THYROID ULTRASOUND, FINE NEEDLE ASPIRATION BIOPSY AND HISTOPATHOLOGICAL CONCORDANCE IN PATIENTS WITH THYROID NODULES IN A HEALTH CENTER IN PEREIRA (COLOMBIA) FROM 2009 TO 2012

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 471-496-Thyroid Neoplasia & Case Reports
Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-494
Henry mauricio Arenas*
universidad tecnológica de Pereira, pereira, Colombia
THYROID ULTRASOUND, FINE NEEDLE ASPIRATION BIOPSY AND HISTOPATHOLOGICAL CONCORDANCE  IN PATIENTS WITH THYROID NODULES IN A HEALTH CENTER IN  PEREIRA FROM 2009 TO 2012. Authors Henry Mauricio Arenas MD, Jose Luis Blanco MD, Hooverman Villa MD.

ABSTRACT The thyroid nodule is a common disease, epidemiological studies suggest that the prevalence of palpable nodules is 4-10%. Despite advances in diagnostic elements , the percentage of resected malignant nodules exceed 50%, demonstrating that we are still making surgeries in benign thyroid disease. Because of the carcinogenic potential of thyroid nodules, it is necessary to evaluate the reliability of ultrasound and fine needle aspiration in our iodine excess environment in order to avoid unnecessary procedures, and to establish adequate diagnostic and therapeutic actions.Objectives. Determine the concordance among ultrasound thyroid report, the fine needle aspiration biopsy and the  thyroid histopathology report from thyroidectomies in patients attended in these two health centers in Pereira between 2009-2012. Methodology. We performed a descriptive, cross-sectional of patients in two health centers in Pereira,  from January 2009 to May 2012. The medical charts, reports and pathological ultrasound information were tabulated according to an instrument of data collection. The collected information is organized in a database on Excel, which validated the variable values. Results. Evaluation in 102 patients revealed that the sensitivity and specificity of ultrasound findings suggestive of malignancy compared with histopathology as the gold standard were 60.27% and 65.2% respectively, while fine needle aspiration biopsy has a sensitivity of 89.04% and a specificity of 62.07%. Ultrasound findings more specific for malignancy found in this group of patients were hypoechogenicity, microcalcifications, lymphadenopathy and the absence of halo. Fine needle aspiration biopsy was reported malignant in  25.49% of the samples, while the histopathology in  28.43%, which apart from the low sensitivity calculated for the first of these diagnostic methods,it is a reflection of a good agreement between these studies. Conclusion.The overall sensitivity and specificity for ultrasonography and fine needle aspiration biopsy were similar to those found in other published articles. There is a clear need to standardize the reporting of ultrasound studies and fine needle aspiration biopsy.  In an area of  iodine excess like ours , there are not significant differences in the ultrasonography findings in the thyroid nodules. Despite of the tools that we have to date, almost 35 to 45% of the thyroidectomies did not show malignancy  despite showing malignancy in the fine needle aspiration biopsy, showing us that we need more tools such as elastography, genetic markers and immunohistochemical markers trying to reduce the number of unnecessary thyrodectomies.

Castro MR, Gharib H.  Thyroid nodules and cancer: when to wait and watch, when to refer. Postgrad Med 2000; 107 (1): 113-124.Gharib H, Goellner JR. Fine-Neddle Aspiration Biopsy of the Thyroid: An appraisal. Ann Inter Med 1993; 118: 288-289.Mortensen JD, Woolner LB, Bennett WA. Gross and microscopic findings in clinically normal thyroid glands. J Clin Endocrinol Metab 1955;15(10):1270–80.Ezzat S, Sar ti DA, Cain DR, et al. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Inter n Med 1994;154(16):1838–40.Tan GH, Gharib H. Thyroid incidentalomas: management approaches to non-palpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 1997;126(3):226–31.Vander JB, Gaston EA, Dawber TR. The significance of nontoxic thyroid nodules: Final report of a 15-year study of the incidence of thyroid malignancy.  Ann   Intern      Med. 1968;69:537-540. [EL 3]Gharib H, Papini E .  Thyroid  nodules:  Clinical  importance, assessment, and treatment.  Endocrinol Metab Clin North Am. 2007;36:707-735Vargas U H. Enfoque del paciente con nódulo tiroideo. MED. UIS. 2008;21(2):76-85Guidelines of the Papanicolaou Society of Cytopathology for fine needle aspiration  procedure and reporting by the Papanicolaou Society of Cytopathology Task Force on standards of practice. Diagn Cytopathol. 1997; 17: 239-247.Papini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 2002;87(5):1941–6.Nam-Goong IS, Kim HY, Gong G, et al. Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clin Endocrinol (Oxf) 2004;60(1):21–8.Wong CKM, Wheeler MH. Thyroid nodules: rational management. World J Surg 2000;24:93 4-41.Haegedüs  L. Clinical practice. The thyroid nodule. N Engl J Med. 2004;351:1764-1771.López Albente G, Pollán M, Aragonés N, Pérez Gómez B, Hernández Barrera V, Lope V, et al. Situación del cáncer en España. An Sist Sanit Navar.2004;27:2:165-73.Mortalidad por causa y sexo (1992-2001). Instituto de Salud Carlos III. Ministerio de Sanidad y Consumo. Gobierno de España. Disponible en: http://www.isciii.es/htdocs/centros/epidemiologia/anexos/www.9201_cau.htm. Rorive S,  D’Haene N. Ultrasound-guided fine-needle aspiration of thyroid nodules: stratification of malignancy risk using follicular proliferation grading, clinical and ultrasonographic features.  European Journal of Endocrinology (2010) 162 1107–1115. Popo G, Jonklaas J. Thyroid Nodules.  Med Clin N Am 96 (2012) 329–349.Cortázar García R et al. Papel del radiólogo en el manejo del nódulo tiroideo. Radiología. 2008;50:471-81. Cooper DS, Doher ty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167–214.2. Gharib H, Papini E, Valcavi R, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 2006;12:63–102.Kangelaris G,  Kim T, Orloff L. Role of Ultrasound in Thyroid Disorders. Otolaryngol Clin N Am 43 (2010) 1209–1227.Ferris RL, Bomeli SR, LeBeau SO, et al. Evaluation of a Thyroid Nodule. Otolaryngol Clin N Am 43 (2010) 229–238.Kardon DE, Edelman M.  Evaluating Thyroid Nodules: The Roles of Finne Neddle Aspiration Cytology and Intraoperative Consultation. Pathol Case Rev 2001; 6 (5): 200-205.De Vos Tot Nederveen Cappel RJ, Bouvy ND, Bonjer HJ, Van Muisuinkel MJ, Chadha S. Finne needle aspiration citology of thyroid nodules: how accurate is it and what are the causes of discrepant cases?  Cytopathology 2001; 12: 339-405.Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas: Prevalence by palpation and ultrasonography. Arch Intern Med. 1994;154:1838-1840.García-Mayor RV, Pérez Méndez LF, Páramo C,  et al .  Fine needle aspiration biopsy of thyroid nodules: impact on clinical practice.  J Endocrinol Invest. 1997; 20: 482-487.  Duque Fisher C S, García D, Osorio O. Thyroid Nodule: Fine-Needle Aspiration Biopsy (FNAB) vs the pathological results, after thyroidectomy or hemithyroidectomy. Acta de Otorrinolaringología & Cirugía de Cabeza y Cuello. Volumen 36 Número 1 marzo de 2008Mortensen JD, Woolner LB, Bennett WA. Gross and microscopic findings in clinically normal thyroid glands. J ClinEndocrinolMetab 1955;15(10): 1270–80.Christensen SB, Ericsson UB, Janzon L, et al. The prevalence of thyroid disorders in a middle-aged female population, with special reference to the solitary thyroid nodule. ActaChirScand 1984;150:13–9.Woon-Jin Moon et al. Ultrasonography and the Ultrasound-Based Management of Thyroid Nodules: Consensus Statement and Recommendations Korean J Radiol 12(1), Jan/Feb 2011.Gharib H, Papini E.  Thyroid  nodules:  Clinical  importance, assessment, and treatment. EndocrinolMetabClin North Am. 2007;36:707-735.Tyler DS, Shaha AR, Udelman RA, Sherman SI, Thompson NW, Moley JF, et al. Thyroid cancer. Ann Surg Oncol 2000;7:376 e 98.G.H. Sakorafas.  Thyroid nodules; interpretation and importance of fine-needle aspiration (FNA) for the clinician - Practical considerations. Surgical Oncology 19 (2010) e130ee139.Nam-Goong IS, Kim HY, Gong G, Lee HK, Hong SJ, Kim WB, et al. Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. ClinEndocrinol (Oxf) 2004;60:21-28.Yassa L, Cibas ES, Benson CB, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111:508-516.CibasE. S.,AliS.Z.The Bethesda System for Reporting Thyroid Cytopathology. Am J ClinPathol  2009;132:658-665. Pelea C. L., Santamaría J.S., Fernández de Mera J. J.Citología con aguja fina del nódulo tiroideo. Terminología diagnóstica y criterios morfológicos según consenso Bethesda-2007. 10º Congreso Virtual Hispanoamericano de Anatomía Patológica. 30 nov 2009.H. Mazeh et al. Cytohistologic correlation of thyroid nodules. The American Journal of Surgery 194 (2007) 161–163.Ali S. Z. Thyroid  Cytopathology: Bethesda and Beyond.  Acta Cytologica 2011;55:4–12.American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-1214.40.     Hamming J.F., Goslings B.M., van Steenis G.J., The value of fine-needle aspiration biopsy in patients with nodular thyroid disease divided into groups of suspicion of malignant neoplasms on clinical grounds, Arch. Int. Med. 150 (1990) 113–116.  K. Tomimori, Roselinda Y. A. Camargo, Combined ultrasonographic and cytological studies in the diagnosis of thyroid nodules. Biochimie 81 (1999) 447−452.  Moon et al. HEAD AND NECK IMAGING: US of Benign and Malignant Thyroid Nodules. Radiology: Volume 247: Number 3—June 2008.Castro MR, Gharib H. Continuing Controversies in the Management of Thyroid Nodule . Ann Intern Med. 2005; 142: 926-931.Alaedeen DI, Khiyami A, McHenry CR.  Fine-needle aspiration biopsy specimen with a predominance of Hürthle cells; a dilemma in the management of nodular thyroid disease.  Surgery 2005;138: 650-657.Mitchell JC, Grant F, Evenson AR,  et al. Preoperative evaluation of thyroid nodules with 18 FDG-PET/CT.  Surgery. 2005; 138:1166-1175. Burch HB.  Evaluation and management of the solid thyroid nodule. Endocrinol Metab Clin North Am 1995; 24: 663-710.Miller JM, Hamburger JI, Kini S. Diagnosis of thyroid nodules. Use of fine-needle aspiration and needle biopsy. JAMA 1979; 241:481.Henrichsen T,  Reading C, Thyroid Ultrasonography. Part 2: Nodules. Radiol Clin N Am 49 (2011) 417–424.Declaración de Helsinki. Asociación Médica Mundial. Principios éticos para la investigación médica con sujetos humanos. Adoptada por la XVII Asamblea Mundial de la Asociación Médica Mundial. Helsinki, Finlandia, junio de 1964 y enmiendas posterior es en Tokio 1975, Venecia 1983, Hong Kong 1989, Somerset West 1996 y Edimburgo 2000. Disponible en la web   http://www.gencat.net/salut/depsan/units/sanitat/html/ca/professionals/spbioe00.htm.Informe Belmont. Principios éticos y orientaciones para la protección de seres humanos y la experimentación. Comisión Nacional para la Protección de Seres Humanos de la Experimentación Biomédica y de la Conducta. 30 de septiembre 1978. Disponible en la web http://www.gencat.net/salut/depsan/units/sanitat/html/ca/professionals/spbioe00.htm.  REPUBLICA DE COLOMBIA. MINISTERIO DE SALUD. RESOLUCION Nº 008430 DE 1993(4 DE OCTUBRE DE 1993). OSORIO J G. PRINCIPIOS ETICOS DE LA INVESTIGACION EN SERES HUMANOS Y EN ANIMALES. MEDICINA (Buenos Aires) 2000; 60: 255-258.Maia FF, Zantut-Wittmann DE. Thyroid nodule management: Clinical, ultrasound and cytopathological parameters for predicting malignancy. Clinics. 2012;67(8): 945-954.

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Sources of Research Support: (1) Castro MR, Gharib H. Thyroid nodules and cancer: when to wait and watch, when to refer. Postgrad Med 2000; 107 (1): 113-124.(2). Gharib H, Goellner JR. Fine-Neddle Aspiration Biopsy of the Thyroid: An appraisal. Ann Inter Med 1993; 118: 288-289.3. Mortensen JD, Woolner LB, Bennett WA. Gross and microscopic findings in clinically normal thyroid glands. J Clin Endocrinol Metab 1955;15(10):1270–80.4. Ezzat S, Sar ti DA, Cain DR, et al. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Inter n Med 1994;154(16):1838–40.5. Tan GH, Gharib H. Thyroid incidentalomas: management approaches to non-palpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 1997;126(3):226–31.6. Vander JB, Gaston EA, Dawber TR. The significance of nontoxic thyroid nodules: Final report of a 15-year study of the incidence of thyroid malignancy. Ann Intern Med. 1968;69:537-540. [EL 3]7. Gharib H, Papini E . Thyroid nodules: Clinical importance, assessment, and treatment. Endocrinol Metab Clin North Am. 2007;36:707-7358. Vargas U H. Enfoque del paciente con nódulo tiroideo. MED. UIS. 2008;21(2):76-859. Guidelines of the Papanicolaou Society of Cytopathology for fine needle aspiration procedure and reporting by the Papanicolaou Society of Cytopathology Task Force on standards of practice. Diagn Cytopathol. 1997; 17: 239-247.10. Papini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 2002;87(5):1941–6.11. Nam-Goong IS, Kim HY, Gong G, et al. Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clin Endocrinol (Oxf) 2004;60(1):21–8.12. Wong CKM, Wheeler MH. Thyroid nodules: rational management. World J Surg 2000;24:93 4-41.13. Haegedüs L. Clinical practice. The thyroid nodule. N Engl J Med. 2004;351:1764-1771.14. López Albente G, Pollán M, Aragonés N, Pérez Gómez B, Hernández Barrera V, Lope V, et al. Situación del cáncer en España. An Sist Sanit Navar.2004;27:2:165-73.15. Mortalidad por causa y sexo (1992-2001). Instituto de Salud Carlos III. Ministerio de Sanidad y Consumo. Gobierno de España. Disponible en: http://www.isciii.es/htdocs/centros/epidemiologia/anexos/www.9201_cau.htm. 16. Rorive S, D’Haene N. Ultrasound-guided fine-needle aspiration of thyroid nodules: stratification of malignancy risk using follicular proliferation grading, clinical and ultrasonographic features. European Journal of Endocrinology (2010) 162 1107–1115. 17. Popo G, Jonklaas J. Thyroid Nodules. Med Clin N Am 96 (2012) 329–349.Cortázar García R et al. Papel del radiólogo en el manejo del nódulo tiroideo. Radiología. 2008;50:471-81. 18. Cooper DS, Doher ty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167–214.19. 2. Gharib H, Papini E, Valcavi R, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 2006;12:63–102.20. Kangelaris G, Kim T, Orloff L. Role of Ultrasound in Thyroid Disorders. Otolaryngol Clin N Am 43 (2010) 1209–1227.21. Ferris RL, Bomeli SR, LeBeau SO, et al. Evaluation of a Thyroid Nodule. Otolaryngol Clin N Am 43 (2010) 229–238.22. Kardon DE, Edelman M. Evaluating Thyroid Nodules: The Roles of Finne Neddle Aspiration Cytology and Intraoperative Consultation. Pathol Case Rev 2001; 6 (5): 200-205.23. De Vos Tot Nederveen Cappel RJ, Bouvy ND, Bonjer HJ, Van Muisuinkel MJ, Chadha S. Finne needle aspiration citology of thyroid nodules: how accurate is it and what are the causes of discrepant cases? Cytopathology 2001; 12: 339-405.24. Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas: Prevalence by palpation and ultrasonography. Arch Intern Med. 1994;154:1838-1840.25. García-Mayor RV, Pérez Méndez LF, Páramo C, et al . Fine needle aspiration biopsy of thyroid nodules: impact on clinical practice. J Endocrinol Invest. 1997; 20: 482-487.26. Duque Fisher C S, García D, Osorio O. Thyroid Nodule: Fine-Needle Aspiration Biopsy (FNAB) vs the pathological results, after thyroidectomy or hemithyroidectomy. Acta de Otorrinolaringología & Cirugía de Cabeza y Cuello. Volumen 36 Número 1 marzo de 200827. Mortensen JD, Woolner LB, Bennett WA. Gross and microscopic findings in clinically normal thyroid glands. J ClinEndocrinolMetab 1955;15(10): 1270–80.28. Christensen SB, Ericsson UB, Janzon L, et al. The prevalence of thyroid disorders in a middle-aged female population, with special reference to the solitary thyroid nodule. ActaChirScand 1984;150:13–9.29. Woon-Jin Moon et al. Ultrasonography and the Ultrasound-Based Management of Thyroid Nodules: Consensus Statement and Recommendations Korean J Radiol 12(1), Jan/Feb 2011.30. Gharib H, Papini E. Thyroid nodules: Clinical importance, assessment, and treatment. EndocrinolMetabClin North Am. 2007;36:707-735.31. Tyler DS, Shaha AR, Udelman RA, Sherman SI, Thompson NW, Moley JF, et al. Thyroid cancer. Ann Surg Oncol 2000;7:376 e 98.32. G.H. Sakorafas. Thyroid nodules; interpretation and importance of fine-needle aspiration (FNA) for the clinician - Practical considerations. Surgical Oncology 19 (2010) e130ee139.33. Nam-Goong IS, Kim HY, Gong G, Lee HK, Hong SJ, Kim WB, et al. Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. ClinEndocrinol (Oxf) 2004;60:21-28.34. Yassa L, Cibas ES, Benson CB, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111:508-516.35. CibasE. S.,AliS.Z.The Bethesda System for Reporting Thyroid Cytopathology. Am J ClinPathol 2009;132:658-665. 36. Pelea C. L., Santamaría J.S., Fernández de Mera J. J.Citología con aguja fina del nódulo tiroideo. Terminología diagnóstica y criterios morfológicos según consenso Bethesda-2007. 10º Congreso Virtual Hispanoamericano de Anatomía Patológica. 30 nov 2009.37. H. Mazeh et al. Cytohistologic correlation of thyroid nodules. The American Journal of Surgery 194 (2007) 161–163.38. Ali S. Z. Thyroid Cytopathology: Bethesda and Beyond. Acta Cytologica 2011;55:4–12.39. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-1214.40. Hamming J.F., Goslings B.M., van Steenis G.J., The value of fine-needle aspiration biopsy in patients with nodular thyroid disease divided into groups of suspicion of malignant neoplasms on clinical grounds, Arch. Int. Med. 150 (1990) 113–116. 41. K. Tomimori, Roselinda Y. A. Camargo, Combined ultrasonographic and cytological studies in the diagnosis of thyroid nodules. Biochimie 81 (1999) 447−452. 42. Moon et al. HEAD AND NECK IMAGING: US of Benign and Malignant Thyroid Nodules. Radiology: Volume 247: Number 3—June 2008.43. Castro MR, Gharib H. Continuing Controversies in the Management of Thyroid Nodule . Ann Intern Med. 2005; 142: 926-931.44. Alaedeen DI, Khiyami A, McHenry CR. Fine-needle aspiration biopsy specimen with a predominance of Hürthle cells; a dilemma in the management of nodular thyroid disease. Surgery 2005;138: 650-657.45. Mitchell JC, Grant F, Evenson AR, et al. Preoperative evaluation of thyroid nodules with 18 FDG-PET/CT. Surgery. 2005; 138:1166-1175.46. Burch HB. Evaluation and management of the solid thyroid nodule. Endocrinol Metab Clin North Am 1995; 24: 663-710.47. Miller JM, Hamburger JI, Kini S. Diagnosis of thyroid nodules. Use of fine-needle aspiration and needle biopsy. JAMA 1979; 241:481.48. Henrichsen T, Reading C, Thyroid Ultrasonography. Part 2: Nodules. Radiol Clin N Am 49 (2011) 417–424.49. Declaración de Helsinki. Asociación Médica Mundial. Principios éticos para la investigación médica con sujetos humanos. Adoptada por la XVII Asamblea Mundial de la Asociación Médica Mundial. Helsinki, Finlandia, junio de 1964 y enmiendas posterior es en Tokio 1975, Venecia 1983, Hong Kong 1989, Somerset West 1996 y Edimburgo 2000. Disponible en la web http://www.gencat.net/salut/depsan/units/sanitat/html/ca/professionals/spbioe00.htm.50. Informe Belmont. Principios éticos y orientaciones para la protección de seres humanos y la experimentación. Comisión Nacional para la Protección de Seres Humanos de la Experimentación Biomédica y de la Conducta. 30 de septiembre 1978. Disponible en la web http://www.gencat.net/salut/depsan/units/sanitat/html/ca/professionals/spbioe00.htm. 51. REPUBLICA DE COLOMBIA. MINISTERIO DE SALUD. RESOLUCION Nº 008430 DE 1993(4 DE OCTUBRE DE 1993). 52. OSORIO J G. PRINCIPIOS ETICOS DE LA INVESTIGACION EN SERES HUMANOS Y EN ANIMALES. MEDICINA (Buenos Aires) 2000; 60: 255-258.53. Maia FF, Zantut-Wittmann DE. Thyroid nodule management: Clinical, ultrasound and cytopathological parameters for predicting malignancy. Clinics. 2012;67(8): 945-954.