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Effect of combining US and US-guided FNA biopsy findings for the diagnosis of thyroid nodules

Effect of combining US and US-guided FNA biopsy findings for the diagnosis of thyroid nodules. Dr. Khalid A. Yarouf Surgical Journal Club. 4MedStudents.com . Introduction. Thyroid nodules are extremely common. On US screening, thyroid abnormalities can be found in up to 25-40%.

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Effect of combining US and US-guided FNA biopsy findings for the diagnosis of thyroid nodules

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  1. Effect of combining US and US-guided FNA biopsy findings for the diagnosis of thyroid nodules Dr. Khalid A. Yarouf Surgical Journal Club 4MedStudents.com

  2. Introduction • Thyroid nodules are extremely common. • On US screening, thyroid abnormalities can be found in up to 25-40%. • FNA biopsy, which is simple, safe, specific, accurate, and cost-effective, is the established method of evaluating such nodules. Its reliability varies from 62% to 100%, and the failure may occur due to inadequate specimen. Dr. KA Yarouf

  3. Con’t Introduction • The combined use of US and FNA biopsy has not been evaluated in a comprehensive prospective study. • Aim: assess the precise diagnosis on US alone, US-guided FNA biopsy alone, and the combination of the two to predict malignancy in thyroid nodules. • Design: prospective open study. • Setting: Thyroid center, Japan. This research was published in the European Journal of Surgery, 2001. Dr. KA Yarouf

  4. Patients • US and US-guided FNA biopsy were used to examine 1758 patients with thyroid nodules. • 309 patients had different thyroid operations: • 50% (156) diagnosed with malignancy. • 16% (48) with follicular adenoma. • 25% (77) with goiters treated for cosmetic reasons or because they were compressing trachea. • 9% (28) whose nodules had increased in size during follow up. Dr. KA Yarouf

  5. Methods • Sample: 279 women and 30 men. • Mean age: 53 years, SD: 14 years, range: 15-82. • Fisher's exact test was used to assess significance of difference between groups, and probabilities < 0.05 were considered significant. Dr. KA Yarouf

  6. US & US-guided FNA biopsy • These procedures were done by 8 staff doctors (5 surgeons + 3 physicians) who are specializing in endocrinology. • Based on US, thyroid nodules were classified into malignant and benign. Criteria were: (Table I). • Suspicious of malignancy: • Was defined as nodules with > 2 of malignant elements noted in Table I excluding invasion of adjacent organs. • Was included in the malignant category for US diagnosis. Dr. KA Yarouf

  7. Cytological Dx • Cytology was interpreted by a single cytologist using 4 categories: malignant, suspicious of malignancy, benign, inadequate. • Specimens suspicious of malignancy were combined with malignant category. • Inadequate specimens were defined as = No cells or degenerate cells alone on the slide glass. Dr. KA Yarouf

  8. Final combined preoperative Dx • Was made by both US & cytological characteristics according to the formula shown in Fig. 1. Histological Dx • Was made by a single pathologist. Dr. KA Yarouf

  9. Results & Discussion Dr. KA Yarouf

  10. Con’t Results & Discussion • There was no difference between accuracy of US and that of cytology. • Fig. 2 shows comparison of cytological Dx with final histological results. • Fig. 4 shows the 20 false (-)ve cases diagnosed by cytology. • US & cytology failed to diagnose any of the follicular carcinoma!  • The 9 cases diagnosed by histology as papillary carcinoma could not be diagnosed by either cytology or US. Difficulty in diagnosing follicular variant of papillary carcinomas has been well described in previous studies. Dr. KA Yarouf

  11. Con’t Results & Discussion • Fig. 3 shows the 16 cases inadequate for cytological Dx. • US incorrectly diagnosed 4 nodules, which were all follicular carcinoma. • US & cytology failed to diagnose any of the follicular carcinoma!  That's because researchers were unable to differentiate a follicular adenoma from a follicular carcinoma. Dr. KA Yarouf

  12. Con’t Results & Discussion • Considering findings of US and cytology together, results were better than those of US or cytology alone: sensitivity was 89%, specificity was 91%, and overall accuracy was 90%. • When 65 follicular tumors were excluded from the calculation, sensitivity was 93%, specificity was 96%, and accuracy was 94%. Dr. KA Yarouf

  13. Conclusion • The combined use of US and cytology for final preoperative Dx improve sensitivity, specificity, and diagnostic accuracy rates of nodular thyroid disease regardless of the size of the nodule, although there are considerable limitations with follicular tumors. Dr. KA Yarouf

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