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      Thyroid Fine-Needle Aspiration in Taiwan: The History and Current Practice

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          Abstract

          In Taiwan, thyroid cancer is the most common endocrine gland malignancy and the incidence of thyroid cancer has increased four-fold in the past two decades. Fine-needle aspiration is an accurate and cost-effective method of evaluating thyroid nodules and has been the gold-standard diagnostic tool for thyroid tumors in Taiwan since the 1980s. This article reviews the history, current practice, reporting systems, training, and quality assurance for thyroid fine-needle aspiration cytology in Taiwan.

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          Korea's thyroid-cancer "epidemic"--screening and overdiagnosis.

          Hyeong Ahn, Hyun Jung Kim, H. Welch (2014)
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            The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis.

            Massimo Bongiovanni, Alessandra Spitale, William Faquin … (2012)
            We aimed to investigate the validity of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) through meta-analysis. All publications between January 1, 2008 and September 1, 2011 that studied TBSRTC and had available histological follow-up data were retrieved. To calculate the sensitivity, specificity and diagnostic accuracy, the cases diagnosed as follicular neoplasm, suspicious for malignancy and malignant which were histopathologically confirmed as malignant were defined as true-positive. True-negative included benign cases confirmed as benign on histopathology. The nondiagnostic category was excluded from the statistical calculation. The correlations between the 6 diagnostic categories were investigated. The publications review resulted in a case cohort of 25,445 thyroid fine-needle aspirations, 6,362 (25%) of which underwent surgical excision; this group constituted the basis of the study. The sensitivity, specificity and diagnostic accuracy were 97, 50.7 and 68.8%, respectively. The positive predictive value and negative predictive value were 55.9 and 96.3%, respectively. The rates of false negatives and false positives were low: 3 and 0.5%, respectively. The results of meta-analysis showed high overall accuracy, indicating that TBSRTC represents a reliable and valid reporting system for thyroid cytology. Copyright © 2012 S. Karger AG, Basel.
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              Thyroid cancer in the thyroid nodules evaluated by ultrasonography and fine-needle aspiration cytology.

              Chia-Der Lin, Chuen Hsueh, Tzu-Chieh Chao … (2005)
              Thyroid nodule is common disorder in endocrine clinics. In Taiwan, thyroid ultrasonography with fine-needle aspiration cytology (FNAC) is the first-line examination procedure. Data in large series on the incidence of thyroid malignancy presenting with thyroid nodules are lacking in this area. To determine the incidence of malignancy in thyroid nodules and compare the results with other populations, this investigation retrospectively reviewed 21,748 subjects who were examined in one medical center from January 1986 to December 1999. All patients underwent thyroid ultrasonography studies using a real-time ultrasonographic machine and a 10-MHz transducer. Fine-needle aspirations were made in the suspected thyroid nodule and stained using the Romanowsky- based method developed by Liu. By the end of 2002, some 3629 patients (16.7%) had thyroid nodules after surgical treatment. This group comprised 3011 women with a mean age of 41.5 +/- 13.9 years, and 618 men with a mean age of 45.7 +/- 14.9 years. Of patients undergoing surgical treatment, 2761 (76.1%) patients were diagnosed with benign nodules, 858 (23.6%) with malignant nodules, and 10 (0.3%) with atypical adenoma (7 follicular and 3 Hürthle cells). The percentages of thyroid malignancy in each age group revealed two peaks in both genders, namely in patients aged 20 to 29 years and in elderly patients (aged over 65 years). The peak age for thyroid malignancy in both genders was 41 to 60 years (male) and 21 to 40 years (female). The highest ratio of malignancy occurred in the elderly group (37.2%) receiving surgical treatment. In young patients (below 19 years) the percentage of malignancy was no greater than for the whole age group (20.2% versus 25.6%). Anaplastic and metastatic cancers affecting the thyroid were the main subjects in the age group. The present results demonstrated a younger distribution for well-differentiated thyroid cancer, particularly papillary thyroid carcinoma, compared to previous studies. This outcome may have resulted from the routine application of ultrasonography with FNAC in assessing the thyroid nodules, possibly helping to achieve more timely detection. The incidence of thyroid malignancy in young patients was no higher than in adults. Early detection of thyroid malignancy may be the main reason for this phenomenon. Male subjects with thyroid nodules displayed a higher incidence of this malignancy than females. Aging subjects with thyroid nodules suffered a higher rate of malignancy and were poorly differentiated. In conclusion, this retrospective large-series study demonstrated that 3.9% (858/21,748 cases) of patients with thyroid nodules showed histopathologically proven malignancy. Thyroid cancer detected by ultrasonography with FNAC occurred an average of 10 years younger than in prior studies.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Pathol Transl Med
                Journal ID (iso-abbrev): J Pathol Transl Med
                Journal ID (publisher-id): JPTM
                Title: Journal of Pathology and Translational Medicine
                Publisher: The Korean Society of Pathologists and the Korean Society for Cytopathology
                ISSN (Print): 2383-7837
                ISSN (Electronic): 2383-7845
                Publication date (Print): November 2017
                Publication date (Electronic): 18 October 2017
                Volume: 51
                Issue: 6
                Pages: 560-564
                Affiliations
                [1 ]Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
                [2 ]School of Medicine, National Yang-Ming University, Taipei, Taiwan
                Author notes
                Corresponding Author Chiung-Ru Lai, MD Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Taipei 11217, Taiwan Tel: +886-2-2875-7451 Fax: +886-2-2873-7052 E-mail: crlai@ 123456vghtpe.gov.tw
                Article
                Publisher ID: jptm-2017-09-20
                DOI: 10.4132/jptm.2017.09.20
                PMC ID: 5700883
                PubMed ID: 29046515
                SO-VID: 5f4451c3-6e49-45e2-966c-8548297df677
                Copyright © © 2017 The Korean Society of Pathologists/The Korean Society for Cytopathology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 12 September 2017
                Date accepted : 20 September 2017
                Categories
                Subject: Review

                Keywords: thyroid,biopsy, fine-needle,cytology,taiwan
                Data availability:
                Keywords: thyroid, biopsy, fine-needle, cytology, taiwan

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