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Thyroid fine needle aspiration: How to improve clinicians' confidence and performance with the technique

Published on Jun 1, 2008in Cancer Letters6.508
· DOI :10.1016/j.canlet.2008.02.056
Angelo Carpi39
Estimated H-index: 39
,
G Di Coscio16
Estimated H-index: 16
+ 4 AuthorsA. Nicolini11
Estimated H-index: 11
Abstract
Abstract Studies from single institutions report an acceptable accuracy rate for thyroid fine needle aspiration (FNA). However, FNA accuracy is much lower in many other centers in Europe and the USA and large multicenter studies indicate that the clinicians’ confidence in the FNA technique remains low. One explanation for this is that there is an excess of inadequate and indeterminate findings for a follicular nodule at FNA cytology. In a University Hospital with large and qualified experience on thyroid nodule diagnosis, a review of 320 slides with an FNA diagnosis of indeterminate follicular nodule from different minor Italian Hospitals led to a different diagnosis in 61%. Since ancillary thyroid imaging may be overutilized and only a few authors report a proportion of excised nodules lower than 10%, we suspect that use of the FNA procedure is suboptimal. Several techniques are reported to improve the performance of thyroid FNA. Among these are tumor markers and large needle aspiration biopsy (LNAB). Immunodetection of the tumor marker galectin-3 has been evaluated by large multinational studies. Analysis of LNAB specimens reduces the number of inadequate FNA findings, improves the diagnostic determination of indeterminate follicular FNA findings and represents a better substrate for the determination of galectin-3. Therefore, we propose that clinical practice guidelines reflect these adjuvant techniques to thyroid FNA in order to improve selection criteria for thyroid nodule surgery.
  • References (75)
  • Citations (23)
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References75
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#2Erik K. Alexander (Harvard University)H-Index: 41
Last. Leonard Wartofsky (MedStar Washington Hospital Center)H-Index: 45
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Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and diff...
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Abstract Tumors of the thyroid characterized by a follicular growth pattern constitute the most common type of lesion of this organ encountered by pathologists. The vast majority of such lesions do not pose difficulties for histopathologic interpretation. A subset of these tumors, however, can represent a serious challenge for diagnosis. Thyroid tumors with a follicular growth pattern include a broad range of lesions that range from benign, hyperplastic nodules to follicular adenomas to follicul...
73 CitationsSource
#1Jack Yang (UTMB: University of Texas Medical Branch)H-Index: 1
#2Vicki J. Schnadig (UTMB: University of Texas Medical Branch)H-Index: 15
Last. Patricia G. Wasserman (UTMB: University of Texas Medical Branch)H-Index: 1
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BACKGROUND. The Papanicolaou Society of Cytopathology recently proposed 6 diagnostic categories for the classification of thyroid fine-needle aspiration (FNA) cytology. Using these categories, the experience with FNA from 2 institutions was studied with emphasis on cytologic-histologic correlation, source of errors, and clinical management. METHODS. Patient cytology data were retrieved by a retrospective search of thyroid FNA in the institutional databases. Cytologic diagnoses were classified as...
468 CitationsSource
#1Teresa RagoH-Index: 35
#2G Di CoscioH-Index: 16
Last. Paolo VittiH-Index: 53
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Summary Background The relationship between thyroid autoimmunity and cancer is still uncertain. Patients We approached this issue in 570 consecutive patients submitted to thyroidectomy for an indeterminate nodule on cytology. Thyroid autoimmunity was defined as positivity of circulating thyroid autoantibodies (TAb), autoimmune hypo- or hyperthyroidism, thyroid hypoechogenicity on ultrasound, and lymphocytic infiltration on histology. Results TAb were found in 122/570 (21·4%), hypoechogenicity in...
48 CitationsSource
#1Angelo CarpiH-Index: 39
#2A. NicoliniH-Index: 11
Last. Federico Carpi (UniPi: University of Pisa)H-Index: 30
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#1Luis Mauricio Hurtado-López (HGM: Hospital General de México)H-Index: 11
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#1Teresa Rago (UniPi: University of Pisa)H-Index: 35
#2G Di CoscioH-Index: 16
Last. Paolo VittiH-Index: 53
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Summary Objective The cytological patterns of follicular and Hϋrthle cell nodules are included among the indeterminate results of fine-needle aspiration cytology, because distinction between benign and malignant lesion can only be made on histological criteria. The diagnostic value of atypia at cytology, clinical parameters and echographic patterns were examined to establish the risk of malignancy in 505 patients with follicular and Hϋrthle cell thyroid nodules at cytology. Design and patients T...
117 CitationsSource
#1Angelo Carpi (UniPi: University of Pisa)H-Index: 39
#2Jeffrey I. Mechanick (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 40
Last. Roberto GiardinoH-Index: 52
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Abstract Recent guidelines for the evaluation of thyroid nodules clarify the diagnostic algorithm while also reporting important differences. The performance of fine needle aspiration (FNA) for cytological examination follows serum TSH determination and thyroid ultrasonography. Thyroid scintigraphy is recommended following a low TSH value and/or FNA yielding an indeterminate follicular cytology. The use of thyroid ultrasonography is the source of some controversy: though it is recommended as a p...
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#1Jeffrey I. Mechanick (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 40
#2Angelo Carpi (UniPi: University of Pisa)H-Index: 39
The preoperative evaluation of thyroid nodules currently relies on a clinical assessment of risk factors and an algorithm based on imprecise tests. With serum TSH, thyroid ultrasound and fine-needle aspiration (FNA) with or without ultrasound guide, accounting for the routine initial evaluation, indeterminate aspirates remain the major obstacle for confidently advising patients whether to have surgery or not. Recent clinical guidelines have attempted to settle various controversies but many inhe...
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#1Angelo Carpi (UniPi: University of Pisa)H-Index: 39
#2Antonio Giuseppe Naccarato (UniPi: University of Pisa)H-Index: 29
Last. Armando BartolazziH-Index: 30
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Thyroid fine-needle aspiration biopsy (FNA)-cytology is widely used for the preoperative characterisation of thyroid nodules but this task is difficult for follicular lesions, which often remain undefined. We propose a strategy for improving the preoperative characterisation of selected follicular thyroid proliferations, which is based on large needle aspiration biopsy (LNAB) and galectin-3 expression analysis. Eighty-five thyroid specimens were obtained by LNAB (20-gauge needles) from thyroid n...
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#1Zubair W. Baloch (UPenn: University of Pennsylvania)H-Index: 52
#2Virginia A. LiVolsi (UPenn: University of Pennsylvania)H-Index: 77
Fine-needle aspiration (FNA) is a quick, valuable, minimally invasive procedure to assess the nature of a thyroidal mass. It should not be confused with “needle biopsy,” which requires a Tru-Cut or Vim-Silverman needle and yields tissue fragments for histologic diagnosis. Details of the FNA technique and the equipment required have been described. Of particular importance is the use of a syringe holder and needles with clear plastic hubs (Oertel, J Clin Endocrinol Metab 80:1467–8, 1995). It is e...
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