2017 Sec 1 Green Book

Otolaryngology–Head and Neck Surgery 154(5)

Table 2. Sensitivity, Specificity, and Positive and Negative Predictive Values.

HP 1 , No.

Characteristic

HP–, No.

PPV/NPV, % Sensitivity/Specificity, %

All, histopathologically proven only

93.5/64.3

93.5/64.3

FNAB positive FNAB negative

72

5 9

5

HP and Clinically Positive, No.

HP and Clinically Negative, No.

PPV/NPV, %

Sensitivity/ Specificity, %

Characteristic

All, histopathological plus clinical follow-up

94.6/97.7

94.6/97.7

FNAB positive FNAB negative

87

5

5

211

Nonthyroid

94.9/99.2

98.2/97.7

FNAB positive FNAB negative

56

3

1

130

Thyroid

93.9/95.3

88.6/97.6

FNAB positive FNAB negative

31

2

4

81

Abbreviations: FNAB, fine-needle aspiration biopsy; HP, histopathologically; NPV, negative predictive value; PPV, positive predictive value.

Table 3. False-Positive and False-Negative FNAB with Final Histopathologic Result, Explanation of Error, and/or Patient Outcome.

Error

FNAB

Histopathology

Outcome

Sampling error (6.8 cm) 31 ; surgery without delay, no complications

BCN ( 3 2)

False negative

Encapsulated follicular PTC

Follicular adenoma 1 papillary hyperplasia

False negative

BCN

Resolved with surgery, no complications

False negative

BLN

Hyaline variant of Castleman’s disease

39 months between initial FNAB and surgery; resolved with surgery, no complications Both are TBSRTC suspicious for malignancy 4 ; surgery without delay, no complications

False negative

Suspicious for PTC

FTC

False positive

Suspicious for PTC

Nodular hyperplasia with 2 dominant nodules

Resolved with surgery, no complications Resolved with surgery, no complications Resolved with surgery, no complications

False positive

Heterogeneous lymphoid population with atypia Suspicious for lymphoproliferative disorder

BLN

False positive

Reactive primary follicular hyperplasia

False positive

Follicular lesion or neoplasm Hyperplastic colloid nodule

70%-85% of SFONs are expected to be benign 4 ; resolved with surgery, no complications

False positive

Low-grade mucoepidermoid carcinoma

Kuttner tumor

Resolved with surgery, no complications

Abbreviations: BCN, benign colloid nodule; BLN, benign lymphadenopathy; FNAB, fine-needle aspiration biopsy; FTC, follicular thyroid carcinoma; PTC, papil- lary thyroid carcinoma; SFON, follicular neoplasm or suspicious for follicular neoplasm; TBSRTC, The Bethesda System for Reporting Thyroid Cytopathology.

The overall sensitivity and specificity of the thyroid FNAB was 88.6% and 97.6%, respectively, which is consis- tent with reports within both the general and pediatric popu- lations. 19,28-30 The applicability of The Bethesda System (TBSRTC) to the pediatric population has been previously examined in the literature and is a recommendation of the

2015 American Thyroid Association (ATA) Guidelines for Pediatric Thyroid Nodules and Cancer. 6,19 We found the 128 thyroid FNABs to have excellent concordance with the rates of malignancy as described by TBSRTC 4 ( Table 5 ). Similar to Lale et al, 19 there was an increased rate of malignancies in the indeterminate TBSRTC categories (III, IV, and V).

194