2017 Sec 1 Green Book

Huyett et al

Table 4. Partial List of Patient Final Diagnoses.

Nonthyroid (169 Patients, 210 FNABs)

Thyroid (88 Patients, 128 FNABs)

Malignant Neoplasms

T-cell lymphoblastic lymphoma Diffuse large B-cell lymphoma

Papillary thyroid carcinoma (13) Medullary thyroid carcinoma Follicular thyroid carcinoma

Ganglioneuroblastoma

Ewing’s sarcoma

Burkitt’s lymphoma

Low-grade mucoepidermoid carcinoma (parotid)

Benign Neoplasms

Pleomorphic adenoma (3)

Oncocytic adenoma (1) Follicular adenoma (4)

Lipoma (2)

Lymphatic malformations (6) Myofibroma Pilomatrixoma Desmoplastic fibroma

Benign Lesions

Benign reactive lymphadenopathy (99)

Benign colloid nodule (31)

Atypical tuberculosis (15)

Chronic lymphocytic thyroiditis (11)

Branchial cleft cyst Cat scratch disease Castleman’s disease

Hyperplastic nodule (8)

Thyroid cyst (9)

Multinodular goiter (2)

Cervicofacial actinomyces Kuttner tumor Langerhans histiocytosis Thymic cyst (2)

Abbreviation: FNAB, fine-needle aspiration biopsy.

Table 5. Risk of Thyroid Malignancy as cited by TBSRTC, 4 Lale et al, 19 and This Study. a

Lale et al. 19

This Study

TBSRTC Category

TBSRTC Risk of Malignancy, % Rate of Malignancy, % FNAB, No.

Rate of Malignancy, % FNAB, No.

Nondiagnostic

1-4 0-3

0.0 2.6

9

0-25

59

Benign

77 19 12

0

136

FLUS

5-15

15.8 41.7 80.0

50

6

Follicular neoplasm

15-30 60-75 97-99

47.36

40

Suspicious for malignancy

5 6

100 100

6

Malignant

100.0

35

Abbreviations: FLUS, follicular lesion of undetermined significance; FNAB, fine-needle aspiration; TBSRTC, The Bethesda System for Reporting Thyroid Cytopathology. a Rate of thyroid malignancy and number of FNABs are presented for each Bethesda System category. Rates according to TBSRTC and Lale et al 19 are pre- sented for reference.

In addition to being highly accurate, FNAB offers the potential for a more rapid diagnosis when the cytopathologist can make an on-site judgment. Our study found that in the 106 instances when an initial diagnosis was offered, it correlated with final cytopathology 99.1% of the time—an improve- ment from 92% in the predecessor study from our institu- tion. 14 Rapid on-site diagnosis correlated with 93.3% of histopathologic results. The ability to offer an accurate on-site diagnosis is not only helpful in treatment planning but also in alleviating patient and family anxiety. The rate of nondiagnostic FNAB results is seemingly high (n = 30, 8.9%) but was found to be lower than in a large meta-analysis of adult HNM. 3 Current management of

such a result consists of clinical follow-up with possible repeat FNAB or surgical excision. With these and all other results, it is critical to remember that neither the sensitivity nor the specificity of FNAB is 100%, and FNAB results must be taken in the context of clinical factors. General Anesthesia General anesthesia or sedation was used in a significant por- tion of the children in this study, thus nullifying one of main benefits of FNAB. Most of these cases were thyroid evaluations, where GA is employed routinely by policy at our institution. While a younger average age was seen in the nonthyroid patients undergoing FNAB with sedation or

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