Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for different thyroid carcinoma in 10 388 thyroid nodules: a ten-year study

doi:10.16150/j.1671-2870.2020.04.007

Abstract

Abstract:

Objective: To investigate the diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy (US-FNAB) in different subtypes of thyroid carcinoma. Methods: A total of 10 388 thyroid nodules from 9 933 patients undergone US-FNAB in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2010 to December 2019 were enrolled, and related data were retrospectively analyzed. The sensitivity, specificity, accuracy, positive and negative predictive value of US-FNAB for thyroid carcinoma were assessed by comparing to the results of surgical pathology. The accuracy rate of diagnosis between different subtypes of thyroid carcinoma was further analyzed. Results: The ten-year study revealed that among 10 388 nodules, 9 379 nodules were malignant. The total sensitivity, specificity, positive and negative predictive value of US-FNAB for thyroid carcinoma were 95.4%, 84.7%, 98.4%, 65.9% and 94.4%, respectively. For the subtypes of thyroid carcinoma, diagnostic accuracies for papillary carcinoma and medullary carcinoma were 95.8% and 69.4%, respectively. Conclusions: US-FNAB is valuable in the diagnosis of thyroid nodules and has the highest diagnostic accuracy for thyroid papillary carcinoma.

Key words: Thyroid carcinoma, Ultrasound-guided fine needle aspiration biopsy, Papillary carcinoma of thyroid

CLC Number:

R736.1

WANG Xing, WANG Ronghui, ZHANG Guiping, DONG Yijie, ZHOU Wei, ZHAN Weiwei. Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for different thyroid carcinoma in 10 388 thyroid nodules: a ten-year study[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(04): 359-363.

Figures/Tables 2

References 25

[1]	Hughes DT, Haymart MR, Miller BS, et al. The most commonly occurring papillary thyroid cancer in the Uni-ted States is now a microcarcinoma in a patient older than 45 years[J]. Thyroid, 2011, 21(3):231-236. doi: 10.1089/thy.2010.0137 pmid: 21268762
[2]	Kowalska A, Walczyk A, Kowalik A, et al. Increase in papillary thyroid cancer incidence is accompanied by changes in the frequency of the BRAF V600E mutation: a single-institution study[J]. Thyroid, 2016, 26(4):543-551. doi: 10.1089/thy.2015.0352 pmid: 26889698
[3]	Morris LG, Tuttle RM, Davies L. Changing trends in the incidence of thyroid cancer in the United States[J]. JAMA Otolaryngol Head Neck Surg, 2016, 142(7):709-711. doi: 10.1001/jamaoto.2016.0230 URL
[4]	Han L, Wu Z, Li W, et al. The real world and thinking of thyroid cancer in China[J]. IJS Oncology, 2019, 4(7):e81.
[5]	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132. doi: 10.3322/caac.21338 URL
[6]	Haugen BR, Alexander EK, Bible KC, et al. 2015 Ame-rican Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer[J]. Thyroid, 2016, 26(1):1-133. doi: 10.1089/thy.2015.0020 pmid: 26462967
[7]	Danese D, Sciacchitano S, Farsetti A, et al. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules[J]. Thyroid, 1998, 8(1):15-21. pmid: 9492148
[8]	American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer[J]. Thyroid, 2009, 19(11):1167-1214. doi: 10.1089/thy.2009.0110 pmid: 19860577
[9]	Ali SZ, Cibas ES. The Bethesda system for reporting thyroid cytopathology Ⅱ[J]. Acta Cytol, 2016, 60(5):397-398. doi: 10.1159/000451071 URL
[10]	彭丽, 顾明君. Meta分析比较常规和超声引导下甲状腺细针穿刺细胞学检查对甲状腺结节的诊断价值[J]. 第二军医大学学报, 2007, 28(9):968-972.
[11]	Shin JH, Baek JH, Chung J, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations[J]. Korean J Radiol, 2016, 17(3):370-395. doi: 10.3348/kjr.2016.17.3.370 URL
[12]	Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee[J]. J Am Coll Radiol, 2017, 14(5):587-595. doi: 10.1016/j.jacr.2017.01.046 URL
[13]	Wémeau JL, Sadoul JL, d'Herbomez M, et al. Guidelines of the French Society of Endocrinology for the Management of Thyroid Nodules[J]. Ann Endocrinol (Paris), 2011, 72(4):251-281. doi: S0003-4266(11)00087-4 pmid: 21782154
[14]	Baskin HJ, Duick DS. The endocrinologists' view of ultrasound guidelines for fine needle aspiration[J]. Thyroid, 2006, 16(3):207-208. pmid: 16571080
[15]	Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules- -2016 Update[J]. Endocr Pract, 2016, 22(5):622-639.
[16]	Ke J, Jianyong L, Ying L, et al. The use of The Bethesda System for Reporting Thyroid Cytopathology in a Chinese population: an analysis of 13 351 specimens[J]. Diagn Cytopathol, 2019, 47(9):876-880. doi: 10.1002/dc.24207 URL
[17]	Zhu Y, Song Y, Xu G, et al. Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review[J]. Diagn Pathol, 2020, 15(1):1. doi: 10.1186/s13000-019-0924-z URL
[18]	Zhu Y, Song Y, Xu G, et al. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC): a report of 2,781 cases in a Chinese population[J]. Chin J Cancer Res, 2020, 32(2):140-148. doi: 10.21147/j.issn.1000-9604.2020.02.02 URL
[19]	Furlan JC, Bedard YC, Rosen IB. Role of fine-needle aspiration biopsy and frozen section in the management of papillary thyroid carcinoma subtypes[J]. World J Surg, 2004, 28(9):880-885. pmid: 15593461
[20]	DeLellis RA. Pathology and genetics of tumours of endocrine organs[M]. Lyon: IARC Press, 2004.
[21]	Ali SZ, Cibas ES, SpringerLink(Online service). The Bethesda system for reporting thyroid cytopathology definitions, criteria and explanatory notes[M]. Boston, MA: Springer Science+Business Media, LLC, 2010.
[22]	Trimboli P, Treglia G, Guidobaldi L, et al. Detection rate of FNA cytology in medullary thyroid carcinoma: A meta-analysis[J]. Clin Endocrinol (Oxf), 2015, 82(2):280-285. doi: 10.1111/cen.12563 URL
[23]	Ghofrani M, Ocal IT. Medullary thyroid carcinoma: a brief review of pathogenesis, diagnosis, and treatment[J]. Pathology Case Reviews, 2015, 20:204-209. doi: 10.1097/PCR.0000000000000108 URL
[24]	Trimboli P, Cremonini N, Ceriani L, et al. Calcitonin measurement in aspiration needle washout fluids has higher sensitivity than cytology in detecting medullary thyroid cancer: a retrospective multicentre study[J]. Clin Endocrinol(Oxf), 2014, 80(1):135-140. doi: 10.1111/cen.12234 URL
[25]	Mathur A, Olson MT, Zeiger MA. Follicular lesions of the thyroid[J]. Surg Clin North Am, 2014, 94(3):499-513. doi: 10.1016/j.suc.2014.02.005 pmid: 24857573

指标	2010年至2014年	2015年	2016年	2017年	2018年	2019年	总计
灵敏度（%）	95.1	97.4	96.8	95.1	94.8	94.7	95.4
特异度（%）	71.0	81.3	77.8	90.4	88.6	92.1	84.7
阳性预测值（%）	96.8	98.0	98.0	98.8	98.8	99.1	98.4
阴性预测值（%）	61.2	77.0	67.9	68.5	62.6	64.5	65.9
阳性似然比（+）	3.279	5.209	4.355	9.860	8.349	12.015	6.220
阴性似然比（-）	0.069	0.032	0.041	0.054	0.059	0.058	0.054
准确率（%）	92.8	95.8	95.3	94.6	94.2	94.5	94.4
约登指数	0.661	0.787	0.746	0.855	0.834	0.868	0.801

病理类型	2010年至2014	2015年	2016年	2017年	2018年	2019年	总计
乳头状癌（%）	95.4(1 418/1 487)	97.7(952/974)	97.2(1 276/1 313)	95.3(1 577/1 654)	95.2(1 751/1 839)	95.0(1 810/1 906)	95.8(8 784/9 173)
髓样癌（%）	5/7	9/13	8/13	7/10	65.5(19/29)	76.9(20/26)	69.4(68/98)