A STUDY OF THE ACCURACY OF FINE NEEDLE ASPIRATION CYTOLOGY IN THYROID PATHOLOGY

Author: Alexandra Contra 6th Grade MG

Coordinator: Lecturer dr. Georgescu Rares

FNA cytology- summary data from literature

Diagnosis procedure

economicalaccurate

efficient

2

FNA CYTOLOGY – SUMMARY DATA FROM LITERATURE

FNA cytolo

gy

Sensitivity

Specificity

Overall accura

cy

PPV NPV FP FN

65-98% 72-100% 75-90% 94-99%

66-97%

0-8%

1-12%

PPV: Positive predictive value NPV: Negative predictive valueFP: False positive FN: False negative

3

PURPOSE OF THE STUDY

patients diagnosed with thyroid nodules

FNA cytology

Surgery Department, Private Medical Clinic ‘’PULS’’

Diagnosis

2011to

2013

Accuracy Of FNA Cytology

4

MATERIALS AND METHOD

Retrospective study 319 cases of thyroid nodules FNA cytology at the ‘’PULS’’

clinic

Cytological diagnosis at ‘’SANTOMAR’’ private laboratory

According to

Bethesda

Ethical approval from

UMF Târgu Mureş

Written informed consent from the

clinic

All the FNA procedures - same surgeon

All the cytological readings - same

pathologist

5

FNA Cytology

Telephonic questionnaire

Thyroidectomy/ Lobectomy followed

HistopathologyEcographic follow-

up at least 6 months after the

FNA

6

Medical treatment followed

MATERIALS AND METHOD

THE TELEPHONIC QUESTIONNAIRE

1. Accuses of painful sensations during the FNA procedure?

2. Accuses of local complications after the FNA procedure?

3. or treatment followed?

Medical Surgical

Ecographicaly followed-up nodule

data

Histopathology diagnosis 7

CRITERIA FOR EXCLUDING FROM THE STUDY

NO contact details

WERE NOT monitored by

an endocrinologist after the FNA cytology

DID NOT answer to thequestionnaire

8Statistical calculations were made using

MedCalc

RESULTS

Variable Age

Sample size 319

Lowest Value 17

Highest value 82

Arithmetic mean 53

9

Variable Sex

Female 289 (90,6%)

Male 30 (9,4%)

Median age and prevalence on gender

Local complications

Intensive pain 1

Hematoma 4

No 212

Total 217

Pain during the procedure

YES 19

NO 198

Total 217

Local complications and pain related questionnaire

10

CYTOLOGY RESULTS

Inad-equat

e, 13.90

%

Benign; 69.30%

Inde-ter-mi-

nate, 15.20

%

Suspect, 1.30%

Malign, 0.30%

11

HISTOLOGY RESULTS AND CORRELATIONS WITH THE CYTOLOGY

Histology results

Benign 34 69,4%

Malign 15 30,6%

Total 49

Histology and cytology correlations

Benign Indeterminate

Malign Inadequate Suspect

Benign 14 13 0 6 1 34

Malign 4 4 1 4 2 15

Total 18 (36.7%)

17 (34.7%) 1 (2.0%)

10 (20.4%) 3 (6.1%) 49

12

CRITERION VALUES AND COORDINATES OF THE ROC CURVE Our results

Standard range worldwide

Thyroid FNA

cytology

Sensitivity

Specificity

Overall accuracy

PPV NPV FP FN

76,47% 83,1% 82,3% 35,1%

96,7% 16,9% 23,0%

Thyroid FNA

cytology

Sensitivity

Specificity

Overall accuracy

PPV NPV FP FN

65-98% 72-100% 75-90% 94-99%

66-97% 0-8% 1-12%

13

ROC CURVE

AUC = 0,798

AUC intervals:0,9-1,0 excellent 0,8-0,9 very good0,7-0,8 good0,6-0,7 medium0,5-0,6 weak<0,5 very weak

p=0,000114

CONCLUSIONS

FNA cytology first line

diagnostic test

15

DISCUSSIONS

Incidentalomas- worth puncturing?

Optimal number of smear readings?

PPV and FP interpretation?

FN value interpretation?16

BIBLIOGRAPHY

1. Joe D. Jakowski, M.D, PathologyOutlines.com, Inc. 2013

2. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidlines for clinical practice for the diagnosis and management of thyroid nodules, Endocrine Practice vol 12 No1 January/February 2006, 63.

3. Edmund S. Cibas, MD, Syed Z. Ali, MD, The Bethesda System for Reporting Thyroid Cytopathology, Am J Clin Pathol 2009;132:658-665.

17