Thyroid bed fine-needle aspiration: experience at a large tertiary care center.
ABSTRACT 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: Monitoring changes in the thyroid bed (TB) is one of the clinical mainstays for surveillance of recurrent thyroid carcinoma. Fine-needle aspiration (FNA) is a diagnostic tool that is commonly used to aid in the identification of residual or recurrent disease. The aim of our study is to evaluate the efficacy of ultrasound-guided FNA of the thyroid bed in detecting recurrent thyroid cancer and to correlate the findings with clinicopathologic parameters to identify predictors of TB recurrence. Methods: We retrieved cases of soft tissue masses within the TB that were evaluated for recurrence between January 1, 2006, and February 1, 2011. All ultrasound-guided FNA biopsies clinically suspected to be lymph node metastasis and specimens with lymphocytes were excluded from the data. Results: Of the 291 patients identified for evaluation of recurrence, 250 had papillary thyroid carcinoma (PTC), 10 had follicular carcinoma (FC), 22 had medullary carcinoma (MC), 7 had Hürthle cell carcinoma (HCC), and 2 had previous thyroidectomy for an unknown type of thyroid carcinoma. For all FNAs that were clinically suspicious or intermediate for recurrence, the rate of positivity was 71.8% (209 patients). All patients diagnosed with "Positive for PTC" or "Suspicious for PTC" on TB FNA were found to have soft tissue metastasis on follow-up surgical resection. This resulted in a negative predictive value of 88.4% and a positive predictive value of 100%. The average time between thyroidectomy and thyroid bed FNA was 73.5 months. Of the patients with a previous diagnosis of PTC, those with suspicious/positive cytology were more likely to be women, increasing age at thyroidectomy, to have documented metastasis to other sites, to have extrathyroidal extension, and have multifocal primary disease as compared to non-diagnostic/negative cytology cases. Patient age ≥ 45 years, primary tumor size at thyroidectomy, and surgical resection margin status had no statistical significance for predicting risk of thyroid bed recurrence. Conclusion: Thyroid bed recurrence of PTC is most likely to occur in patients who have the following clinicopathologic parameters: documented metastasis to any site, extrathyroidal extension, as well as increased number of primary cancer foci.Thyroid: official journal of the American Thyroid Association 02/2013; · 2.60 Impact Factor
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ABSTRACT: Following thyroidectomy for primary thyroid malignancies, patients are closely monitored for recurrence or metastasis. Fine needle aspiration (FNA) has been used as the appropriate diagnostic modality for occult masses identified radiographically in the thyroid bed. In this study, we report our institutional experience with FNA of the thyroid bed and propose practical diagnostic categories. A retrospective chart review of all thyroid bed FNAs between April 2008 and January 2013 was performed and a cohort of 39 patients was retrieved. The cytology diagnoses were divided into five categories including: non-diagnostic, inflammatory/reactive, bland follicular cells, suspicious for neoplasm/malignancy and malignant. The follow up histologic and/or clinical findings were collected for each category. The 39 patients included 9 males and 30 females (ages 15-79 years). Prior thyroidectomies were due to papillary thyroid carcinoma (31 cases), follicular carcinoma (3 cases), medullary carcinoma (1 case), Hürthle cell carcinoma (1 case), malignancy unspecified (1 case), follicular adenoma (1 case), and multinodular goiter (1 case). Overall, 33% (13 cases) of thyroid bed FNAs were non-diagnostic and 10% (4 cases) were categorized as “inflammatory/reactive”. None of the patients in these two categories demonstrated evidence of clinical recurrence. One patient with a “bland follicular cells” thyroid bed FNA diagnosis had metastatic papillary thyroid carcinoma on follow-up histology. Ten out of fourteen patients in the “suspicious” and “malignant” categories had malignant follow-up diagnosis on histology. In conclusion, thyroid bed FNA with standardized diagnostic categories is a useful modality for follow-up in patients that have undergone thyroidectomy.Annals of diagnostic pathology 06/2014; · 1.11 Impact Factor
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ABSTRACT: Thyroid surgery may cause regional scarring and some degree of fibrotic process which may extend into the perithyroidal soft tissues. This may result in problems when collecting thyroid fine-needle aspiration biopsy (FNAB) samples and evaluating the cellular abnormalities. This study aimed to determine if a history of thyroid surgery is a risk factor for nondiagnostic (ND) FNAB results. Patients with ≥1 discrete nodular lesion of the thyroid who underwent FNAB were included. The patients with a history of thyroid surgery constituted group 1, and the others constituted group 2. The factors which may influence FNAB results, including age, gender, presence of Hashimoto's thyroiditis, and ultrasound characteristics, were also evaluated. Group 1 included 123 patients with 200 nodules, and group 2 included 132 patients with 200 nodules. The two groups were similar with respect to demographic characteristics of the patients and ultrasonographic features of the nodules including diameter, content (cystic or solid), echogenicity, margin, and calcifications (P > 0.05). In all, 176 (44 %) of the participants had ND FNAB results. The median time interval between thyroid surgery and FNAB was 15 years [range, 1-45 years; interquartile range (IQR) 13 years]. Significantly more nodules in group 1 had ND FNAB results than in group 2 [98 (49 %) vs 78 (39 %), respectively, P = 0.028]. Multivariate analysis revealed that history of thyroid surgery was independently associated with ND FNAB [odds ratio (OR) 1.55, 95 % confidence interval (CI) 1-2.33, P = 0.033]. A history of thyroid surgery increases the risk of initial ND FNAB.Endocrine Pathology 11/2013; · 1.64 Impact Factor