Search

Objective: Thyroid fine‐needle aspiration (FNA) is a principal diagnostic procedure for thyroid nodules. A specific cytomorphological structure, known as the thyroid spherule, is often seen in FNA specimens. The clinical significance of these spherules in terms of diagnosis and prevalence remains largely unexplored. Methods: We performed a retrospective study on 310 thyroid FNA specimens and categorized them according to the Bethesda System for Reporting Thyroid Cytopathology. The presence, size and number of thyroid spherules in each specimen were examined and these data were subsequently correlated with the clinicopathological features. Results: Thyroid spherules were almost exclusively detected in benign cases, comprising 7.6% of all benign diagnoses. The average diameter of spherules in benign cases was 84.9 μm. Benign cases and cases with atypia of undetermined significance cases primarily exhibited low cellularity, while follicular neoplasms and malignant cases typically showed moderate to high cellularity. In the subgroup of FNA cases with moderate to high cellularity, spherules were identified in 12 (20%) of 59 benign FNA cases. Within this group, the sensitivity and specificity of thyroid spherules for detecting benign FNA cases were 20% and 100%, respectively. Conclusions: Our results suggest that the presence of thyroid spherules in FNA specimens can serve as a highly specific marker for benign thyroid conditions. The prevalence of spherule detection is strongly influenced by the cellularity. In cases with moderate to high cellularity, the identification of spherules can assist the cytopathologists in diagnosing thyroid FNA cases as benign. [ABSTRACT FROM AUTHOR]

Introduction: Fine needle aspiration (FNA) is fundamental in the pre‐operative assessment of thyroid nodules. However, the shining success of thyroid FNA is occasionally eclipsed by false positive (FP) cytological diagnoses. We describe our experience regarding FP cytological diagnoses and present a literature review concerning FP rates. Materials and methods: We retrospectively analyzed 2031 consecutive cytology reports. FP was defined as a case with "suspicious for malignancy" or "malignant" cytology, whose surgical follow‐up failed to confirm the initial diagnosis of malignancy. We used the PubMed database for the literature review using specific search terms ("thyroid", "cytology", "false positive"). Results: Out of 2031 FNA reports, 93 cases with "suspicious for malignancy" or "malignant" cytology underwent surgical excision. Histopathology did not confirm malignancy in 10 cases (0.6% FP rate). Nodules with FP cytology were significantly larger (P = 0.0024) than those with with TP (true positive) cytology. A review of 25 publications shows comparable results to ours with some slight differences. The majority of studies achieve a FP rate below 3%. Most FP cytological diagnoses turn out to be non‐neoplastic lesions (nodular hyperplasia, adenomatous nodule, lymphocytic thyroiditis), which combined account for 80.5% of all histological diagnoses. Conclusions: Thyroid nodules with FP cytology were larger than nodules with TP cytology. Most studies manage to adhere to the recommended FP rates, or values close to them, with some outliers. Nevertheless, the mean FP rate values are very close to the value recommended by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The FP rate value depends on how one defines true negative cases, which can be either histologically proven benign cases, via a benign clinical course, or by assuming that cytologically benign cases remain as such. The shining success of thyroid FNA is occasionally eclipsed by false positive (FP) cytological diagnoses. This article presents the authors' experience regarding FPs, and a brief review of 25 publications in search of FP rates. Most studies adhere to the recommended FP rates, or values close to them, with some outliers. The FP rate value depends on how one defines true negative cases, which can be either histologically proven benign cases, via a benign clinical course, or by assuming that cytologically benign cases remain as such. [ABSTRACT FROM AUTHOR]

Background: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is widely utilised by cytopathologists. The American College of Radiology (ACR) has also proposed a thyroid imaging reporting and data system (TIRADS) to classify thyroid nodules and guide their selection for fine needle aspiration (FNA). The current study aimed to analyse the usefulness of TBSRTC in thyroid cytology reporting, to examine its histological correlation with TIRADS, and to compare the management of lesions in each cytological category in our institute to the TBSRTC recommendations. Materials and methods: A retrospective study was performed on all thyroid FNAs from a 2‐year period at a tertiary care centre. Histological correlations of TBSRTC and ACR TIRADS were examined for cases with surgical follow‐up, and the risk of malignancy in each TBSRTC category, and sensitivity and specificity of FNA and TIRADS, were calculated. Results: A total of 337 thyroid FNAs were examined, with histological follow‐up in 99 cases. Risk of malignancy in categories I‐VI was 9.5%, 2.3%, 0.0, 8%, 87.5% and 100.0%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of FNA were 60.0%, 99.0%, 85.7%, and 97.5%, respectively, while those values for thyroid ultrasound were 90.3%, 72.2%, 92.9% and 65%, respectively. Conclusion: The study substantiates the usefulness of TBSRTC in arriving at a more precise diagnosis. Hurthle cell lesions with atypia were the common cause of misdiagnosis. The combination of TIRADS and TBSRTC aids in better stratification of thyroid nodules and in decision making for management of lesions. The reporting of AUS/FLUS lesions with a supplementary note describing the presence of architectural and/or cytological atypia may be helpful in treatment decisions since cytological atypia could suggest the possibility of NIFTP or malignancy. TIRADS score in conjunction with TBSRTC cytological diagnosis can aid in better stratification of thyroid nodules. [ABSTRACT FROM AUTHOR]

Objective: The 2017 revised Bethesda System for Reporting Thyroid Cytopathology (BSRTC) included new malignancy rates for each category as well as new management recommendations. Here, we evaluate the malignancy rate and test performance for BSRTC categories in a middle‐sized institution outside the United States (US). Design: Retrospective single centre case series with chart review. Patients: All patients who underwent thyroid surgery with a preoperative BSRTC between the years 2010 and 2018 at our institution. Measurements: In order to assess the malignancy rate for each BSRTC, all medical records were reviewed to collect demographics, nodule's size, BSRTC and final pathology. Results: Three hundred and sixty‐four patients were included, with an overall malignancy rate of 34.3%. The malignancy rate for BSRTC categories I‐VI was as follows: 13.3%, 5.1%, 25.0%, 24.4%, 91.3% and 95.2%, respectively. The most sensitive test was when BSRTC III‐VI were evaluated (91%). Overall best performance (sensitivity, specificity, PPV, NPV and accuracy) was obtained when BSRTC V‐VI were grouped together with a substantial decrease when adding BSRTC III‐IV (90%, 97%, 94%, 95%, 95% vs, respectively, 91%, 73%, 62%, 95%, 79%, respectively). Conclusions: Despite differences from the reported 2017 BSRTC malignancy rates, we demonstrated that the revised 2017 BSRTC management recommendations for thyroid nodules are also valid in smaller non‐US centre, supporting its use globally. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to evaluate the disease spectrum of thyroid cytopathology and correlation of the Bethesda reporting system with final histopathology in our medical centre. Methods: This retrospective study was conducted from histopathology reports from Galilee Medical Center between August 2013 and September 2017. Results: A total of 287 thyroid fine needle aspirations were included in the study. The majority (55.1%) of these were benign (B2). Surgery was performed on 53 cases and the total malignancy rate was 39.6%. Our study had a favourable accuracy rate of 70%. A B4 Bethesda category had a higher malignancy rate (50%) than previously reported. Conclusion: We found a higher malignancy rate (50%) based on the Bethesda B4 category of the fine needle aspirations in our series, yet it is based on a small sample. The differences in malignancy rates between centres have an important impact on clinical decisions. In this retrospective study we reviewed thyroid fine needle aspirations and compared them to final pathology. We found an accuracy rate of 70%, and a higher Bethesda 4 category malignancy rate than previously reported. [ABSTRACT FROM AUTHOR]