PREOPERATIVE ASSESSMENT OF THYROID NODULES: ROLE OF ULTRASONOGRAPHY AND FINE NEEDLE ASPIRATION BIOPSY FOLLOWED BY CYTOLOGY
To evaluate the preoperative assessment of thyroid nodules using ultrasound studies and cytology of nodular aspirates. 2,468 patients with thyroid nodules were examined from 1999 to 2005. All patients were clinically examined and underwent ultrasonography followed by fine-needle aspiration biopsy (F...
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description | To evaluate the preoperative assessment of thyroid nodules using ultrasound studies and cytology of nodular aspirates.
2,468 patients with thyroid nodules were examined from 1999 to 2005. All patients were clinically examined and underwent ultrasonography followed by fine-needle aspiration biopsy (FNAB) and cytology.
Nodules larger than 10 mm were classified ultrasonographically in a 4-tier system and received a score according to the criterion of possible malignancy. Cytological examinations were conducted independently by 2 cytologists and classified as benign (score 1), indeterminate (score 2), suspicious (score 3), and malignant (score 6). Combining both scores, an index was generated that would indicate a higher probability of malignancy (benign, doubtful, suspicious, and malignant). Thyroid surgery was performed in 274 patients. Of those, 115 patients had a score of 2 to 5 and only 8 had a histological diagnosis of thyroid cancer (6.9%). For patients with a score of 5 (n = 51), 11.5% had a malignant lesion, and 51% of the 61 patients with a score of 6 had confirmed thyroid cancer. Of the 98 patients with a combined score of 7 to 10, 99% had a histological confirmation of malignancy.
The index score had a sensitivity of 94.1% and specificity of 77.5%. The overall accuracy was 85.8%. Therefore, we concluded that this methodology may improve the preoperative diagnosis of thyroid cancer in nodules larger than 10 mm. Association with other methods such as color Doppler echography, serum TSH concentration, galectin-3 expression analysis, and FDG/PET scan would be useful in avoiding the higher costs of thyroid surgical procedures.
Avaliar a possibilidade de diagnòstico pré-operativo de nódulos da tireóide (de diâmetro superior a 10mm) usando ultra-sonografia da glândula tireóide e citologia de punção aspirativa por agulha fina guiada pela ultra-sonografia.
Nódulos tireóideos (maiores que 10mm) foram classificados ultra-sonograficamente em graus de I a IV e escores numéricos de 1 a 4, de acordo com crescente possibilidade de malignidade. O exame citológico, subseqüentemente, classificou os nódulos como benigno (escore 1) indeterminado (escore 2) suspeito (escore 3) e maligno (escore 6). Somando-se os escores obtidos nas duas metodologias obtém-se um índice considerado benigno (índice combinado 2-4), duvidoso (índice combinado 5) suspeito para malignidade (índice combinado 6) e elevada probabilidade de malignidade (índice combinado 7 a 10). Cirurgia da Tireói |
doi_str_mv | 10.1590/S1807-59322007000400007 |
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2,468 patients with thyroid nodules were examined from 1999 to 2005. All patients were clinically examined and underwent ultrasonography followed by fine-needle aspiration biopsy (FNAB) and cytology.
Nodules larger than 10 mm were classified ultrasonographically in a 4-tier system and received a score according to the criterion of possible malignancy. Cytological examinations were conducted independently by 2 cytologists and classified as benign (score 1), indeterminate (score 2), suspicious (score 3), and malignant (score 6). Combining both scores, an index was generated that would indicate a higher probability of malignancy (benign, doubtful, suspicious, and malignant). Thyroid surgery was performed in 274 patients. Of those, 115 patients had a score of 2 to 5 and only 8 had a histological diagnosis of thyroid cancer (6.9%). For patients with a score of 5 (n = 51), 11.5% had a malignant lesion, and 51% of the 61 patients with a score of 6 had confirmed thyroid cancer. Of the 98 patients with a combined score of 7 to 10, 99% had a histological confirmation of malignancy.
The index score had a sensitivity of 94.1% and specificity of 77.5%. The overall accuracy was 85.8%. Therefore, we concluded that this methodology may improve the preoperative diagnosis of thyroid cancer in nodules larger than 10 mm. Association with other methods such as color Doppler echography, serum TSH concentration, galectin-3 expression analysis, and FDG/PET scan would be useful in avoiding the higher costs of thyroid surgical procedures.
Avaliar a possibilidade de diagnòstico pré-operativo de nódulos da tireóide (de diâmetro superior a 10mm) usando ultra-sonografia da glândula tireóide e citologia de punção aspirativa por agulha fina guiada pela ultra-sonografia.
Nódulos tireóideos (maiores que 10mm) foram classificados ultra-sonograficamente em graus de I a IV e escores numéricos de 1 a 4, de acordo com crescente possibilidade de malignidade. O exame citológico, subseqüentemente, classificou os nódulos como benigno (escore 1) indeterminado (escore 2) suspeito (escore 3) e maligno (escore 6). Somando-se os escores obtidos nas duas metodologias obtém-se um índice considerado benigno (índice combinado 2-4), duvidoso (índice combinado 5) suspeito para malignidade (índice combinado 6) e elevada probabilidade de malignidade (índice combinado 7 a 10). Cirurgia da Tireóide foi realizada em 274 pacientes, dos quais 64 apresentavam índice de 2-4; destes, apenas 2 pacientes (3,1%) apresentaram comprovação histológica de câncer. Em pacientes com índice 5 (n= 51), 11,8% apresentaram câncer de tireóide e, em 61 pacientes com índice 6, (n= 31), 51% tiveram diagnóstico confirmado de malignidade. O índice combinado de 7-10 (n= 98) apresentou 99% de pacientes com câncer de tireóide.
O índice combinado apresentou sensibilidade de 94,1% e especificidade de 77,5%. A precisão desta metodologia foi de 85,8%. Concluímos que o índice combinado pode ser útil no diagnóstico pré-cirúrgico do nódulo tireóideo, mormente se associado com outras metodologias como a ecografia com Doppler colorido, nível elevado de TSH sérico, análise de expressão de galectina-3 e imagens por FDG/PET.</description><identifier>ISSN: 1807-5932</identifier><identifier>ISSN: 1980-5322</identifier><identifier>EISSN: 1980-5322</identifier><identifier>DOI: 10.1590/S1807-59322007000400007</identifier><identifier>PMID: 17823703</identifier><language>eng</language><publisher>Brazil: Elsevier España, S.L.U</publisher><subject>Aspiration ; Biopsy ; Biopsy, Fine-Needle - methods ; Citologia da Tireóide ; Câncer de Tireóide ; Female ; Fine-needle ; Humans ; Male ; MEDICINE, GENERAL & INTERNAL ; Middle Aged ; Nódulo tireóideo ; Sensitivity and Specificity ; Severity of Illness Index ; Thyroid cancer ; Thyroid cytology ; Thyroid Neoplasms - diagnostic imaging ; Thyroid Neoplasms - pathology ; Thyroid Neoplasms - surgery ; Thyroid Nodule - diagnostic imaging ; Thyroid Nodule - pathology ; Thyroid Nodule - surgery ; Thyroid nodules ; Thyroid ultrasound ; Thyroidectomy ; Ultra-sonografia Cervical ; Ultrasonography</subject><ispartof>Clinics (São Paulo, Brazil), 2007-08, Vol.62 (4), p.411-418</ispartof><rights>2007 CLINICS</rights><rights>This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c457t-fd4073040bfcb6f740985e9edc5bfb579ddd9b14b53ed0af4930b13df3c4fdcb3</citedby><cites>FETCH-LOGICAL-c457t-fd4073040bfcb6f740985e9edc5bfb579ddd9b14b53ed0af4930b13df3c4fdcb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,864,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17823703$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Camargo, Rosalinda YA</creatorcontrib><creatorcontrib>Tomimori, Eduardo K</creatorcontrib><creatorcontrib>Knobel, Meyer</creatorcontrib><creatorcontrib>Medeiros-Neto, Geraldo</creatorcontrib><title>PREOPERATIVE ASSESSMENT OF THYROID NODULES: ROLE OF ULTRASONOGRAPHY AND FINE NEEDLE ASPIRATION BIOPSY FOLLOWED BY CYTOLOGY</title><title>Clinics (São Paulo, Brazil)</title><addtitle>Clinics (Sao Paulo)</addtitle><description>To evaluate the preoperative assessment of thyroid nodules using ultrasound studies and cytology of nodular aspirates.
2,468 patients with thyroid nodules were examined from 1999 to 2005. All patients were clinically examined and underwent ultrasonography followed by fine-needle aspiration biopsy (FNAB) and cytology.
Nodules larger than 10 mm were classified ultrasonographically in a 4-tier system and received a score according to the criterion of possible malignancy. Cytological examinations were conducted independently by 2 cytologists and classified as benign (score 1), indeterminate (score 2), suspicious (score 3), and malignant (score 6). Combining both scores, an index was generated that would indicate a higher probability of malignancy (benign, doubtful, suspicious, and malignant). Thyroid surgery was performed in 274 patients. Of those, 115 patients had a score of 2 to 5 and only 8 had a histological diagnosis of thyroid cancer (6.9%). For patients with a score of 5 (n = 51), 11.5% had a malignant lesion, and 51% of the 61 patients with a score of 6 had confirmed thyroid cancer. Of the 98 patients with a combined score of 7 to 10, 99% had a histological confirmation of malignancy.
The index score had a sensitivity of 94.1% and specificity of 77.5%. The overall accuracy was 85.8%. Therefore, we concluded that this methodology may improve the preoperative diagnosis of thyroid cancer in nodules larger than 10 mm. Association with other methods such as color Doppler echography, serum TSH concentration, galectin-3 expression analysis, and FDG/PET scan would be useful in avoiding the higher costs of thyroid surgical procedures.
Avaliar a possibilidade de diagnòstico pré-operativo de nódulos da tireóide (de diâmetro superior a 10mm) usando ultra-sonografia da glândula tireóide e citologia de punção aspirativa por agulha fina guiada pela ultra-sonografia.
Nódulos tireóideos (maiores que 10mm) foram classificados ultra-sonograficamente em graus de I a IV e escores numéricos de 1 a 4, de acordo com crescente possibilidade de malignidade. O exame citológico, subseqüentemente, classificou os nódulos como benigno (escore 1) indeterminado (escore 2) suspeito (escore 3) e maligno (escore 6). Somando-se os escores obtidos nas duas metodologias obtém-se um índice considerado benigno (índice combinado 2-4), duvidoso (índice combinado 5) suspeito para malignidade (índice combinado 6) e elevada probabilidade de malignidade (índice combinado 7 a 10). Cirurgia da Tireóide foi realizada em 274 pacientes, dos quais 64 apresentavam índice de 2-4; destes, apenas 2 pacientes (3,1%) apresentaram comprovação histológica de câncer. Em pacientes com índice 5 (n= 51), 11,8% apresentaram câncer de tireóide e, em 61 pacientes com índice 6, (n= 31), 51% tiveram diagnóstico confirmado de malignidade. O índice combinado de 7-10 (n= 98) apresentou 99% de pacientes com câncer de tireóide.
O índice combinado apresentou sensibilidade de 94,1% e especificidade de 77,5%. A precisão desta metodologia foi de 85,8%. Concluímos que o índice combinado pode ser útil no diagnóstico pré-cirúrgico do nódulo tireóideo, mormente se associado com outras metodologias como a ecografia com Doppler colorido, nível elevado de TSH sérico, análise de expressão de galectina-3 e imagens por FDG/PET.</description><subject>Aspiration</subject><subject>Biopsy</subject><subject>Biopsy, Fine-Needle - methods</subject><subject>Citologia da Tireóide</subject><subject>Câncer de Tireóide</subject><subject>Female</subject><subject>Fine-needle</subject><subject>Humans</subject><subject>Male</subject><subject>MEDICINE, GENERAL & INTERNAL</subject><subject>Middle Aged</subject><subject>Nódulo tireóideo</subject><subject>Sensitivity and Specificity</subject><subject>Severity of Illness Index</subject><subject>Thyroid cancer</subject><subject>Thyroid cytology</subject><subject>Thyroid Neoplasms - diagnostic imaging</subject><subject>Thyroid Neoplasms - pathology</subject><subject>Thyroid Neoplasms - surgery</subject><subject>Thyroid Nodule - diagnostic imaging</subject><subject>Thyroid Nodule - pathology</subject><subject>Thyroid Nodule - surgery</subject><subject>Thyroid nodules</subject><subject>Thyroid ultrasound</subject><subject>Thyroidectomy</subject><subject>Ultra-sonografia Cervical</subject><subject>Ultrasonography</subject><issn>1807-5932</issn><issn>1980-5322</issn><issn>1980-5322</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUVtv0zAUthAT2wp_AfzEW4ZTO3PMW9a4a6QQR0kKypNVXyJlapsRt0jbr59DO_GABA_WsXy-i893APgUopswYuhLHcaIBhHD8zlCFCFE_EH0DbgKWYyCyL-_9fdX0CW4du4BIcwwid6By5DGc0wRvgLPZcVFyaukyb5zmNQ1r-tvvGigWMJm1VYiS2Eh0nXO66-wEjmfGuu8qZJaFOK-SspVC5Mihcus4LDgPM0nmTKbFEUB7zJR1i1cijwXP3gK71q4aBuRi_v2PbjoNltnP5zrDKyXvFmsAt_MFkkeaBLRQ9AZgij2A6pOq9uOEsTiyDJrdKQ6FVFmjGEqJCrC1qBNRxhGKsSmw5p0Ris8AzcnXad7ux3kw3Ac995Q_g5R_hWiJ3w-ER7H4efRuoPc9U7b7Xazt8PRydt4TgjxvBmgJ6AeB-dG28nHsd9txicZIjnt6R8WH88WR7Wz5g_vvBgPSE4A65P51dtRTr_fa2v60eqDNEP_X5MX1s-WYA</recordid><startdate>20070801</startdate><enddate>20070801</enddate><creator>Camargo, Rosalinda YA</creator><creator>Tomimori, Eduardo K</creator><creator>Knobel, Meyer</creator><creator>Medeiros-Neto, Geraldo</creator><general>Elsevier España, S.L.U</general><general>Faculdade de Medicina / USP</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>GPN</scope></search><sort><creationdate>20070801</creationdate><title>PREOPERATIVE ASSESSMENT OF THYROID NODULES: ROLE OF ULTRASONOGRAPHY AND FINE NEEDLE ASPIRATION BIOPSY FOLLOWED BY CYTOLOGY</title><author>Camargo, Rosalinda YA ; Tomimori, Eduardo K ; Knobel, Meyer ; Medeiros-Neto, Geraldo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c457t-fd4073040bfcb6f740985e9edc5bfb579ddd9b14b53ed0af4930b13df3c4fdcb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Aspiration</topic><topic>Biopsy</topic><topic>Biopsy, Fine-Needle - methods</topic><topic>Citologia da Tireóide</topic><topic>Câncer de Tireóide</topic><topic>Female</topic><topic>Fine-needle</topic><topic>Humans</topic><topic>Male</topic><topic>MEDICINE, GENERAL & INTERNAL</topic><topic>Middle Aged</topic><topic>Nódulo tireóideo</topic><topic>Sensitivity and Specificity</topic><topic>Severity of Illness Index</topic><topic>Thyroid cancer</topic><topic>Thyroid cytology</topic><topic>Thyroid Neoplasms - diagnostic imaging</topic><topic>Thyroid Neoplasms - pathology</topic><topic>Thyroid Neoplasms - surgery</topic><topic>Thyroid Nodule - diagnostic imaging</topic><topic>Thyroid Nodule - pathology</topic><topic>Thyroid Nodule - surgery</topic><topic>Thyroid nodules</topic><topic>Thyroid ultrasound</topic><topic>Thyroidectomy</topic><topic>Ultra-sonografia Cervical</topic><topic>Ultrasonography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Camargo, Rosalinda YA</creatorcontrib><creatorcontrib>Tomimori, Eduardo K</creatorcontrib><creatorcontrib>Knobel, Meyer</creatorcontrib><creatorcontrib>Medeiros-Neto, Geraldo</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>SciELO</collection><jtitle>Clinics (São Paulo, Brazil)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Camargo, Rosalinda YA</au><au>Tomimori, Eduardo K</au><au>Knobel, Meyer</au><au>Medeiros-Neto, Geraldo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>PREOPERATIVE ASSESSMENT OF THYROID NODULES: ROLE OF ULTRASONOGRAPHY AND FINE NEEDLE ASPIRATION BIOPSY FOLLOWED BY CYTOLOGY</atitle><jtitle>Clinics (São Paulo, Brazil)</jtitle><addtitle>Clinics (Sao Paulo)</addtitle><date>2007-08-01</date><risdate>2007</risdate><volume>62</volume><issue>4</issue><spage>411</spage><epage>418</epage><pages>411-418</pages><issn>1807-5932</issn><issn>1980-5322</issn><eissn>1980-5322</eissn><abstract>To evaluate the preoperative assessment of thyroid nodules using ultrasound studies and cytology of nodular aspirates.
2,468 patients with thyroid nodules were examined from 1999 to 2005. All patients were clinically examined and underwent ultrasonography followed by fine-needle aspiration biopsy (FNAB) and cytology.
Nodules larger than 10 mm were classified ultrasonographically in a 4-tier system and received a score according to the criterion of possible malignancy. Cytological examinations were conducted independently by 2 cytologists and classified as benign (score 1), indeterminate (score 2), suspicious (score 3), and malignant (score 6). Combining both scores, an index was generated that would indicate a higher probability of malignancy (benign, doubtful, suspicious, and malignant). Thyroid surgery was performed in 274 patients. Of those, 115 patients had a score of 2 to 5 and only 8 had a histological diagnosis of thyroid cancer (6.9%). For patients with a score of 5 (n = 51), 11.5% had a malignant lesion, and 51% of the 61 patients with a score of 6 had confirmed thyroid cancer. Of the 98 patients with a combined score of 7 to 10, 99% had a histological confirmation of malignancy.
The index score had a sensitivity of 94.1% and specificity of 77.5%. The overall accuracy was 85.8%. Therefore, we concluded that this methodology may improve the preoperative diagnosis of thyroid cancer in nodules larger than 10 mm. Association with other methods such as color Doppler echography, serum TSH concentration, galectin-3 expression analysis, and FDG/PET scan would be useful in avoiding the higher costs of thyroid surgical procedures.
Avaliar a possibilidade de diagnòstico pré-operativo de nódulos da tireóide (de diâmetro superior a 10mm) usando ultra-sonografia da glândula tireóide e citologia de punção aspirativa por agulha fina guiada pela ultra-sonografia.
Nódulos tireóideos (maiores que 10mm) foram classificados ultra-sonograficamente em graus de I a IV e escores numéricos de 1 a 4, de acordo com crescente possibilidade de malignidade. O exame citológico, subseqüentemente, classificou os nódulos como benigno (escore 1) indeterminado (escore 2) suspeito (escore 3) e maligno (escore 6). Somando-se os escores obtidos nas duas metodologias obtém-se um índice considerado benigno (índice combinado 2-4), duvidoso (índice combinado 5) suspeito para malignidade (índice combinado 6) e elevada probabilidade de malignidade (índice combinado 7 a 10). Cirurgia da Tireóide foi realizada em 274 pacientes, dos quais 64 apresentavam índice de 2-4; destes, apenas 2 pacientes (3,1%) apresentaram comprovação histológica de câncer. Em pacientes com índice 5 (n= 51), 11,8% apresentaram câncer de tireóide e, em 61 pacientes com índice 6, (n= 31), 51% tiveram diagnóstico confirmado de malignidade. O índice combinado de 7-10 (n= 98) apresentou 99% de pacientes com câncer de tireóide.
O índice combinado apresentou sensibilidade de 94,1% e especificidade de 77,5%. A precisão desta metodologia foi de 85,8%. Concluímos que o índice combinado pode ser útil no diagnóstico pré-cirúrgico do nódulo tireóideo, mormente se associado com outras metodologias como a ecografia com Doppler colorido, nível elevado de TSH sérico, análise de expressão de galectina-3 e imagens por FDG/PET.</abstract><cop>Brazil</cop><pub>Elsevier España, S.L.U</pub><pmid>17823703</pmid><doi>10.1590/S1807-59322007000400007</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Aspiration Biopsy Biopsy, Fine-Needle - methods Citologia da Tireóide Câncer de Tireóide Female Fine-needle Humans Male MEDICINE, GENERAL & INTERNAL Middle Aged Nódulo tireóideo Sensitivity and Specificity Severity of Illness Index Thyroid cancer Thyroid cytology Thyroid Neoplasms - diagnostic imaging Thyroid Neoplasms - pathology Thyroid Neoplasms - surgery Thyroid Nodule - diagnostic imaging Thyroid Nodule - pathology Thyroid Nodule - surgery Thyroid nodules Thyroid ultrasound Thyroidectomy Ultra-sonografia Cervical Ultrasonography |
title | PREOPERATIVE ASSESSMENT OF THYROID NODULES: ROLE OF ULTRASONOGRAPHY AND FINE NEEDLE ASPIRATION BIOPSY FOLLOWED BY CYTOLOGY |
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