Ultrasound-guided fine needle aspiration biopsy of thyroid nodules performed in the office

INTRODUCTION: The majority of thyroid fine needle aspiration biopsies (FNAB) today are performed in the office freehand by palpation. Not infrequently, patients are sent to radiology for an ultrasound-guided FNAB (USG-FNB). Real-time ultrasound (US) allows for continuous visualization of the needle during insertion and sampling. Historically, USG-FNAB has been a procedure performed by a radiologist in a designated radiology suite. In more recent years, with the development of smaller more portable US machines, there has been a push for clinicians other than radiologists to perform the procedure. OBJECTIVE: To evaluate the accuracy and specimen adequacy of thyroid FNAB performed in the office under US guidance by one senior otolaryngologist. METHODS: Retrospective chart review of 203 patients who underwent ultrasound-guided USG-FNA of the thyroid gland between September, 2005, to February, 2007, in the office setting by one senior otolaryngologist. Specimens were reviewed onsite at the time of biopsy for cellular adequacy by a cytotechnologist. RESULTS: A total of 203 patients, 176 females and 27 males, underwent USG-FNA of the thyroid gland. The average age of the females was 52 years, and 59.4 years for the males. A total of 271 FNA biopsies were performed. Two hundred and twenty FNAB were satisfactory specimens (81.2%), 26 were unsatisfactory (9.6%), and 25 (9.2%) were limited due to blood clotting or hypocellularity. Of the FNA specimens that had enough cells to evaluate, 159 were benign, 48 were indeterminate for malignacy, and 13 were positive for malignancy. Of the nodules biopsied, 143 were greater than 1.5 cm (average 2.59 cm, unsatisfactory rate 12.6%), and 128 were less than 1.5 cm (average 1.21 cm, unsatisfactory rate 6.3%).In 44 patients, one or more nodule was biopsied at the same office visit. DISCUSSION: Thyroid US is an indispensable tool in the workup and diagnosis of thyroid disease. It may be used to help identify pathology and physical features suspicious for malignancy and guide FNAB of suspicious nodules. The availability of an office US machine allows the referring physician to perform a service that is normally done in a different department. This ultimately frees up time for both the patient and physician and reduces health care costs by eliminating extra office visits. More importantly, it allows the primary physician to be more knowledgeable and hands on with the patient's overall care. CONCLUSION: This study shows that a trained physician may perform a USG-FNA of the thyroid gland in the office with results comparable to that in the radiology literature.     

Implantation metastasis of head and neck cancer after fine needle aspiration biopsy

One possible complication of the aspiration biopsy of malignant tumors is dissemination of tumor cells along the needle track. However, a search of the literature revealed few definite reports of implantation metastases of head and neck tumors after fine needle aspiration biopsy (FNAB). Here we report two cases of skin metastasis of head and neck cancer after FNAB, including a patient with papillary adenocarcinoma of the thyroid and one with adenoid cystic carcinoma of the submandibular gland. Surgical treatment prevented the spread of the tumor in both cases and there have been no evidence of recurrence to date. This report should alert head and neck surgeons to the possibility of implantation metastasis after FNAB.     

Pediatric thyroid nodules: A single center experience

Objectives1. Analyze our center's experience with thyroid nodules. 2. Evaluate the efficacy of fine needle biopsy. 3. Compare our experience with the 2015 ATA guidelines.MethodsIRB approved retrospective chart review from July 1993–July 2014 at a tertiary pediatric institution. Patients under age 21 with documented thyroid nodules who underwent fine needle aspiration, and/or thyroidectomy were included.Results126 patients were identified. 84.1% (n = 106) were female. Age range was 12 months–20 years. The average age was 13.3 ± 4.1 years. The nodules ranged from 0.5 cm to 6 cm 53.9% (n = 68) had a fine needle biopsy done. 42.6% (n = 29) fine needle biopsies were benign, 26.5% (n = 18) were non-diagnostic, 13.2% (n = 9) were classified as “atypia”, 0.09% (n = 6) were consistent with thyroiditis, and 0.09% (n = 6) were suspicious for papillary carcinoma.78.6% (n = 99) underwent surgery. 7 patients with “benign” needle biopsies underwent surgery: all had follicular adenoma. 7 patients with “atypia” needle biopsies underwent surgery: one patient had papillary thyroid cancer. 8 patients with non-diagnostic needle biopsies underwent surgery: one patient had papillary thyroid cancer. All the patients with needle biopsy suspicious for papillary carcinoma had papillary carcinoma on final pathology.99 patients underwent surgery: 14.1% (n = 14) had papillary carcinoma and 2% (n = 2) had medullary carcinoma.ConclusionOur review of pediatric thyroid nodules at our institution supports data previously reported. 84% of identified patients were female, supporting previous data that nodules are more prevalent in the female population. Of the 126 patients identified, 12.7% had thyroid carcinoma, supporting the 7–25% range described in previous literature. Our institution showed a high positive predictive value of FNA for papillary thyroid carcinoma.     

Fine needle aspiration biopsy: role in diagnosis of pediatric head and neck masses

OBJECTIVE: To assess the feasibility and role of fine needle aspiration biopsy (FNAB) as a diagnostic tool in children with neck masses. DESIGN: Retrospective chart review. SETTING: Tertiary care children's hospital. PATIENTS: Consecutive series of 71 children with a head and neck mass who underwent FNAB as the primary diagnostic modality. INTERVENTIONS: FNAB was performed and interpreted by a pediatric cytopathologist. Rapid on-site analysis was performed to allow immediate assessment of specimen adequacy and to attain a preliminary diagnosis, after which routine cytologic staining was performed. Flow cytometry was performed on cytological specimens when malignancy was suspected, and open biopsy was performed when the cytologic diagnosis was in question. MAIN OUTCOME MEASURES: Technical feasibility of FNAB in children, complications, cytopathological diagnoses, accuracy of rapid on-site analysis, need for subsequent diagnostic evaluations, clinical outcomes and follow-up. RESULTS: Mean age was 8.4 years (S.D. 5.3 years), with mean follow-up of 4.1 months (S.D. 9.6 months). FNAB was performed under general anesthesia in 54 cases (76%). There were no technical complications. On-site rapid interpretation was completed in 55 cases, 18/55 confirmed adequacy of specimen only, 37/55 yielded a preliminary diagnosis, and in 34/37 cases, was same as final cytopathologic result. Overall, FNAB biopsy demonstrated 64 benign lesions, 3 malignant diagnoses, 2 follicular thyroid neoplasms, and 2 non-diagnostic specimens. FNAB was the only pathological test performed in 54 (76%) cases. The most common diagnosis was reactive lymphoid hyperplasia (n=39), followed by benign granulomatous disease (n=8). Flow cytometry was performed on 7 specimens (non-diagnostic in 5, negative for malignancy in 2). Of the 15 cases with surgical specimens, 3 revealed a pathologic diagnosis different from initial FNAB. There were no cases in which FNAB missed a malignancy, and there were 2 cases where FNAB suggested malignancy, with benign disease subsequently found on open biopsy. CONCLUSIONS: Fine needle aspiration biopsy is developing into a feasible option in diagnosing pediatric neck masses, with its main advantage being its minimally-invasive nature and avoidance of an open surgical procedure for benign persistent lymphadenitis. On-site rapid interpretation can be used successfully to confirm specimen adequacy and to give an accurate preliminary diagnosis for concerned parents. Issues to consider include the need for a specialized pediatric cytopathologist familiar with pediatric differential diagnoses, the need for general anesthesia in many cases, and the possibility of inaccurate diagnosis requiring an open procedure.     

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.     

Non-thyroid neck lumps: appraisal of the role of fine needle aspiration cytology

To compare the non-diagnostic rate of fine needle aspiration cytology (FNAC) of non-thyroid neck lumps performed under ultrasound (US) guidance against non-guided FNAC (performed in outpatient clinic). Final histology results were compared with cytological diagnosis. We performed a retrospective study of 625 patients identified as having undergone FNAC of non-thyroid neck lumps from the pathology/radiology databases over a 3 year period. A total of 396 patients underwent non-ultrasound guided FNAC (12 excluded). 34% of patients had a non-diagnostic sample. A total number of 229 patients underwent ultrasound guided FNAC with a non-diagnostic rate of 12%. The Chi-squared test showed a significant difference (P < 0.001). FNAC results were compared with definitive histology in 238 patients. Sensitivity was 92% and specificity was 90%. US-guided FNAC resulted in a lower non-diagnostic rate. FNAC was highly sensitive for diagnosis of malignant lumps but less good at confirming a lump to be benign.     

超声造影和弹性成像鉴别良恶性甲状腺结节作用的Logistic回归分析

目的 应用Logistic回归模型评价超声造影及弹性成像在甲状腺结节良恶性鉴别诊断中的价值.方法 对149例患者的甲状腺结节进行超声造影及弹性成像检查,建立以甲状腺结节超声特征为变量的Logistic回归模型.绘制受试者工作特征曲线,评价Logistic回归模型的预报能力,通过比较各变量的似然比,评价超声造影及弹性成像在甲状腺结节良恶性鉴别诊断中的价值.结果 运用前进法二分类Logistic回归分析,筛选出对甲状腺结节良恶性鉴别诊断中有统计学意义的特征变量包括钙化、增强程度、最大灌注强度及弹性评分.超声造影定量指标的似然比明显高于其他变量.所建立的回归模型对甲状腺结节良恶性预报的正确率为91.90％.结论 超声造影和弹性成像对诊断甲状腺结节的良恶性具有较高的价值,所建立的Logistic回归模型具有较高的诊断正确率.     

Clinical value of fine needle aspiration cytology in pediatric cervical lymphadenopathy patients under 12-years-of-age

Objective

The purpose of this study was to evaluate the usefulness and accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of pediatric cervical lymphadenopathy in patients under 12-years-of-age.

Methods

A retrospective chart review was performed to evaluate patients under 12-years-of-age with cervical lymphadenopathy who underwent lymph node excision biopsy from January 2007 to June 2013. The results of FNAC were compared them with the corresponding histopathological diagnosis.

Results

Eighteen of the 27 patients had undergone FNAC before performing excision biopsy, which diagnosed benign diseases in 15 patients and malignant diseases in three patients. All 18 patients underwent excision biopsy. FNAC had a diagnostic sensitivity of 100%, positive-predictive value of 93.3%, and accuracy of 94.5% for diagnosing pediatric cervical lymphadenopathy.

Conclusions

FNAC is a useful and accurate adjunct for the evaluation of pediatric cervical lymphadenopathy. FNAC should be part of the initial evaluation of pediatric patients with cervical lymphadenopathy before determining the treatment plan     

Fine-needle aspiration biopsy findings suspicious for papillary thyroid carcinoma: a review of cytopathological criteria

OBJECTIVES/HYPOTHESIS: The objective was to evaluate the usefulness of standard suspect cytological features on fine-needle aspiration biopsy (FNAB) in predicting papillary thyroid carcinoma. STUDY DESIGN: Retrospective chart review of consecutive fine-needle biopsies of the thyroid. METHODS: The study was a retrospective review of consecutive patients presenting with a diagnosis of suspected (group 1) or positive papillary thyroid carcinoma (group 2). The frequency of standard cytological features (i.e., papillary architecture, multinucleated giant cell, nuclear pseudo-inclusions, nuclear grooves, micronucleoli, powdery chromatin, and psammoma bodies) were recorded for each group. These were compared using chi test. Sensitivity and specificity for both individual and a combination of features were calculated for patients in group 1. RESULTS: One hundred eight patients were eligible for the study (group 1, n = 57; group 2, n = 51). Fifty-one patients (89%) in group 1 and all patients in group 2 had a histopathological diagnosis of papillary thyroid carcinoma. Respectively, the most frequent features present on fine-needle aspiration biopsy in group 1 versus group 2 were nuclear grooves (79% vs. 88%), micronucleoli (74% vs. 86%), pseudo-inclusions (58% vs. 88%), and powdery chromatin (47% vs. 59%); P values for these features were P > .05, P > .05, P < .05, and P > .05, respectively. In group 1, the sensitivities of nuclear grooves and micronucleoli were 80% and 71%, respectively. The presence of psammoma bodies was associated with a specificity of 100%. A combination of nuclear grooves, micronucleoli, pseudo-inclusions, powdery chromatin, and multinucleated giant cells was 100% specific in detecting papillary thyroid carcinoma. CONCLUSION: In choosing the most appropriate management of a finding suspect for papillary thyroid carcinoma on fine-needle aspiration biopsy, the surgeon must be aware of the diagnostic importance of certain cytopathological features. The presence of a combination of these factors may allow a more confident surgical approach.     

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.     

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.     

Bayesian analysis of high-resolution ultrasonography and guided fine needle aspiration cytology in diagnosis of palpable thyroid nodules

Introduction

To evaluate diagnostic accuracy of high-resolution ultrasonography in differentiation of benign and malignant thyroid nodules in comparison to results of guided fine needle aspiration cytology based on the Bayes rule.

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.     

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.     

Benefits of ultrasound vs. computed tomography in the diagnosis of pediatric lateral neck abscesses

Objective

There are no studies comparing the accuracy of ultrasound and computed tomography in the same population of pediatric patients with lateral neck abscesses. This case series assesses the accuracy of the two imaging techniques.

Methods

One hundred and forty imaging studies (ultrasound n = 39 or CT n = 101) that were performed from 2005 to 2011 prior to incision and drainage of a lateral neck mass at a tertiary care academic institution were retrospectively reviewed. All children 0–18 years of age with lateral neck abscesses who underwent CT or ultrasound imaging prior to drainage were included. Sensitivity, specificity, and positive and negative predictive values of ultrasound and CT were determined as compared to the gold standard, incision and drainage of the suspected abscess.

Results

In children undergoing incision and drainage, the prevalence of an abscess was 89%. Ultrasound has a high specificity (100%) but a low sensitivity (53%). The positive predictive value (96%) is high while the negative predictive value is low (16%), assuming a positive abscess prevalence of 0.9. In contrast, CT has low specificity (18%) but slightly higher sensitivity (68%) compared to ultrasound. Similar to ultrasound, CT had low negative (6%) and high positive (88%) predictive values.

Conclusions

This study demonstrates that ultrasound may be an equivalently sensitive and more specific diagnostic tool when compared to CT in the work-up of lateral neck abscesses in children. It is safe and effective in diagnosis when there is an undetermined probability of an abscess.     

针径大小和穿刺手法对甲状腺结节细针穿刺细胞学检查标本满意率的影响

目的 探讨小同型号穿刺针和芽刺手法对甲状腺结节细针芽刺细胞字检查(FNAC)标本满意率的影响.方法 回顾分析959例(1018个)甲状腺结节FNAC患者临床资料,根据穿刺针直径大小及穿刺手法不同分为4组.22G前后组352例(382个),使用22G针配合前后穿刺手法;22G螺旋组289例(300个),使用22G针配合前...     

Seeding of tumor cells after fine needle aspiration cytology in benign parotid tumor: a case report and literature review

Fine needle aspiration cytology (FNAC) is generally considered a safe, sensitive, and specific diagnostic tool and is widely used for various clinical indications. However, some authors have raised concerns regarding the possibility of tumor cell seeding along the needle track. We present to our knowledge the first case of tumor seeding after FNAC of a benign parotid tumor. This is followed by a review of the literature on tumor seeding after aspiration with fine needles of 20 gauge and smaller and the implications for clinical practice.     

甲状腺细胞病理学Bethesda报告系统的临床应用:肿瘤专科医院5729例样本的回顾性分析

目的分析肿瘤专科医院甲状腺细胞病理学Bethesda报告系统的数据特点,评价甲状腺细针穿刺(fine needle aspiration,FNA)的诊断能力。方法回顾性分析2017年1月至2018年12月中国医学科学院肿瘤医院行甲状腺FNA检查的5729个组织的临床资料,来自5011例患者,其中男1174例,女3837例,年龄7~88岁,中位年龄45岁。以术后组织病理学结果为金标准,分析Bethesda分级系统各诊断级别的恶性风险和甲状腺FNA的诊断能力。结果5729个细胞学诊断包括:无法诊断或标本不满意(nondiagnostic or unsatisfactory,ND/UNS)456个(8.0%),良性(benign)1055个(18.4%),意义不明确的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)409个(7.1%),滤泡性肿瘤或可疑滤泡性肿瘤(follicular neoplasm or suspicious for a follicular neoplasm,FN/SFN)80个(1.4%),可疑恶性(suspicious for malignancy,SUS)982个(17.1%),恶性(malignant)2747个(47.9%)。3239个有术后病理结果,其中恶性者3109个(95.99%)。各诊断级别的恶性风险分别为:ND/UNS 75.00%,良性40.91%,AUS/FLUS 77.67%,FN/SFN 41.67%,SUS 96.86%,恶性99.96%。FNA诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为98.8%、60.5%、97.7%、98.9%和59.1%。结论肿瘤专科医院甲状腺Bethesda报告系统的数据具有恶性诊断占比高和各诊断级别恶性风险高的特点。FNA诊断准确性高,且有较高的阳性预测值。