Endocrinology and Metabolism

Original Articles

The Diagnostic Role of Repeated Biopsy of Thyroid Nodules with Atypia of Undetermined Significance with Architectural Atypia on Core-Needle Biopsy: Hye Hyeon Moon, Sae Rom Chung, Young Jun Choi, Tae-Yon Sung, Dong Eun Song, Tae Yong Kim, Jeong Hyun Lee, Jung Hwan Baek; Received September 4, 2023 Accepted November 14, 2023 Published online January 3, 2024; DOI: https://doi.org/10.3803/EnM.2023.1818 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
We aimed to evaluate the utility of repeat biopsy of thyroid nodules classified as atypia of undetermined significance with architectural atypia (IIIB) on core-needle biopsy (CNB).
Methods
This retrospective study evaluated patients with thyroid nodules categorized as IIIB on CNB between 2013 and 2015. Demographic characteristics, subsequent biopsy results, and ultrasound (US) images were evaluated. The malignancy rates of nodules according to number of CNBs and the number of IIIB diagnoses was compared. Demographic and US features were evaluated to determine factors predictive of malignancy.
Results
Of 1,003 IIIB nodules on CNB, the final diagnosis was determined for 328 (32.7%) nodules, with 121 of them confirmed as malignant, resulting in a malignancy rate of 36.9% (95% confidence interval, 31.7% to 42.1%). Repeat CNB was performed in 248 nodules (24.7%), with 75 (30.2%), 131 (52.8%), 13 (5.2%), 26 (10.5%), one (0.4%), and two (0.8%) reclassified into categories II, IIIB, IIIA, IV, V, and VI, respectively. Malignancy rates were not significantly affected by the number of CNBs (P=0.291) or the number of IIIB diagnoses (P=0.473). None of the nodules confirmed as category II on repeat CNB was malignant. US features significantly associated with malignancy (P<0.003) included solid composition, irregular margins, microcalcifications, and high suspicion on the US risk stratification system.
Conclusion
Repeat biopsy of nodules diagnosed with IIIB on CNB did not increase the detection of malignancy but can potentially reduce unnecessary surgery. Repeat biopsy should be performed selectively, with US features guiding the choice between repeat biopsy and diagnostic surgery.

Thyroid Thyroid Cancer Screening
Diagnostic Performance of Ultrasound-Based Risk Stratification Systems for Thyroid Nodules: A Systematic Review and Meta-Analysis: Leehi Joo, Min Kyoung Lee, Ji Ye Lee, Eun Ju Ha, Dong Gyu Na; Endocrinol Metab. 2023;38(1):117-128. Published online February 27, 2023; DOI: https://doi.org/10.3803/EnM.2023.1670

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Background
This study investigated the diagnostic performance of biopsy criteria in four society ultrasonography risk stratification systems (RSSs) for thyroid nodules, including the 2021 Korean (K)-Thyroid Imaging Reporting and Data System (TIRADS).
Methods
The Ovid-MEDLINE, Embase, Cochrane, and KoreaMed databases were searched and a manual search was conducted to identify original articles investigating the diagnostic performance of biopsy criteria for thyroid nodules (≥1 cm) in four widely used society RSSs.
Results
Eleven articles were included. The pooled sensitivity and specificity were 82% (95% confidence interval [CI], 74% to 87%) and 60% (95% CI, 52% to 67%) for the American College of Radiology (ACR)-TIRADS, 89% (95% CI, 85% to 93%) and 34% (95% CI, 26% to 42%) for the American Thyroid Association (ATA) system, 88% (95% CI, 81% to 92%) and 42% (95% CI, 22% to 67%) for the European (EU)-TIRADS, and 96% (95% CI, 94% to 97%) and 21% (95% CI, 17% to 25%) for the 2016 K-TIRADS. The sensitivity and specificity were 76% (95% CI, 74% to 79%) and 50% (95% CI, 49% to 52%) for the 2021 K-TIRADS_1.5 (1.5-cm size cut-off for intermediate-suspicion nodules). The pooled unnecessary biopsy rates of the ACR-TIRADS, ATA system, EU-TIRADS, and 2016 K-TIRADS were 41% (95% CI, 32% to 49%), 65% (95% CI, 56% to 74%), 68% (95% CI, 60% to 75%), and 79% (95% CI, 74% to 83%), respectively. The unnecessary biopsy rate was 50% (95% CI, 47% to 53%) for the 2021 K-TIRADS_1.5.
Conclusion
The unnecessary biopsy rate of the 2021 K-TIRADS_1.5 was substantially lower than that of the 2016 K-TIRADS and comparable to that of the ACR-TIRADS. The 2021 K-TIRADS may help reduce potential harm due to unnecessary biopsies.

Citations

Citations to this article as recorded by

To Screen or Not to Screen?
Do Joon Park
Endocrinology and Metabolism.2023; 38(1): 69. CrossRef
The 2017 United States Preventive Services Task Force Recommendation for Thyroid Cancer Screening Is No Longer the Gold Standard
Ka Hee Yi
Endocrinology and Metabolism.2023; 38(1): 72. CrossRef
Thyroid Cancer Screening: How to Maximize Its Benefits and Minimize Its Harms
Jung Hwan Baek
Endocrinology and Metabolism.2023; 38(1): 75. CrossRef
2023 Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules
Young Joo Park, Eun Kyung Lee, Young Shin Song, Soo Hwan Kang, Bon Seok Koo, Sun Wook Kim, Dong Gyu Na, Seung-Kuk Baek, So Won Oh, Min Kyoung Lee, Sang-Woo Lee, Young Ah Lee, Yong Sang Lee, Ji Ye Lee, Dong-Jun Lim, Leehi Joo, Yuh-Seog Jung, Chan Kwon Jung
International Journal of Thyroidology.2023; 16(1): 1. CrossRef
Evaluation of the Appropriateness of Thyroid Fine-Needle Aspiration
Lairce Cristina Ribeiro Brito, Iara Beatriz De Carvalho Botêlho, Lanna Matos Silva Fernandes, Nayze Lucena Sangreman Aldeman, Uziel Nunes Silva
International Journal for Innovation Education and Research.2023; 11(6): 8. CrossRef

Thyroid Thyroid Cancer Screening
A Comprehensive Assessment of the Harms of Fine-Needle Aspiration Biopsy for Thyroid Nodules: A Systematic Review: Ji Yong Park, Wonsuk Choi, A Ram Hong, Jee Hee Yoon, Hee Kyung Kim, Ho-Cheol Kang; Endocrinol Metab. 2023;38(1):104-116. Published online February 27, 2023; DOI: https://doi.org/10.3803/EnM.2023.1669

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Background
There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of FNAB.
Methods
Studies related with the harms of FNAB were searched on MEDLINE, Embase, Cochrane library, and KoreaMed from 2012 to 2022. Also, studies reviewed in the previous systematic reviews were evaluated. Included clinical complications were postprocedural pain, bleeding events, neurological symptoms, tracheal puncture, infections, post-FNAB thyrotoxicosis, and needle tract implantation of thyroid cancers.
Results
Twenty-three cohort studies were included in this review. Nine studies which were related with FNAB-related pain showed that most of the subjects had no or mild discomfort. The 0% to 6.4% of the patients had hematoma or hemorrhage after FNAB, according to 15 studies. Vasovagal reaction, vocal cord palsy, and tracheal puncture have rarely described in the included studies. Needle tract implantation of thyroid malignancies was described in three studies reporting 0.02% to 0.19% of the incidence rate.
Conclusion
FNAB is considered to be a safe diagnostic procedure with rare complications, which are mainly minor events. Thorough assessement of the patients’ medical condition when deciding to perform FNABs would be advisable to lower potential complications.

Citations

Citations to this article as recorded by

A Narrative Review of the 2023 Korean Thyroid Association Management Guideline for Patients with Thyroid Nodules
Eun Kyung Lee, Young Joo Park, Chan Kwon Jung, Dong Gyu Na
Endocrinology and Metabolism.2024; 39(1): 61. CrossRef
Fine-needle aspiration cytology for neck lesions in patients with antithrombotic/anticoagulant medications: systematic review and meta-analysis
Dongbin Ahn, Ji Hye Kwak, Gill Joon Lee, Jin Ho Sohn
European Radiology.2024;[Epub] CrossRef
To Screen or Not to Screen?
Do Joon Park
Endocrinology and Metabolism.2023; 38(1): 69. CrossRef
Thyroid Cancer Screening: How to Maximize Its Benefits and Minimize Its Harms
Jung Hwan Baek
Endocrinology and Metabolism.2023; 38(1): 75. CrossRef
Evaluation of the Appropriateness of Thyroid Fine-Needle Aspiration
Lairce Cristina Ribeiro Brito, Iara Beatriz De Carvalho Botêlho, Lanna Matos Silva Fernandes, Nayze Lucena Sangreman Aldeman, Uziel Nunes Silva
International Journal for Innovation Education and Research.2023; 11(6): 8. CrossRef

Thyroid
Diagnostic Performance of Thyroid Core Needle Biopsy Using the Revised Reporting System: Comparison with Fine Needle Aspiration Cytology: Kwangsoon Kim, Ja Seong Bae, Jeong Soo Kim, So Lyung Jung, Chan Kwon Jung; Endocrinol Metab. 2022;37(1):159-169. Published online February 28, 2022; DOI: https://doi.org/10.3803/EnM.2021.1299

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Abstract PDF Supplementary Material PubReader ePub

Background
We aim to validate the diagnostic performance of thyroid core needle biopsy (CNB) for diagnosing malignancy in clinical settings to align with the changes made in recently updated thyroid CNB guidelines.
Methods
We retrospectively analyzed 1,381 thyroid CNB and 2,223 fine needle aspiration (FNA) samples. The FNA and CNB slides were interpreted according to the Bethesda System for Reporting Thyroid Cytopathology and updated practice guidelines for thyroid CNB, respectively.
Results
Compared to FNA, CNB showed lower rates of inconclusive results: categories I (2.8% vs. 11.2%) and III (1.2% vs. 6.2%), and higher rates of categories II (60.9% vs. 50.4%) and IV (17.5% vs. 2.0%). The upper and lower bounds of the risk of malignancy (ROM) for category IV of CNB were 43.2% and 26.6%, respectively. The CNB subcategory IVb with nuclear atypia had a higher ROM than the subcategory without nuclear atypia (40%–62% vs. 23%–36%). In histologically confirmed cases, there was no significant difference in the diagnostic performance between CNB and FNA for malignancy. However, neoplastic diseases were more frequently detected by CNB than by FNA (88.8% vs. 77.6%, P=0.046). In category IV, there was no difference in unnecessary surgery rate between CNB and FNA (4.7% vs. 6.9%, P=0.6361).
Conclusion
Thyroid CNB decreased the rate of inconclusive results and showed a higher category IV diagnostic rate than FNA. The revised guidelines for thyroid CNB proved to be an excellent reporting system for assessing thyroid nodules.

Citations

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Examining the impact of several factors including COVID‐19 on thyroid fine‐needle aspiration biopsy
Muzaffer Serdar Deniz, Merve Dindar
Diagnostic Cytopathology.2024; 52(1): 42. CrossRef
Consensus SFE-AFCE-SFMN 2022 sur la prise en charge des nodules thyroïdiens : intérêt et place de la cytologie thyroïdienne
Myriam Decaussin-Petrucci, Beatrix Cochand Priollet, Emannuelle Leteurtre, Frédérique Albarel, Françoise Borson-Chazot
Annales de Pathologie.2024; 44(1): 20. CrossRef
A comparative analysis of core needle biopsy and repeat fine needle aspiration in patients with inconclusive initial cytology of thyroid nodules
Xuejiao Su, Can Yue, Wanting Yang, Buyun Ma
Frontiers in Endocrinology.2024;[Epub] CrossRef
Preoperative Risk Stratification of Follicular-patterned Thyroid Lesions on Core Needle Biopsy by Histologic Subtyping and RAS Variant-specific Immunohistochemistry
Meejeong Kim, Sora Jeon, Chan Kwon Jung
Endocrine Pathology.2023; 34(2): 247. CrossRef
2023 Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules
Young Joo Park, Eun Kyung Lee, Young Shin Song, Soo Hwan Kang, Bon Seok Koo, Sun Wook Kim, Dong Gyu Na, Seung-Kuk Baek, So Won Oh, Min Kyoung Lee, Sang-Woo Lee, Young Ah Lee, Yong Sang Lee, Ji Ye Lee, Dong-Jun Lim, Leehi Joo, Yuh-Seog Jung, Chan Kwon Jung
International Journal of Thyroidology.2023; 16(1): 1. CrossRef
Reevaluating diagnostic categories and associated malignancy risks in thyroid core needle biopsy
Chan Kwon Jung
Journal of Pathology and Translational Medicine.2023; 57(4): 208. CrossRef
A Matched-Pair Analysis of Nuclear Morphologic Features Between Core Needle Biopsy and Surgical Specimen in Thyroid Tumors Using a Deep Learning Model
Faridul Haq, Andrey Bychkov, Chan Kwon Jung
Endocrine Pathology.2022; 33(4): 472. CrossRef

Case Report

A Case of Adult Fanconi Syndrome with Hypophosphatemic Osteomalacia.: Ji Hyun Lee, Young Sup Byun, Bong Soo Cha, Moon Suk Nam, Young Duk Song, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Kap Bum Huh, Jin Kim, Jong In Yook; J Korean Endocr Soc. 1996;11(1):93-101. Published online November 7, 2019

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Abstract PDF: The Fanconi syndrome is characterized by generalized disturbance of tubular function. It leads to excessive losses of amino acids, glucose, phosphate, bicarbonate, and other organic and inorganic substrates handled by the proximal tubules. The metabolic consequences are acidosis, hypophosphatemia, hypocalemia, dehydration, rickets, osteomalacia, osteoporosis, and growth retardation. This syndrome may either be congenital or acquired, primary or secondary. Acquired Fanconi syndrome may result from multiple myeloma, Wilsons disease, primary amyloidosis, light chain nephropathy, and heavy metal poisoning such as lead, mercury, and cadmium. A 33-year-old female presented with multiple bone pain, and progressive proximal muscle weakness for 15 months. The blood urea nitrogen, creatinine, calcium, phosphate, and uric acid were 12.1 mg/dL, 1.5 mg/dL, 8.4 mg/dL, 1.8 mg/dL, and 1.7 mg/dL, respectively. The urine volume, protein, calcium, phosphate, and creatinine clearance were 2,330 ml, 343.7 mg, 146 mg, 424 mg, and 44.6 ml/min, respectively in 24 hour collection urine study. The tubular reabsorption rate of phosphate was decreased. In arterial blood gas analysis study, pH was 7.348, bicarbonate was 17.6 mmol/L, which means metabolic acidosis. In chest X-ray, fracture was seen in eighth and ninth left ribs. The whole body bone scan revealed hot uptake at both first and second ribs, right third rib, both eighth and ninth ribs, left sacroiliac joint and right hip joint. Bone densitometry showed moderate osteopenia in spine and femur neck. After NE4Cl loading, the urine pH was decreased below 5.0 at two and third hour, which means proximal renal tubular acidosis. Amino acid such as, hydroxyproline, threonine, serine, asparagine, glutamine excreted much more than normal in 24 hour urine. Bone biopsy showed the presence of increased osteoid volume and osteoid seam width and marked decreased mineral appositional rate as evidence for osteomalacia. The patients symptoms, including bone pain and proximal muscle weakness, were relieved after supplement of calcitonin, Vitamin D and calcium carbonate. We report a case of Fanconi syndrome with hypophosphatemic osteomalacia with brief review of literature.

Original Articles

Clinical Study
Comparison of Natural Course between Thyroid Cancer Nodules and Thyroid Benign Nodules: Kyun-Jin Yun, Jeonghoon Ha, Min-Hee Kim, Ye Young Seo, Mee Kyoung Kim, Hyuk-Sang Kwon, Ki-Ho Song, Moo Il Kang, Ki-Hyun Baek; Endocrinol Metab. 2019;34(2):195-202. Published online June 24, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.2.195

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Background

The natural course of thyroid cancer nodules and benign nodules is different. This study was to compare the changes in size between thyroid cancer nodules and thyroid benign nodules. The risk factors associated with the changes of thyroid cancer nodules were assessed.

Methods

This study contains retrospective observational and prospective analysis. A total of 113 patients with 120 nodules were recruited in the cancer group, and 116 patients with 119 nodules were enrolled in the benign group. Thyroid ultrasonography was performed at least two times at more than 1-year interval.

Results

The mean follow-up durations were 29.5±18.8 months (cancer group) and 31.9±15.8 months (benign group) (P=0.32). The maximum diameter change in length was 0.36±0.97 mm/year in the cancer group and –0.04±0.77 mm/year in the benign group (P<0.01). The volume was significantly increased in the cancer group compared with the benign group (0.06±0.18 mL/year vs. 0.004±0.05 mL/year, respectively, P<0.01; 26.9%±57.9%/year vs. 1.7%±26.0%/year, P<0.01). Initial maximum diameter (β=0.02, P<0.01) and initial volume (β=0.13, P<0.01) were significantly associated with volume change (mL)/year. Initial maximum standardized uptake value did not predict the nodule growth.

Conclusion

It is suggested that thyroid cancer nodules progress rapidly compared with benign nodules. Initial size and volume of nodule were independent risk factors for cancer nodule growth.

Citations

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RAS-Mutated Cytologically Indeterminate Thyroid Nodules: Prevalence of Malignancy and Behavior Under Active Surveillance
Hannah J. Sfreddo, Elizabeth S. Koh, Karena Zhao, Christina E. Swartzwelder, Brian R. Untch, Jennifer L. Marti, Benjamin R. Roman, Jared Dublin, Ronald S. Wang, Rong Xia, Jean-Marc Cohen, Bin Xu, Ronald Ghossein, Babak Givi, Jay O. Boyle, R. Michael Tuttl
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Ultrasound for the assessment of thyroid nodules: an overview for non-radiologists
Conor Hamill, Peter Ellis, Philip C Johnston
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Sensors.2021; 21(13): 4459. CrossRef
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Sangeet Ghai, Ciara O’Brien, David P. Goldstein, Anna M. Sawka, Lorne Rotstein, Dale Brown, John de Almeida, Patrick Gullane, Ralph Gilbert, Douglas Chepeha, Jonathan Irish, Jesse Pasternak, Shereen Ezzat, James P. Brierley, Richard W. Tsang, Eric Monteir
Insights into Imaging.2021;[Epub] CrossRef
Association between various thyroid gland diseases, TSH values and thyroid cancer: a case–control study
Leif Schiffmann, Karel Kostev, Matthias Kalder
Journal of Cancer Research and Clinical Oncology.2020; 146(11): 2989. CrossRef
Combination of peroxisome proliferator–activated receptor gamma and retinoid X receptor agonists induces sodium/iodide symporter expression and inhibits cell growth of human thyroid cancer cells
Jui-Yu Chen, Jane-Jen Wang, Hsin-Chen Lee, Chin-Wen Chi, Chen-Hsen Lee, Yi-Chiung Hsu
Journal of the Chinese Medical Association.2020; 83(10): 923. CrossRef
Growth rates of malignant and benign thyroid nodules in an ultrasound follow-up study: a retrospective cohort study
Michael Cordes, Theresa Ida Götz, Karen Horstrup, Torsten Kuwert, Christian Schmidkonz
BMC Cancer.2019;[Epub] CrossRef

Clinical Study
Does Radiofrequency Ablation Induce Neoplastic Changes in Benign Thyroid Nodules: A Preliminary Study: Su Min Ha, Jun Young Shin, Jung Hwan Baek, Dong Eun Song, Sae Rom Chung, Young Jun Choi, Jeong Hyun Lee; Endocrinol Metab. 2019;34(2):169-178. Published online May 15, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.2.169

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Background

To evaluate the clinical feasibility of radiofrequency ablation (RFA) of benign thyroid nodules along with cytomorphological alteration, and any malignant transformation through biopsy.

Methods

The data were retrospectively collected between April 2008 and June 2013 and core needle biopsy (CNB) was performed on 16 benign thyroid nodules previously treated using RFA. The parameters of the patients were compared, between the time of enrollment and the last follow-up examination, using linear mixed model statistical analysis.

Results

No atypical cells or neoplastic transformation were detected in the undertreated peripheral portion of treated benign nodules on the CNB specimen. RFA altered neither the thyroid capsule nor the thyroid tissue adjacent to the treated area. On histopathological examinations, we observed 81.2% acellular hyalinization, which was the most common finding. After a mean follow-up period of over 5 years, the mean volume of thyroid nodule had decreased to 6.4±4.2 mL, with a reduction rate of 81.3%±5.8% (P<0.0001).

Conclusion

RFA is a technically feasible treatment method for benign thyroid nodules, with no carcinogenic effect or tissue damage of the normal thyroid tissue adjacent to the RFA-treated zone.

Citations

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Jae Ho Shin, Minkook Seo, Min Kyoung Lee, So Lyung Jung
Korean Journal of Radiology.2024; 25(2): 199. CrossRef
Thermoablation of thyroid nodules reveals excellent results with low morbidity
Robert M. Eisele, Philipp R. Scherber, Monika Schlüter, Thorsten Drews, Matthias Glanemann, Gereon Gäbelein
Technology and Health Care.2022; 30(3): 683. CrossRef
Radiofrequency ablation and related ultrasound‐guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with
Lisa A. Orloff, Julia E. Noel, Brendan C. Stack, Marika D. Russell, Peter Angelos, Jung Hwan Baek, Kevin T. Brumund, Feng‐Yu Chiang, Mary Beth Cunnane, Louise Davies, Andrea Frasoldati, Anne Y. Feng, Laszlo Hegedüs, Ayaka J. Iwata, Emad Kandil, Jennifer K
Head & Neck.2022; 44(3): 633. CrossRef
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James Y. Lim, Jennifer H. Kuo
Techniques in Vascular and Interventional Radiology.2022; 25(2): 100824. CrossRef
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Roberto Cesareo, Silvia Egiddi, Anda M. Naciu, Gaia Tabacco, Andrea Leoncini, Nicola Napoli, Andrea Palermo, Pierpaolo Trimboli
Reviews in Endocrine and Metabolic Disorders.2022; 23(5): 1051. CrossRef
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Lin Yan, Xinyang Li, Yingying Li, Jing Xiao, Mingbo Zhang, Yukun Luo
European Radiology.2022; 33(1): 730. CrossRef
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Yuan-dong Sun, Hao Zhang, Hai-tao Zhu, Chun-xue Wu, Miao-ling Chen, Jian-jun Han
Frontiers in Oncology.2022;[Epub] CrossRef
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Haris Muhammad, Prasanna Santhanam, Jonathon O. Russell, Jennifer H. Kuo
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Haris Muhammad, Prasanna Santhanam, Jonathon O. Russell
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Rahul K. Sharma, Jennifer H Kuo
Current Otorhinolaryngology Reports.2021; 9(1): 79. CrossRef
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Hervé Monpeyssen, Ahmad Alamri, Adrien Ben Hamou
Frontiers in Endocrinology.2021;[Epub] CrossRef
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International Journal of Endocrinology.2021; 2021: 1. CrossRef
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Enock Adjei Agyekum, Jian-hua Fu, Fei-Ju Xu, Yong-Zhen Ren, Debora Akortia, Qing Chen, Xiao-Qin Qian, Yuguo Wang, Xian Wang
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Thyroid
A Comparison of Ultrasound-Guided Fine Needle Aspiration versus Core Needle Biopsy for Thyroid Nodules: Pain, Tolerability, and Complications: Eun Ji Jeong, Sae Rom Chung, Jung Hwan Baek, Young Jun Choi, Jae Kyun Kim, Jeong Hyun Lee; Endocrinol Metab. 2018;33(1):114-120. Published online March 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.1.114

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Background

To compare pain, tolerability, and complications associated with fine needle aspiration (FNA) versus core needle biopsy (CNB).

Methods

FNAs were performed using 23-gauge needles and CNBs were performed using 18-gauge double-action spring-activated needles in 100 patients for each procedure. Patients were asked to record a pain score using a 10-cm visual analog scale and procedure tolerability. Complications and number of biopsies were recorded.

Results

The median pain scores were similar for the FNA and CNB approaches during and 20 minutes after the biopsy procedures (3.7 vs. 3.6, P=0.454; 0.9 vs. 1.1, P=0.296, respectively). The procedure was tolerable in all 100 FNA patients and in 97 CNB patients (P=0.246). The mean number of biopsies was fewer in the CNB group (1.4 vs. 1.2, P=0.002). By subgroup analysis (staff vs. non-staff), no significant difference was detected in any parameter. There were no major complications in either group, but three patients who underwent CNB had minor complications (P=0.246).

Conclusion

FNA and CNB show no significant differences for diagnosing thyroid nodules in terms of pain, tolerability, or complications.

Citations

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A comparative analysis of core needle biopsy and repeat fine needle aspiration in patients with inconclusive initial cytology of thyroid nodules
Xuejiao Su, Can Yue, Wanting Yang, Buyun Ma
Frontiers in Endocrinology.2024;[Epub] CrossRef
Assessing Adequacy: A Meta-Analysis of Rapid Onsite Evaluation of Thyroid Nodules
Peter P. Issa, Christina McCarthy, Mohammad Hussein, Aaron L. Albuck, Essam Emad, Mohamed Shama, Krzysztof Moroz, Eman Toraih, Emad Kandil
Journal of Surgical Research.2024; 296: 523. CrossRef
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Chun-Nan Chen, Tsung-Lin Yang
European Archives of Oto-Rhino-Laryngology.2023; 280(8): 3773. CrossRef
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Tapoi Dana Antonia, Lambrescu Ioana Maria, Gheorghisan-Galateanu Ancuta-Augustina
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Review Article

Recent Advances in Core Needle Biopsy for Thyroid Nodules: Chan Kwon Jung, Jung Hwan Baek; Endocrinol Metab. 2017;32(4):407-412. Published online December 14, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.4.407

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Core needle biopsy (CNB) was introduced as an alternative diagnostic tool to fine-needle aspiration (FNA), and is increasingly being used in the preoperative assessment of thyroid nodules. CNB provides a definitive diagnosis in most cases, but it sometimes may be inconclusive. CNB has the advantage of enabling a histologic examination in relation to the surrounding thyroid tissue, immunohistochemistry, and molecular testing that can provide a more accurate assessment than FNA in selected cases. Nevertheless, CNB should be performed only by experienced experts in thyroid interventions to prevent complications because CNB needles are larger in caliber than FNA needles. As recent evidence has accumulated, and with improvements in the technique and devices for thyroid CNB, the Korean Society of Thyroid Radiology released its 2016 thyroid CNB guidelines and the Korean Endocrine Pathology Thyroid Core Needle Biopsy Study Group published a consensus statement on the pathology reporting system for thyroid CNB in 2015. This review presents the current consensus and recommendations regarding thyroid CNB, focusing on indications, complications, and pathologic classification and reporting.

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Utilidad de la biopsia con aguja gruesa ecoguiada en nódulos tiroideos con punción aspirativa con aguja fina no diagnóstica
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Usefulness of ultrasound-guided core biopsy in thyroid nodules with inconclusive fine-needle aspiration biopsy findings
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Radiología (English Edition).2022; 64(3): 195. CrossRef
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Original Articles

Risk of Malignancy in Thyroid Nodules 4 cm or Larger: Uchechukwu C. Megwalu; Endocrinol Metab. 2017;32(1):77-82. Published online February 6, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.1.77

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Background

Several authors have questioned the accuracy of fine-needle aspiration cytology (FNAC) in large nodules. Some surgeons recommend thyroidectomy for nodules ≥4 cm even in the setting of benign FNAC, due to increased risk of malignancy and increased false negative rates in large thyroid nodules. The goal of our study was to evaluate if thyroid nodule size is associated with risk of malignancy, and to evaluate the false negative rate of FNAC for thyroid nodules ≥4 cm in our patient population.

Methods

This is a retrospective study of 85 patients with 101 thyroid nodules, who underwent thyroidectomy for thyroid nodules measuring ≥4 cm.

Results

The overall risk of malignancy in nodules ≥4 cm was 9.9%. Nodule size was not associated with risk of malignancy (odds ratio, 1.02) after adjusting for nodule consistency, age, and sex (P=0.6). The false negative rate for FNAC was 0%.

Conclusion

Nodule size was not associated with risk of malignancy in nodules ≥4 cm in our patient population. FNAC had a false negative rate of 0. Patients with thyroid nodules ≥4 cm and benign cytology should not automatically undergo thyroidectomy.

Citations

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Effect of thyroid nodule size on cytology reliability and incidence of malignancy: A large cohort of 1205 patients from a single center
Muhammed Erkam Sencar, Murat Calapkulu, Hayri Bostan, Davut Sakiz, Sema Hepsen, Muhammed Kizilgul, Ilknur Ozturk Unsal, Ozgur Ozcelik, Emre Arslan, Bekir Ucan, Cem Azili, Mustafa Ozbek, Erman Cakal
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Accuracy of fine‐needle aspiration cytopathology to differentiate malignant and benign thyroid nodules with ≥4 cm diameter: A retrospective study
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Clinical Study
Molecular Diagnosis Using Residual Liquid-Based Cytology Materials for Patients with Nondiagnostic or Indeterminate Thyroid Nodules: Hyemi Kwon, Won Gu Kim, Markus Eszlinger, Ralf Paschke, Dong Eun Song, Mijin Kim, Suyeon Park, Min Ji Jeon, Tae Yong Kim, Young Kee Shong, Won Bae Kim; Endocrinol Metab. 2016;31(4):586-591. Published online November 4, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.4.586

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Background

Molecular analysis for common somatic mutations in thyroid cancer can improve diagnostic accuracy of fine-needle aspiration cytology (FNAC) in the nondiagnostic or indeterminate category of thyroid nodules. In this study, we evaluated the feasibility of molecular diagnosis from residual liquid-based cytology (LBC) material after cytological diagnosis.

Methods

This prospective study enrolled 53 patients with thyroid nodules diagnosed as nondiagnostic, atypia of undetermined significance (AUS), or follicular lesion of undetermined significance (FLUS) after FNAC. DNAs and RNAs were isolated from residual LBC materials. BRAF^V600E and RAS point mutations, PAX8/peroxisome proliferator-activated receptor γ (PPARγ), RET/PTC1, and RET/PTC3 rearrangements were evaluated by real-time polymerase chain reaction and pyrosequencing.

Results

All DNAs from 53 residual LBC samples could be analysed and point mutations were detected in 10 samples (19%). In 17 AUS nodules, seven samples (41%) had point mutations including BRAF (n=4), NRAS (n=2), and KRAS (n=1). In 20 FLUS nodules, three samples (15%) had NRAS point mutations. RNA from only one FLUS nodule could be analysed for rearrangements and there was no abnormality.

Conclusion

Molecular analysis for BRAF and RAS mutations was feasible in residual LBC materials and might be useful for diagnosis of indeterminate thyroid nodules.

Citations

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Masahiro Itonaga, Reiko Ashida, Shin-Ichi Murata, Yasunobu Yamashita, Keiichi Hatamaru, Takashi Tamura, Yuki Kawaji, Yuudai Kayama, Tomoya Emori, Manabu Kawai, Hiroki Yamaue, Ibu Matsuzaki, Hirokazu Nagai, Yuichi Kinoshita, Ke Wan, Toshio Shimokawa, Masay
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Next-Generation Sequencing Identifies Gene Mutations That Are Predictive of Malignancy in Residual Needle Rinses Collected From Fine-Needle Aspirations of Thyroid Nodules
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Thyroid
The Validity of Ultrasonography-Guided Fine Needle Aspiration Biopsy in Thyroid Nodules 4 cm or Larger Depends on Ultrasonography Characteristics: Jin Hwa Kim, Na Kyung Kim, Young Lyun Oh, Hye Jeong Kim, Sang Yong Kim, Jae Hoon Chung, Sun Wook Kim; Endocrinol Metab. 2014;29(4):545-552. Published online December 29, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.4.545

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Abstract PDF PubReader

Background

The objective of this study was to evaluate the validity of fine needle aspiration biopsy (FNAB) according to ultrasonography (US) characteristics in thyroid nodules 4 cm and larger.

Methods

We retrospectively reviewed the cases of 263 patients who underwent thyroid surgery for thyroid nodules larger than 4 cm between January 2001 and December 2010.

Results

The sensitivity of US-FNAB was significantly higher in nodules with calcifications (micro- or macro-) than those without (97.9% vs. 87.% P<0.05). The accuracy of US-FNAB was higher in large thyroid nodules with US features suspicious of malignancy, such as a solid component, ill-defined margin, hypoechogenicity or marked hypoechogenicity, or any calcifications (micro- or macro-) compared to thyroid nodules with none of these features. Furthermore, the accuracy improved as the number of these features increased. The overall false negative rate (FNR) was 11.9%. The FNR of thyroid nodules that appeared benign on US, such as mixed nodules (7.7%) or nodules without calcification (9.8%), trended toward being lower than that of solid nodules (17.9%) or nodules with any microcalcification or macrocalcification (33.3%). In nodules without suspicious features of malignancy, the FNR of US-FNAB was 0% (0/15).

Conclusion

We suggest individualized strategies for large thyroid nodules according to US features. Patients with benign FNAB can be followed in the absence of any malignant features in US. However, if patients exhibit any suspicious features, potential false negative results of FNAB should be kept in mind and surgery may be considered.

Citations

Citations to this article as recorded by

Risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy in thyroid nodules with diameters greater than 4 centimeters
Rafaela N. Barcelos, Cléber P. Camacho, Maria da Conceição de O. C. Mamone, Elza S. Ikejiri, Felipe A. B. Vanderlei, Ji H. Yang, Rosália P. Padovani, Leandro A. L. Martins, Rosa Paula M. Biscolla, Danielle Macellaro, Susan C. Lindsey, Rui M. B. Maciel, Jo
Archives of Endocrinology and Metabolism.2023;[Epub] CrossRef
The comparison of accuracy of ultrasonographic features versus ultrasound-guided fine-needle aspiration cytology in diagnosis of malignant thyroid nodules
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Journal of Ultrasound.2019; 22(3): 315. CrossRef
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Hye Shin Ahn, Dong Gyu Na, Jung Hwan Baek, Jin Yong Sung, Ji‐Hoon Kim
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Thyroid nodules over 4 cm do not have higher malignancy or benign cytology false-negative rates
Muhammed Kizilgul, Rupendra Shrestha, Angela Radulescu, Maria R. Evasovich, Lynn A. Burmeister
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Large Cytologically Benign Thyroid Nodules Do Not Have High Rates of Malignancy or False-Negative Rates and Clinical Observation Should be Considered: A Meta-Analysis
Nicole A. Cipriani, Michael G. White, Peter Angelos, Raymon H. Grogan
Thyroid.2018; 28(12): 1595. CrossRef
Risk of Malignancy in Thyroid Nodules 4 cm or Larger
Uchechukwu C. Megwalu
Endocrinology and Metabolism.2017; 32(1): 77. CrossRef
Usefulness of NRAS codon 61 mutation analysis and core needle biopsy for the diagnosis of thyroid nodules previously diagnosed as atypia of undetermined significance
Eun Kyung Jang, Won Gu Kim, Eui Young Kim, Hyemi Kwon, Yun Mi Choi, Min Ji Jeon, Jung Hwan Baek, Jeong Hyun Lee, Tae Yong Kim, Young Kee Shong, Jene Choi, Dong Eun Song, Won Bae Kim
Endocrine.2016; 52(2): 305. CrossRef
Association between neck ultrasonographic findings and clinico‐pathological features in the follicular variant of papillary thyroid carcinoma
Eun Kyung Jang, Won Gu Kim, Yun Mi Choi, Min Ji Jeon, Hyemi Kwon, Jung Hwan Baek, Jeong Hyun Lee, Tae Yong Kim, Young Kee Shong, Dong Eun Song, Won Bae Kim
Clinical Endocrinology.2015; 83(6): 968. CrossRef
Articles in 'Endocrinology and Metabolism' in 2014
Won-Young Lee
Endocrinology and Metabolism.2015; 30(1): 47. CrossRef

Thyroid
Insufficient Experience in Thyroid Fine-Needle Aspiration Leads to Misdiagnosis of Thyroid Cancer: Jung Il Son, Sang Youl Rhee, Jeong-taek Woo, Won Seo Park, Jong Kyu Byun, Yu-Jin Kim, Ja Min Byun, Sang Ouk Chin, Suk Chon, Seungjoon Oh, Sung Woon Kim, Young Seol Kim; Endocrinol Metab. 2014;29(3):293-299. Published online September 25, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.3.293

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Background

Fine-needle aspiration (FNA) of the thyroid is a widely accepted confirmatory test for thyroid cancer with high sensitivity and specificity. FNA is a simple procedure that is learned by many clinicians to enable accurate diagnosis of thyroid cancer. However, it is assumed that because the FNA test is a relatively simple procedure, its cytologic results are reliable regardless of the operator's experience. The aim of this study was to evaluate the differences in the diagnostic indices of FNA between operators with different levels of experience.

Methods

A total of 694 thyroid FNA specimens from 469 patients were reviewed, and were separated based on the experience of the clinicians who performed the procedure. One hundred and ninety were categorized in the experienced group, and 504 in the inexperienced group. All FNA results were then compared with histological data from surgically resected specimens, and the sample adequacy and diagnostic accuracy of the groups were compared.

Results

The age, gender, and nodule size and characteristics were similar in both groups. The sample adequacy rate was not significantly different between the experienced and nonexperienced groups (96.3% vs. 95.4%, P=0.682). However, the non-experienced group had a higher false-negative rate than the experienced group (6.4% vs. 17.2%, P=0.038), and the sensitivity of the FNA test also tended to be lower in the nonexperienced group (95.6% vs. 88.9%, P=0.065).

Conclusion

These results suggest that FNA operators who have less experience may miss cases of thyroid cancer by performing the procedure incorrectly. As such, the experience of the FNA operator should be considered when diagnosing thyroid cancer. When clinicians are being trained in FNA, more effort should be made to increase the accuracy of the procedure; therefore, enhanced teaching programs and/or a more detailed feedback system are recommended.

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Robert Post, Kelly Doxzon, Allison Goldberg
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Agnaldo J. Graciano, Carlos A. Fischer, Carlos T. Chone, Giuliano S. Bublitz, Marina Sonagli, Cezar A. Rodrigues Filho
Head & Neck.2017; 39(3): 439. CrossRef
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Eun Kyung Jang, Won Gu Kim, Eui Young Kim, Hyemi Kwon, Yun Mi Choi, Min Ji Jeon, Jung Hwan Baek, Jeong Hyun Lee, Tae Yong Kim, Young Kee Shong, Jene Choi, Dong Eun Song, Won Bae Kim
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Carcinosarcoma of the Thyroid Gland
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Letter: Insufficient Experience in Thyroid Fine-Needle Aspiration Leads to Misdiagnosis of Thyroid Cancer (Endocrinol Metab2014;29:293-9, Jung Il Son et al.)
Hyon-Seung Yi, Sihoon Lee
Endocrinology and Metabolism.2014; 29(4): 590. CrossRef
Response: Insufficient Experience in Thyroid Fine-Needle Aspiration Leads to Misdiagnosis of Thyroid Cancer (Endocrinol Metab2014;29:293-9, Jung Il Son et al.)
Jung Il Son, Jeong-taek Woo
Endocrinology and Metabolism.2014; 29(4): 592. CrossRef

Review Article

Thyroid
Indications for Fine Needle Aspiration in Thyroid Nodules: Jin Young Kwak; Endocrinol Metab. 2013;28(2):81-85. Published online June 18, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.2.81

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55 Download
22 Web of Science
21 Crossref

Abstract PDF PubReader

Thyroid nodules are a common clinical problem with the widespread use of ultrasonography. Fine needle aspiration (FNA) is the mainstay for diagnosing a thyroid malignancy. There have been several guidelines on when to perform FNA in thyroid nodules. This review is based on several published recommendations and helps physicians easily understand the factors favoring FNA.

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Magdalena Mileva, Bojana Stoilovska, Anamarija Jovanovska, Ana Ugrinska, Gordana Petrushevska, Slavica Kostadinova-Kunovska, Daniela Miladinova, Venjamin Majstorov
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Usefulness of NRAS codon 61 mutation analysis and core needle biopsy for the diagnosis of thyroid nodules previously diagnosed as atypia of undetermined significance
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Case Report

Thyroid
A Case of Acute Suppurative Thyroiditis with Thyrotoxicosis in an Elderly Patient: Bo Sang Kim, Kil Woo Nam, Jeong Eun Kim, Ji Hoon Park, Jun Sik Yoon, Jung Hwan Park, Sang Mo Hong, Chang Bum Lee, Yong Soo Park, Woong Hwan Choi, You Hern Ahn, Dong Sun Kim; Endocrinol Metab. 2013;28(1):50-54. Published online March 25, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.1.50

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Abstract PDF PubReader

Acute suppurative thyroiditis (AST) is a rare condition, as the thyroid gland is relatively resistant to infection. Thyroid function tests are usually normal in AST. A few cases of AST associated with thyrotoxicosis have been reported in adults. We report a case of AST that was associated with thyrotoxicosis in a 70-year-old woman. We diagnosed AST with thyroid ultrasonography and fine needle aspiration of pus. The patient improved after surgical intervention and had no anatomical abnormality. Fine needle aspiration is the best method for the difficult task of differentiating malignancy and subacute thyroiditis from AST with thyrotoxicosis. Earlier diagnosis and proper treatment for AST might improve the outcome.

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