ECE2023 Rapid Communications Rapid Communications 2: Thyroid (6 abstracts)
A simplified four-tier classification of thyroid core needle biopsies (CNB) is an efficient system. Evidence based on more than 1,000 surgical cases
Miguel Paja Fano 1,2 , Rosa Zabala 3 , Igone Korta 3 , Sandra Delgado 3 , Jose Luis Del Cura 4 , Josune Rodríguez-Soto 5 , Jon Izquierdo 5 , Jon Garai 5 , Amelia Oleaga 5 , M. Teresa Gutiérrez 6 , Amaia Expósito 6 , Maite Zufiaurre 7 & Aitziber Ugalde 7
1Basurto University Hospital – OSI Bilbao-Basurto, Radiology, Bilbao , Spain; 2Basque Country University, Medicine, Leioa, Spain; 3Basurto University Hospital, Radiology, Bilbo, Spain; 4Donostia University Hospital – OSI Donostialdea, Radiology, Donostia, Spain; 5Basurto University Hospital, Endocrinology, Bilbo, Spain; 6Basurto University Hospital, Endocrine Surgery, Bilbo, Spain; 7Basurto University Hospital, Pathology, Bilbao, Spain
CNB is increasingly being used as a diagnostic test for thyroid nodules with an inadequate (Bethesda 1) or indeterminate (Bethesda 3 and 4) FNAC results, which can account for up to 30% of the samples in some studies. CNB, using larger specimens and histological sections rather than cytological samples, allows better definition. We propose a simplified four-tiered classification of CNB specimens instead of the Bethesda system and evaluate its efficiency compared to definitive surgical diagnosis. CNB samples were classified as inadequate, benign, follicular tumor (FT) or malignant. The last two were considered neoplastic surgical indications. Follicular tumors included samples with numerous follicles, usually microfollicles, with scant colloid and insufficient nuclear changes to be considered a follicular variant of papillary thyroid cancer (FV-PTC). Thyroidectomy was recommended for benign biopsies based on clinical sings, patient preference, or goiter growth. Inadequate samples were usually biopsied again. The final results of the last CNB were compared with the histological results of surgery. CNBs were collected since 2005, when we adopted it as main diagnostic test because our poor FNAC results. A total of 1,687 thyroid nodules were operated on in 1,506 patients out of more than 6,000 CNBs from 2005 to 2022: 23 with inadequate CNB, 865 with benign CNB, 294 diagnosed as follicular tumors in CNB (94 oxyphilic) and 505 as malignant (478 PTC). Inadequate CNBs revealed 18 benign lesions and five malignancies. three with other biopsied nodules with surgical indication in the same gland. Of the 865 benign CNBs, 820 were benign nodules and 45 were neoplastic, 26 were follicular adenomas and 19 were malignant (16 PTC and three follicular carcinomas). Follicular tumors were 39 benign nodules (13.3%) and 253 neoplastic: 215 follicular adenomas (73.1%) and 40 malignant (13.6%): 19 PTCs, ten FTCs, nine HCCs, one MTC and one invasive parathyroid carcinoma. Malignant CNBs were confirmed in 493/505 nodules. Eleven were hyperplastic and one was an oxyphilic adenoma. The overall sensitivity of malignant CNB was 96.3%. The specificity of benign CNB was 98.7%. The positive predictive value of malignant CNB was 97.6% and the negative predictive value of benign CNB was 94.8%. Only 17.4% of the operations were due to an indeterminate biopsy (FT) and only 13.6% of these were malignant, although 79.9% corresponded to neoplastic lesions, more of which were adenomas. CNB confirmed as a very reliable diagnostic technique, with high diagnostic efficiency of the proposed four-tiered classification.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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