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Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review

OBJECTIVE: FNA is a simple, safe, cost-effective and accurate diagnostic tool for the initial screening of patients with thyroid nodules. The aims of this study were to determine the diagnostic utility of FNAC performed in our institution, assess the cytomorphologic features that contribute to diagn...

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Autores principales: Zhu, Yanli, Song, Yuntao, Xu, Guohui, Fan, Zhihui, Ren, Wenhao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942345/
https://www.ncbi.nlm.nih.gov/pubmed/31900180
http://dx.doi.org/10.1186/s13000-019-0924-z
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author Zhu, Yanli
Song, Yuntao
Xu, Guohui
Fan, Zhihui
Ren, Wenhao
author_facet Zhu, Yanli
Song, Yuntao
Xu, Guohui
Fan, Zhihui
Ren, Wenhao
author_sort Zhu, Yanli
collection PubMed
description OBJECTIVE: FNA is a simple, safe, cost-effective and accurate diagnostic tool for the initial screening of patients with thyroid nodules. The aims of this study were to determine the diagnostic utility of FNAC performed in our institution, assess the cytomorphologic features that contribute to diagnostic errors and propose improvement measures. METHODS: A total of 2781 FNACs were included in the study, and 1122 cases were compared with their histological diagnoses. We retrospectively reexamined our discordant (both false-negative and false-positive) cases and performed a systematic review of previous studies on causes of misdiagnoses. RESULTS: When DC V and DC VI were both considered cytologic-positive, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 98.3, 30.9, 94.9, 58.3 and 93.5%, respectively. If DC VI was considered cytologic-positive, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC were 98.0, 84.0, 99.4, 58.3, and 97.5% respectively. The main cause of false-negative diagnoses was sampling error (13/15, 86.7%), while interpretation error led to the majority of the false-positive diagnoses (38/47, 80.9%). Overlapping cytological features in adenomatous hyperplasia, thyroiditis and cystic lesions were the major factors contributing to interpretation errors, while the size and number of nodules may have led to false-negative diagnoses because of heterogeneity and unsampled areas. CONCLUSIONS: The sensitivity and PPV of thyroid FNAC in our institution were higher than those in the published data, while the specificity and NPV were lower. Regarding the FNA category DC V, a frozen section analysis during diagnostic lobectomy is necessary. Multiple passes should be performed in various parts of a large nodule or from different nodules to reduce the risk of false-negative findings. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis and cystic lesions to avoid false-positive diagnoses. NIFTP has little effect on diagnostic accuracy and the distribution of diagnostic errors.
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spelling pubmed-69423452020-01-07 Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review Zhu, Yanli Song, Yuntao Xu, Guohui Fan, Zhihui Ren, Wenhao Diagn Pathol Research OBJECTIVE: FNA is a simple, safe, cost-effective and accurate diagnostic tool for the initial screening of patients with thyroid nodules. The aims of this study were to determine the diagnostic utility of FNAC performed in our institution, assess the cytomorphologic features that contribute to diagnostic errors and propose improvement measures. METHODS: A total of 2781 FNACs were included in the study, and 1122 cases were compared with their histological diagnoses. We retrospectively reexamined our discordant (both false-negative and false-positive) cases and performed a systematic review of previous studies on causes of misdiagnoses. RESULTS: When DC V and DC VI were both considered cytologic-positive, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 98.3, 30.9, 94.9, 58.3 and 93.5%, respectively. If DC VI was considered cytologic-positive, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC were 98.0, 84.0, 99.4, 58.3, and 97.5% respectively. The main cause of false-negative diagnoses was sampling error (13/15, 86.7%), while interpretation error led to the majority of the false-positive diagnoses (38/47, 80.9%). Overlapping cytological features in adenomatous hyperplasia, thyroiditis and cystic lesions were the major factors contributing to interpretation errors, while the size and number of nodules may have led to false-negative diagnoses because of heterogeneity and unsampled areas. CONCLUSIONS: The sensitivity and PPV of thyroid FNAC in our institution were higher than those in the published data, while the specificity and NPV were lower. Regarding the FNA category DC V, a frozen section analysis during diagnostic lobectomy is necessary. Multiple passes should be performed in various parts of a large nodule or from different nodules to reduce the risk of false-negative findings. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis and cystic lesions to avoid false-positive diagnoses. NIFTP has little effect on diagnostic accuracy and the distribution of diagnostic errors. BioMed Central 2020-01-03 /pmc/articles/PMC6942345/ /pubmed/31900180 http://dx.doi.org/10.1186/s13000-019-0924-z Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Zhu, Yanli
Song, Yuntao
Xu, Guohui
Fan, Zhihui
Ren, Wenhao
Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review
title Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review
title_full Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review
title_fullStr Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review
title_full_unstemmed Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review
title_short Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review
title_sort causes of misdiagnoses by thyroid fine-needle aspiration cytology (fnac): our experience and a systematic review
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942345/
https://www.ncbi.nlm.nih.gov/pubmed/31900180
http://dx.doi.org/10.1186/s13000-019-0924-z
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