignancy (ROM) in 185 specimens were the following: non-diagnostic 39 (21.1%; ROM 12%), non-neoplastic 35 (18.9%; ROM 0%), atypia of undetermined significance (AUS) 17 (9.2%; ROM 46.1%), benign neoplasm 75 (40.5%; ROM 4.9%), salivary gland neoplasm of uncertain malignant potential 4 (2.2%; ROM 100%), suspicious for malignancy 7 (3.8%; ROM 100%), malignant 8 (4.3%; ROM 100%). No false positives were observed in groups IVb, V, and VI in this series. The overall sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy were 88%, 91.8%, 96.3%, 76.7%, and 91% respectively.ConclusionThe ROM reported in our study was in keeping with ROM published by the MSRSGC. This system provides standardized information for risk stratification. The category AUS encompassed cases causing uncertainty representing a challenge in management. Defining criteria for AUS category need to be refined. The system facilitates communication between pathologists and clinicians favoring improvement in patient care.     

Frozen section in a cytological diagnosis of thyroid follicular neoplasm

OBJECTIVE/HYPOTHESIS: Fine-needle aspiration biopsy is the most accurate diagnostic test for thyroid nodules, its only limitation being the diagnosis of follicular neoplasm that does not distinguish between benign and malignant follicular lesions. STUDY DESIGN: To determine the utility of intraoperative frozen-section analysis in cases of a cytological diagnosis of follicular neoplasm, a retrospective review of 66 patients with a solitary thyroid nodule and follicular neoplasm who underwent thyroid surgery was carried out. METHODS: Fine-needle aspiration was classified following the Papanicolaou Society of Cytopathology Classification, and frozen section was defined as malignant or "deferred." If a malignant diagnosis was made by frozen-section analysis, a total thyroidectomy was carried out. The extension of thyroid surgery in the deferred cases was based on the definitive histological diagnosis. RESULTS: Sixty-four cases were classified as deferred, and two as suspect for malignancy. Among the 64 deferred cases, 15 were malignant in the final pathological findings, and 49 were benign. The two suspect cases were papillary carcinoma. Frozen-section analysis classified 2 of 17 (11.7%) cases as follicular variant of papillary carcinoma that could not be diagnosed by cytological study. However, these two cases had a strong clinical evidence of malignancy. CONCLUSION: The routine use of frozen-section analysis is useless in cases of cytological diagnosis of follicular neoplasm on fine-needle aspiration biopsy, because of the low probability of achieving the diagnosis of follicular carcinoma and the inability to provide additional information apart from the clinical and the cytological data.