DOI: https://doi.org/10.22141/2224-0721.14.5.2018.142692

Possibilities of preoperative and intraoperative methods for the diagnosis of thyroid nodules

L.H. Voskoboinyk

Abstract


In case of thyroid nodules, it is important to determine the nature of the pathological process in a timely manner, since the algorithm for treating the patient depends on this. The main and effective method of preoperative diagnosis is fine needle aspiration biopsy. However, at this stage, it is not always possible to obtain informative results and also to avoid unnecessary surgeries or to clearly identify/exclude the malignant process. Needle biopsy, which is suggested as an alternative to repeated fine needle aspiration biopsy, helps to reduce the proportion of non-informative results in a number of cases. Another approach that is widely used to improve preoperative diagnosis of thyroid nodules is additional studies with specific molecular markers and tests. To identify benign thyroid lesions, the gene expression classifier is most often used, and to detect malignant process — a test for the presence of mutations and gene rearrangements. Since even such a comprehensive approach does not always make it possible to distinguish benign and malignant tumors, intraoperative express histological studies remain relevant. In this case, the parallel implementation of express histological studies and intraoperative cytology increases the effectiveness of intraoperative diagnosis. Thus, the spectrum of the methods presented is broad, therefore, in this review, the features of each approach, including effectiveness, possibilities and limitations, were examined, and also it is shown, in which situations it is expedient to carry out certain studies or their set.

Keywords


thyroid nodules; fine needle aspiration biopsy; core needle biopsy; molecular tests; express histological stu­dies; intraoperative cytology; overview

References


Misiakov EP, Margari N, Meristoudis C, et al. Cytopathologic diagnosis of fine needle aspiration biopsies of thyroid nodules. World J Clin Cases. 2016 Feb 16;4(2):38-48. doi: 10.12998/wjcc.v4.i2.38.

Manning AM, Yang H, Falciglia M, Mark JR, Stewars DL. Thyroid ultrasound-guided fine-needle aspiration cytology results: observed increases in indeterminate rate over the past decade. Otolaryngol Head Neck Surg. 2017 Apr;156(4):611-615. doi: 10.1177/0194599816688190.

Nikiforov YE. Role of molecular markers in thyroid nodule management: then and now. Endocr Pract. 2017 Aug;23(8):979-988. doi: 10.4158/EP171805.RA.

Suh CH, Baek JH, Lee JH, et al. The role of core-needle biopsy in the diagnosis of thyroid malignancy in 4580 patients with 4746 thyroid nodules: a systematic review and meta-analysis. Endocrine. 2016;54(2):315-328. doi: 10.1007/s12020-016-0991-9.

Roychoudhure S, Souza F, Gimenez C, et al. Utility of intraoperative frozen sections for thyroid nodules with prior fine needle aspiration cytology diagnosis. Diagn Cytopathol. 2017 Sep;45(9):789-794. doi: 10.1002/dc.23765.

Bogdanova TI, Zurnadzhy LJu, Degtjar'ova TL, et al. Intraoperative express histological researches and modern changes in pathological diagnostics of thyroid tumours. Endokrynologia. 2018;23(1):34-41. (in Ukrainian).

Voskobojnyk LG, Bogdanova TI, Zurnadzhy LJu, Degtjar'ova TL. An estimation of efficiency of the use of express histological and cytological methods in intraoperative diagnostics of thyroid tumours. Endokrynologiya. 2009;14(1):4-13. (in Ukrainian).

Rybakov SI. Rak shchitovidnoi zhelezy: klinicheskie lektsii [Thyroid cancer: clinical lections]. Poltava: ООО АSMI; 2012. 572 p. (in Russian).

Moon HJ, Lee HS, Kim EK, et al. Thyroid nodules ≤ 5 mm on ultrasonography: are they “leave me along” lesions? Endocrine. 2015 Aug;49(3):735-44. doi: 10.1007/s12020-015-0526-9.

Kim DW, Lee YJ, Eom JW, Jung SJ, Ha TK, Kang T. Ultrasound-based diagnosis for solid thyroid nodules with the largest diameter < 5 mm. Ultrasound Med Biol. 2013 Jul;39(7):1190-6. doi: 10.1016/j.ultrasmedbio.2013.01.016.

Bongiovanni M, Trimboli P, Rossi ED, Fadda G, Nobile A, Giovanella L. High-yield thyroid fine-needle aspiration cytology: an update focused on ancillary techniques improving its accuracy. Eur J Endocrinol. 2016 Feb;174(2):R53-63. doi: 10.1530/EJE-15-0817.

Zelinska GV. Possibilities of cytological diagnostics in preoperative prognostication of behavior of tumours and choice of adequate therapy. Endokrynologia. 2018;23(1):47-52. (in Ukrainian).

Cibas ES, Ali SZ; NCI Thyroid FNA State of the Science Conference. The Bethesda System For Reporting Thyroid Cytopathology. Am J Clin Pathol. 2009 Nov;132(5):658-65. doi: 10.1309/AJCPPHLWMI3JV4LA.

De Silva C. The Bethesda System for Reporting Thyroid Cytopathology: should Sri Lanka adopt it? Ceylon J Otolaryngol. 2013;3(1):9-14. doi: 10.4038/cjo.v3i1.5211.

Hambleton C, Kandil E. Appropriate and accurate diagnosis of thyroid nodules: a review of thyroid fine-needle aspiration. Int J Clin Exp Med. 2013 Jun 26;6(6):413-22.

Wesoła M, Jeleń M. Bethesda system in the evaluation of thyroid nodules: review. Adv Clin Exp Med. 2017 Jan-Feb;26(1):177-182. doi: 10.17219/acem/27319.

Tamhane S, Gharib H. Retracted article: thyroid nodules update in diagnosis and management. Clin Diabetes Endocrinol. 2015 Sep 18;1:11. doi: 10.1186/s40842-015-0011-7.

Lerma E, Arguelles R, Rigla M, et al. Comparative findings of lymphocytic thyroiditis and thyroid lymphoma. Acta Cytol. 2003 Jul-Aug;47(4):575-80. doi: 10.1159/000326571.

Volchenkova NN, Slavnova EN. Cytologic criteria of diagnostics of thyroid cancer. Sibirskii onkologicheskii zhurnal. 2006;(3):5-7. (in Russian).

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. Endocr Pract. 2016 May;22(5):622-39. doi: 10.4158/EP161208.GL.

Orija IB, Pineyro M, Biscotti C, Reddy SS, Hamrahian AH. Value of repeating a nondiagnostic thyroid fine-needle aspiration biopsy. Endocr Pract. 2007 Nov-Dec;13(7):735-42. doi: 10.4158/EP.13.7.735.

Na DG, Baek JH, Jung SL, et al. Core needle biopsy of the thyroid: 2016 Consensus statement and recommendations from Korean Society of thyroid radiology. Korean J Radiol. 2017 Jan-Feb;18(1):217-237. doi: 10.3348/kjr.2017.18.1.217.

Yoo C, Choi HJ, Im S, et al. Fine needle aspiration cytology of thyroid follicular neoplasm: cytohistology correlation and accuracy. Korean J Pathol. 2013 Feb;47(1):61-6. doi: 10.4132/KoreanJPathol.2013.47.1.61.

Trimboli P, Guidobaldi L, Amendola S, et al. Galectin-3 and HBME-1 improve the accuracy of core biopsy in indeterminate thyroid nodules. Endocrine. 2016 Apr;52(1):39-45. doi: 10.1007/s12020-015-0678-7.

Screaton NJ, Berman LH, Grant JW. US-guided core-needle biopsy of the thyroid gland. Radiology. 2003;226(3):827-832. doi: 10.1148/radiol.2263012073.

Lee SH, Kim MH, Bae JS, Lim DJ, Jung SL, Jung CK. Clinical outcomes in patients with non-diagnostic thyroid fine needle aspiration cytology: usefulness of the thyroid core needle biopsy. Ann Surg Oncol. 2014 Jun;21(6):1870-7. doi: 10.1245/s10434-013-3365-z.

Chen BT, Jain AB, Dagis A, et al. Comparison of the efficacy and safety of ultrasoundguided core needle biopsy versus fine-needle aspiration for evaluating thyroid nodules. Endocr Pract. 2015 Feb;21(2):128-35. doi: 10.4158/EP14303.OR.

Yunker WK, Hassan SF, Ferrell LB, et al. Needle core biopsy in the diagnosis of pediatric thyroid neoplasms: a single institution retrospective review. Pediatr Surg Int. 2013 May;29(5):437-43. doi: 10.1007/s00383-013-3278-8.

Choi SH, Baek JH, Lee JH, et al. Thyroid nodules with initially non-diagnostic, fine-needle aspiration results: comparison of core-needle biopsy and repeated fine-needle aspiration. Eur Radiol. 2014 Nov;24(11):2819-26. doi: 10.1007/s00330-014-3325-4.

Park KT, Ahn SH, Mo JH, et al. Role of core needle biopsy and ultrasonographic finding in management of indeterminate thyroid nodules. Head Neck. 2011 Feb;33(2):160-5. doi: 10.1002/hed.21414.

Yoon RG, Baek JH, Lee JH, et al. Diagnosis of thyroid follicular neoplasm: fine-needle aspiration versus core-needle biopsy. Thyroid. 2014 Nov;24(11):1612-7. doi: 10.1089/thy.2014.0140.

Han S, Shin JH, Hahn SY, Oh YL. Modified core biopsy technique to increase diagnostic yields for well-circumscribed indeterminate thyroid nodules: a retrospective analysis. AJNR Am J Neuroradiol. 2016 Jun;37(6):1155-9. doi: 10.3174/ajnr.A4650.

Buxey K, Serpel J. Importance of core biopsy in the diagnosis of thyroid lymphoma. ANZ J Surg. 2012 Jan-Feb;82(1-2):90. doi: 10.1111/j.1445-2197.2011.05935.x.

Ha EJ, Baek JH, Na DG, et al. The role of core needle biopsy and its impact on surgical management in patients with medullary thyroid cancer: clinical experience at 3 medical institutions. AJNR Am J Neuroradiol. 2015 Aug;36(8):1512-7. doi: 10.3174/ajnr.A4317.

Haugen BR. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: What is new and what has changed? Cancer. 2017 Feb 1;123(3):372-381. doi: 10.1002/cncr.30360.

Alexander EK, Schorr M, Klopper J, et al. Multicentric clinical experience with the Afirma gene expression classifier. J Clin Endocrinol Metab. 2014 Jan;99(1):119-25. doi: 10.1210/jc.2013-2482.

Nikiforov YE, Carty SE, Chiosea SI, et al. Highly accurate diagnosis of cancer in thyroid nodules with follicular neoplasm/suspicious for a follicular neoplasm cytology by Thyro- Seq v2 next-generation sequencing assay. Cancer. 2014 Dec 1;120(23):3627-34. doi: 10.1002/cncr.29038.

Nikiforov YE, Ohori NP, Hodak SP, et al. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules: a prospective analysis of 1056 FNA samples. J Clin Endocrinol Metab. 2011 Nov;96(11):3390-7. doi: 10.1210/jc.2011-1469.

Labourier E, Shifrin A, Busseniers AE, et al. Molecular testing for miRNA, mRNA and DNA on fine needle aspiration improves the preoperative diagnosis of thyroid nodules with indeterminate cytology. J Clin Endocrinol Metab. 2015 Jul;100(7):2743-50. doi: 10.1210/jc.2015-1158.

Paschke R, Cantara S, Crescenzi A, Jarzab B, Musholt TJ, Sobrinho Simoes M. European Thyroid Association guidelines regarding thyroid nodule molecular fine-needle aspiration cytology diagnostic. Eur Thyroid J. 2017 Jul;6(3):115-129. doi: 10.1159/000468519.

Marti JL, Avadhani V, Donatelli LA, et al. Wide inter-institutional variation in performance of a molecular classifier for indeterminate thyroid nodules. Ann Surg Oncol. 2015 Nov;22(12):3996-4001. doi: 10.1245/s10434-015-4486-3.

Posillico SE, Wilhelm SM, McHenry CR. The utility of frozen section examination for determining the extent of thyroidectomy in patients with a thyroid nodule and "atypia/follicular lesion of undetermined significance".Am J Surg. 2015 Mar;209(3):552-6. doi: 10.1016/j.amjsurg.2014.09.026.

Hosseini M, Alizadeh Otaghvar HR, Tizmaghz A, Shabestanipour G, Arvaneh S. Evaluating the accuracy of fine needle aspiration and frozen section based on permanent histology in patients with follicular lesions. Med J Islam Repub Iran. 2015 Jul 21;29:239.

Bogdanova TI, Zurnadzhy LJu, Kovalenko AJe, et al. Standardization of indications for intraoperative rapid histological examination of nodal tumors of the thyroid gland. Information letter on innovations in the field of health care. 2015;(89). (in Ukrainian).

Antic T, Taxy JB. Thyroid frozen section: supplementary or unnecessary. Am J Surg Pathol. 2013 Feb;37(2):282-6. doi: 10.1097/PAS.0b013e318267aee6.

Lumachi F, Borsato S, Tregnaghi A, et al. FNA cytology and frozen section examination in patients with follicular lesions of the thyroid gland. Anticancer Res. 2009 Dec;29(12):5255-7.

Pradeep PV, Vissa S. Follicular neoplasm involving one lobe of thyroid: is hemithyroidectomy the adequate initial procedure? Ir J Med Sci. 2013 Mar;182(1):37-40. doi: 10.1007/s11845-012-0822-9.

Tan WJ, Sanghvi K, Liau KH, Low CH. An audit study of the sensitivity and specificity of ultrasound, fine needle aspiration cytology and frozen section in the evaluation of thyroid malignancies in a tertiary institution. Ann Acad Med Singapore. 2010 May;39(5):359-62.

Reiners Ch, Dietlein M, Luster M. Radio-iodine therapy in differentiated thyroid cancer: indications and procedures. Best Pract Res Clin Endocrinol Metab. 2008 Dec;22(6):989-1007. doi: 10.1016/j.beem.2008.09.013.

Woitczak B, Sutkowski K, Bolanowski M, et al. The prognostic value of fine-needle aspiration biopsy of the thyroid gland - analysis of results of 1078 patients. Neuro Endocrinol Lett. 2012;33(5):511-6.

Zanocco K, Heller M, Etarai D, Sturgeon C. Cost effectiveness of intraoperative pathology examination during diagnostic hemithyroidectomy for unilateral follicular thyroid neoplasms. J Am Coll Surg. 2013 Oct;217(4):702-10. doi: 10.1016/j.jamcollsurg.2013.05.008.

Yu XM, Lloyd R, Chen H. Current treatment of papillary thyroid microcarcinoma. Adv Surg. 2012;46:191-203.

Pisanu A, Deplano D, Reccia I, Porceddu G, Uccheddu A. Encapsulated papillary thyroid carcinoma: is it a distinctive clinical entity with low grade malignancy? J Endocrinol Invest. 2013 Feb;36(2):78-83. doi: 10.3275/8241.

Piana S, Ragazzi M, Tallini G, et al. Papillary thyroid microcarcinoma with fatal outcome: evidence of tumor progression in lymph node metastases: Report of 3 cases, with morphological and molecular analysis. Hum Pathol. 2013 Apr;44(4):556-65. doi: 10.1016/j.humpath.2012.06.019.

Ardito G, Revelli L, Giustozzi E, et al. Aggressive papillary thyroid microcarcinoma: prognostic factors and therapeutic strategy. Clin Nucl Med. 2013 Jan;38(1):25-8. doi: 10.1097/RLU.0b013e318279bc65.

Tronko MD, Bogdanova TI. Thyroid cancer in Ukrainian children (as a result of Chornobyl incidence). Kyiv: Chernobyl'interinform; 1997. 199 p. (in Russian).

Tronko M, Bogdanova T, Saenko V, Thomas GA, Likhtarov I, Yamashita S. Thyroid cancer in Ukraine after Chernobyl: dosimetry, epidemiology, pathology, molecular biology. Nagasaki, Japan: IN-TEX; 2014. 175 p.

Ianchii IR, Bolgov MJu, Bogdanova TI. Background for organ-preserving operations in cases of papillary thyroid carcinoma in patients, who were children and adolescents at the time of the Chernobyl accident. Endokrynologia. 2014;19(3):177-183. (in Ukrainian).

Kennedy JM, Robinson RA. Thyroid frozen sections in patients with preoperative FNAs: review of surgeons’ preoperative rationale, intraoperative decisions, and final outcome. Am J Clin Pathol. 2016 May;145(5):660-5. doi: 10.1093/ajcp/aqw042.

Tarashchenko YuN, Kovalenko AE, Guda BB, Melnyk MD. Combined methodology of operations on thyroid gland. In: Thesis of ХХХІІІ Congress of Ukrainian Surgeons. Kyiv; 2015. 602 p. (in Ukrainian).

Leiker AJ, Yen TW, Cheung K, Evans DB, Wang TS. Cost analysis of thyroid lobectomy and intraoperative frozen section versus total thyroidectomy in patients with a cytologic diagnosis of “suspicious for papillary thyroid cancer”. Surgery. 2013 Dec;154(6):1307-13; discussion 1313-4. doi: 10.1016/j.surg.2013.06.031.

Voskoboynyk LG. Intraoperative cytology as additional method for detecting papillary thyroid carcinoma. Mìžnarodnij endokrinologìčnij žurnal. 2018;14(1):4-10. doi: 10.22141/2224-0721.14.1.2018.127083. (in Russian).

Pyo JS, Sohn JH, Kang G. Diagnostic assessment of intraoperative cytology for papillary thyroid carcinoma: using a decision tree analysis. J Endocrinol Invest. 2017 Mar;40(3):305-311. doi: 10.1007/s40618-016-0563-0.

Tarashchenko YuN, Kovalenko AE, Bolgov MYu, et al. BRAF-status of papillary thyroid carcinomas and strategy of surgical treatment. Klinichna hirurgiia. 2015;(6):49-54 (in Russian).




Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© "Publishing House "Zaslavsky", 1997-2018

 

   Seo анализ сайта