Thyroid Bed Fine-Needle Aspiration Experience at a Large Tertiary Care Center
Dept. of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.American Journal of Clinical Pathology (Impact Factor: 2.51). 08/2010; 134(2):335-9. DOI: 10.1309/AJCPD60AHRUCMDPF
Fine-needle aspiration (FNA) of thyroid bed (TB) lesions is a common diagnostic modality in monitoring patients for recurrent cancer after a thyroidectomy. To elucidate the value of TB FNA, we reviewed our experience at The Johns Hopkins Hospital, Baltimore, MD. We identified 57 TB FNA specimens from 50 patients. Of the patients, 36 were being followed up for papillary carcinoma, 7 for medullary carcinoma, 4 for follicular carcinoma (1 also had papillary carcinoma), and 1 for poorly differentiated neuroendocrine carcinoma; 3 had previous benign diagnoses. TB FNA yielded diagnostic material in 49 of 57 cases. Of 37 malignant or atypical FNA samples, 32 had surgical follow-up; 30 of 32 were confirmed malignant. The FNA result was benign in 12 of 57, including 6 cases of benign thyroid and 1 case of parathyroid tissue. Immunohistochemical staining was contributory in 5 of 57 cases. TB FNA is a highly reliable tool for diagnosing recurrent thyroid carcinoma. Residual benign thyroid and parathyroid tissue are potential pitfalls; awareness of these and judicious use of immunohistochemical staining can prevent misdiagnoses.
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ABSTRACT: Background: Ultrasound, and sometimes cytology, cannot differentiate between recurrent or persistent thyroid cancer and benign forms of space occupying lesions (SOLs) in the thyroid bed, including unsuspected thyroid remnants, that are noted several months to years after thyroidectomy (Tx) for thyroid cancer. The purpose of the present study was to evaluate the hypothesis that measurement of thyroglobulin (Tg) in fine-needle aspirates from these lesions might help differentiate between benign and malignant SOLs in the thyroid bed. Methods: We studied 47 lesions in the thyroid bed from 43 patients who, 8-240 months previously, had 43 Txs for thyroid cancer. Eleven patients had a lobectomy and 32 patients had a total Tx. Also, some patients had radioactive iodine (RAI) ablation after their thyroid surgery and some did not. "Recurrence" was defined as the SOL, which was confirmed by cytological or histopathological results. "Benign SOL" was defined as a focal lesion, which was benign or nondiagnostic result on cytology and for which there was no RAI uptake on whole-body scintigraphy with both negative serum Tg and Tg antibodies. Diagnostic performances of fine-needle aspiration cytology (FNAC), FNA-Tg, and combining FNAC with FNA-Tg level were assessed for detection of malignant SOL. The diagnostic performance of FNA-Tg was assessed using three threshold values: 1 ng/mL, 10 ng/mL, and an FNA-Tg/serum-Tg ratio of 1.0. Results: FNA-Tg level and combining FNA-Tg levels with FNAC had higher sensitivities (100% in all three threshold values) and diagnostic accuracies (91.5%-95.7%) than FNAC alone (sensitivity of 85.3%, accuracy of 89.4%) in all threshold values. In both the RAI ablation and non-RAI ablation groups, the FNA-Tg levels and combining the FNA-Tg levels with FNAC had a higher sensitivity and diagnostic accuracy than FNAC alone with threshold values of 10 ng/mL and FNA-Tg/serum-Tg ratio of 1.0. The non-RAI ablation group did not have a different diagnostic accuracy than the RAI ablation group in all threshold values (p>0.05). FNA-Tg level showed a negative predictive value of 100% in all threshold values, in both the RAI ablation and the non-RAI ablation groups. Conclusions: Measurement of Tg levels in the FNA of SOLs in the thyroid bed can be helpful in diagnosing tumor recurrence, because an FNA-Tg level lower than the threshold value has the added value of suggesting a benign lesion rather than tumor recurrence.Thyroid: official journal of the American Thyroid Association 09/2012; 23(3). DOI:10.1089/thy.2011.0303 · 4.49 Impact Factor
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ABSTRACT: Objectives: The purpose of this study was to determine the importance of nondiagnostic fine-needle aspiration biopsy results for post-thyroidectomy bed lesions in patients with thyroid cancer. Methods: The Institutional Review Board approved this retrospective Health Insurance Portability and Accountability Act-compliant study with a waiver for informed consent. Twenty-one patients with nondiagnostic fine-needle aspiration biopsy of a thyroid bed lesion after thyroidectomy with at least 1 year of follow-up with neck imaging were retrospectively enrolled in our study. The tumor type, local staging, radiotherapy, serum thyroglobulin levels, and imaging characteristics of the thyroid bed lesions were recorded. All patients underwent sonographically guided fine-needle aspiration biopsy of the thyroid bed lesion. Results: The mean imaging follow-up ± SD was 46.3 ± 28.7 months. Lesions in 20 patients (95.2%) were stable on imaging. Most thyroid bed lesions were hypoechoic (80.9%), and none showed calcifications. The mean thyroid bed mass maximum diameter was 1.17 ± 0.6 cm (range, 0.3-2.9 cm). Conclusions: Thyroid bed lesions with nondiagnostic fine-needle aspiration biopsy results after thyroidectomy can be managed with imaging follow-up; 1-year imaging is a reasonable interval after biopsy.Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2012; 31(12):1973-6. · 1.54 Impact Factor
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ABSTRACT: BACKGROUND: To evaluate the efficacy and the limitation of fine-needle aspiration (FNA) biopsy in thyroid bed lesions, a retrospective review was performed of the medical records of thyroid cancer patients who underwent ultrasound-guided FNA biopsy of the thyroid bed at The University of Texas MD Anderson Cancer Center over a 5-year period. METHODS: Data were reviewed on 220 FNA biopsies taken from thyroid bed lesions in 195 patients who had undergone thyroidectomy for thyroid carcinoma. Thyroid bed FNA results were compared with clinical follow-up, including neck dissection results. RESULTS: Recurrent carcinoma was diagnosed by FNA biopsy in 139 of 220 (63%) cases. Neck dissections were performed for 112 sites identified by FNA biopsies, and recurrent carcinoma was confirmed in 110 sites. The concordance between positive and/or suspicious FNA diagnosis and positive neck dissection results was 98% (118 of 120 cases). A false-positive FNA occurred in one patient with follicular thyroid carcinoma. The other discrepancy was attributed to failure to remove the lesion by neck dissection. The diagnostic accuracy of thyroid bed FNA was 100% in papillary and medullary thyroid carcinoma and 93% in follicular thyroid carcinoma. Suspicious and rare false-negative FNA results were attributed to low cellularity and lack of characteristic cytomorphologic features of thyroid carcinoma. CONCLUSIONS: Ultrasound-guided thyroid bed FNA biopsy is accurate and efficient in triaging patients who require post-thyroidectomy follow-up for recurrent thyroid carcinoma. Caution should be taken in the interpretation of FNA specimens that have low cellularity and lack characteristic cytologic features of thyroid carcinoma. Cancer (Cancer Cytopathol) 2012. © 2012 American Cancer Society.Cancer Cytopathology 02/2013; 121(2). DOI:10.1002/cncy.21202 · 3.35 Impact Factor
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