Prediction of cytology–histology discrepancy when Bethesda cytology reports benign results for thyroid nodules in women: with special emphasis on pregnancy
ABSTRACTObjectives: Benign category of Bethesda classification is generally well known to carry a false-negative rate of 0–3%. The current study was designed to investigate the rate of false-negative cytology in patients who underwent thyroidectomy for presumably benign thyroid diseases. Predictive...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2023-12-01
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| Series: | Libyan Journal of Medicine |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/19932820.2023.2258670 |
| _version_ | 1827632244372537344 |
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| author | Aysun Firat Ethem Unal |
| author_facet | Aysun Firat Ethem Unal |
| author_sort | Aysun Firat |
| collection | DOAJ |
| description | ABSTRACTObjectives: Benign category of Bethesda classification is generally well known to carry a false-negative rate of 0–3%. The current study was designed to investigate the rate of false-negative cytology in patients who underwent thyroidectomy for presumably benign thyroid diseases. Predictive risk factors for false results and malignancy were evaluated along with cytology–histology discrepant cases.Materials and methods: Females who underwent thyroidectomy between May 2014 and December 2022 were included. Demographics, ultrasound (US) features, fine-needle aspiration (FNA) diagnosis, surgical indications and outcomes, final histology reports, risk factors, and malignancy rate were recorded. Cytology–histology discrepant cases were further evaluated for interpretation errors and risk factors. Statistical analyses were performed using Fisher’s exact and Mann–Whitney U tests.Results: Of 581 women with a benign thyroid disease who underwent thyroidectomy, 91 was diagnosed as incidental carcinoma (15.6%) and most was T1a (4.9 ± 2.7 mm, 95.6%). Final histology reports revealed mostly papillary carcinoma (93.4%). Predictors of malignancy such as age, family history, previous radiation exposure, and iodine-deficient diet did not help in risk stratification (p > 0.05, for each). However, FNA taken during pregnancy was determined as a risk factor (n = 7, 7.6%, p < 0.05) since it may cause a delay in diagnosis. Cytology–histology discrepant cases were seen to be mostly due to sampling errors (45%, p < 0.05), followed by misinterpretations (37.3%, p < 0.05). There was no reason for discrepancy in 17.5%, and this was linked to inherent nature of thyroid nodule with overlapping cytologic features. Best identifiable risk factor for misinterpretation was pregnancy as well (n = 5, 14.7%, p < 0.05).Conclusions: Risk of malignancy in a presumably benign thyroid disease should not be ignored. Radiology–cytology correlation by an experienced dedicated team may help in decreasing sampling errors. Physiologic changes caused by pregnancy may shade malignant transformation in thyrocytes, and it would be appropriate to be cautious about benign FNA taken during this period. |
| first_indexed | 2024-03-09T14:34:20Z |
| format | Article |
| id | doaj.art-13d3962a143448a4a755156ea74e37f7 |
| institution | Directory Open Access Journal |
| issn | 1993-2820 1819-6357 |
| language | English |
| last_indexed | 2024-03-09T14:34:20Z |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Libyan Journal of Medicine |
| spelling | doaj.art-13d3962a143448a4a755156ea74e37f72023-11-27T14:59:05ZengTaylor & Francis GroupLibyan Journal of Medicine1993-28201819-63572023-12-0118110.1080/19932820.2023.2258670Prediction of cytology–histology discrepancy when Bethesda cytology reports benign results for thyroid nodules in women: with special emphasis on pregnancyAysun Firat0Ethem Unal1Instructor in Obstetrics and Gynecology, Departments of General Surgery, and Obstetrics and Gynecology, University of Health Sciences Turkey, Istanbul, TurkeyGeneral Surgery and Surgical Oncology, Departments of General Surgery, and Obstetrics and Gynecology, University of Health Sciences Turkey, Istanbul, TurkeyABSTRACTObjectives: Benign category of Bethesda classification is generally well known to carry a false-negative rate of 0–3%. The current study was designed to investigate the rate of false-negative cytology in patients who underwent thyroidectomy for presumably benign thyroid diseases. Predictive risk factors for false results and malignancy were evaluated along with cytology–histology discrepant cases.Materials and methods: Females who underwent thyroidectomy between May 2014 and December 2022 were included. Demographics, ultrasound (US) features, fine-needle aspiration (FNA) diagnosis, surgical indications and outcomes, final histology reports, risk factors, and malignancy rate were recorded. Cytology–histology discrepant cases were further evaluated for interpretation errors and risk factors. Statistical analyses were performed using Fisher’s exact and Mann–Whitney U tests.Results: Of 581 women with a benign thyroid disease who underwent thyroidectomy, 91 was diagnosed as incidental carcinoma (15.6%) and most was T1a (4.9 ± 2.7 mm, 95.6%). Final histology reports revealed mostly papillary carcinoma (93.4%). Predictors of malignancy such as age, family history, previous radiation exposure, and iodine-deficient diet did not help in risk stratification (p > 0.05, for each). However, FNA taken during pregnancy was determined as a risk factor (n = 7, 7.6%, p < 0.05) since it may cause a delay in diagnosis. Cytology–histology discrepant cases were seen to be mostly due to sampling errors (45%, p < 0.05), followed by misinterpretations (37.3%, p < 0.05). There was no reason for discrepancy in 17.5%, and this was linked to inherent nature of thyroid nodule with overlapping cytologic features. Best identifiable risk factor for misinterpretation was pregnancy as well (n = 5, 14.7%, p < 0.05).Conclusions: Risk of malignancy in a presumably benign thyroid disease should not be ignored. Radiology–cytology correlation by an experienced dedicated team may help in decreasing sampling errors. Physiologic changes caused by pregnancy may shade malignant transformation in thyrocytes, and it would be appropriate to be cautious about benign FNA taken during this period.https://www.tandfonline.com/doi/10.1080/19932820.2023.2258670Fine-needle aspiration (FNA)Bethesda cytologyfalse negativecytology–histology discrepancypregnancy |
| spellingShingle | Aysun Firat Ethem Unal Prediction of cytology–histology discrepancy when Bethesda cytology reports benign results for thyroid nodules in women: with special emphasis on pregnancy Libyan Journal of Medicine Fine-needle aspiration (FNA) Bethesda cytology false negative cytology–histology discrepancy pregnancy |
| title | Prediction of cytology–histology discrepancy when Bethesda cytology reports benign results for thyroid nodules in women: with special emphasis on pregnancy |
| title_full | Prediction of cytology–histology discrepancy when Bethesda cytology reports benign results for thyroid nodules in women: with special emphasis on pregnancy |
| title_fullStr | Prediction of cytology–histology discrepancy when Bethesda cytology reports benign results for thyroid nodules in women: with special emphasis on pregnancy |
| title_full_unstemmed | Prediction of cytology–histology discrepancy when Bethesda cytology reports benign results for thyroid nodules in women: with special emphasis on pregnancy |
| title_short | Prediction of cytology–histology discrepancy when Bethesda cytology reports benign results for thyroid nodules in women: with special emphasis on pregnancy |
| title_sort | prediction of cytology histology discrepancy when bethesda cytology reports benign results for thyroid nodules in women with special emphasis on pregnancy |
| topic | Fine-needle aspiration (FNA) Bethesda cytology false negative cytology–histology discrepancy pregnancy |
| url | https://www.tandfonline.com/doi/10.1080/19932820.2023.2258670 |
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