Sage Journals: Discover world-class research

Abstract

Background

The non-diagnostic category of the Bethesda system has a low malignancy rate; nevertheless, repeat ultrasonography-guided fine needle aspiration (US-FNA) is recommended with no consensus for follow-up intervals.

Purpose

To investigate whether a six-month time interval for repeat US-FNA is appropriate for non-diagnostic thyroid nodules after applying the Bethesda system.

Material and Methods

From January 2010 to January 2014, 322 thyroid nodules ≥10 mm with non-diagnostic results on initial US-FNA with any follow-up with US or US-FNA were included (mean age = 52.2 years ± 12.4). Clinical and US features were compared according to size change (increase, no change, decrease) and follow-up interval (<6 months and ≥6 months after initial US-FNA), and the minimal time interval observed in nodules with size increase on follow-up. The outcome of non-diagnostic nodules according to follow-up interval and size change were evaluated.

Results

Of the 322 nodules, 13 (4.0%) were malignant and 309 (96.0%) were benign. None of the 82 nodules with decreased size were malignant and 90.2% nodules with decreased size were found after six months. Of 175 nodules with repeat US-FNA, repeat cytology results did not differ significantly between the groups with follow-up US-FNA before and after six months (P = 0.337). No significant differences were seen in size or extrathyroidal extension among the 13 malignant nodules according to the six-month interval (all P > 0.05), and no lateral lymph node metastasis was present.

Conclusion

Repeat US-FNA for initially non-diagnostic thyroid nodules can be performed at a six-month interval after initial procedure without tumor progression.

Keywords

Thyroid fine needle aspiration non-diagnostic Bethesda system

Get full access to this article

View all access options for this article.

References

Cibas

Ali

. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid 2009; 19: 1159–1165.

Gharib

Papini

Paschke

et al.

American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. J Endocrinol Invest 2010; 33: 51–56.

Haugen

Alexander

Bible

et al.

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26: 1–133.

Brister

Singh

Wang

. Reporting thyroid FNA before and after implementation of the Bethesda system-one institution’s experience. Diagn Cytopathol 2015; 43: 28–31.

Yoon

Moon

Kim

et al.

Inadequate cytology in thyroid nodules: should we repeat aspiration or follow-up?

Ann Surg Oncol 2011; 18: 1282–1289.

Coorough

Hudak

Jaume

et al.

Nondiagnostic fine-needle aspirations of the thyroid: is the risk of malignancy higher?

J Surg Res 2013; 184: 746–750.

Stelow

Dustin

et al.

Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol 2010; 134: 450–456.

Bongiovanni

Krane

Cibas

et al.

The atypical thyroid fine-needle aspiration: past, present, and future. Cancer Cytopathol 2012; 120: 73–86.

Bongiovanni

Spitale

Faquin

et al.

The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis. Acta Cytol 2012; 56: 333–339.

10.

Nayar

Ivanovic

. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer 2009; 117: 195–202.

11.

Theoharis

Schofield

Hammers

et al.

The Bethesda thyroid fine-needle aspiration classification system: year 1 at an academic institution. Thyroid 2009; 19: 1215–1223.

12.

Yoon

Lee

Kim

et al.

Thyroid nodules: nondiagnostic cytologic results according to thyroid imaging reporting and data system before and after application of the Bethesda System. Radiology 2015; 276: 579–587.

13.

Ferreira

Gerhard

Schmitt

. Analysis of nondiagnostic results in a large series of thyroid fine-needle aspiration cytology performed over 9 years in a single center. Acta Cytol 2014; 58: 229–234.

14.

Lubitz

Nagarkatti

Faquin

et al.

Diagnostic yield of nondiagnostic thyroid nodules is not altered by timing of repeat biopsy. Thyroid 2012; 22: 590–594.

15.

Baloch

LiVolsi

Jain

et al.

Role of repeat fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules. Diagn Cytopathol 2003; 29: 203–206.

16.

Layfield

Abrams

Cochand-Priollet

et al.

Post-thyroid FNA testing and treatment options: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Diagn Cytopathol 2008; 36: 442–448.

17.

Brito

Castro

Dean

et al.

Survey of current approaches to non-diagnostic fine-needle aspiration from solid thyroid nodules. Endocrine 2015; 49: 745–751.

18.

Kim

Park

Chung

et al.

New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. Am J Roentgenol 2002; 178: 687–691.

19.

Kwak

Han

Yoon

et al.

Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011; 260: 892–899.

20.

Koh

Kim

Kwak

et al.

Repeat fine-needle aspiration can be performed at 6 months or more after initial atypia of undetermined significance or follicular lesion of undetermined significance results for thyroid nodules 10 mm or larger. Eur Radiol 2016; 26: 4442–4448.

21.

Anderson

Atalay

Grand

et al.

Management of nodules with initially nondiagnostic results of thyroid fine-needle aspiration: can we avoid repeat biopsy?

Radiology 2014; 272: 777–784.

22.

Hryhorczuk

Stephens

Bude

et al.

Prevalence of malignancy in thyroid nodules with an initial nondiagnostic result after ultrasound guided fine needle aspiration. Ultrasound Med Biol 2012; 38: 561–567.

23.

Moon

Kim

Kwak

et al.

Repeat ultrasound-guided fine-needle aspiration for thyroid nodules 10 mm or larger can be performed 10.7 months after initial nondiagnostic results. Am J Roentgenol 2016; 206: 823–828.

24.

Ito

Tomoda

Uruno

et al.

Papillary microcarcinoma of the thyroid: how should it be treated?

World J Surg 2004; 28: 1115–1121.

25.

Ito

Tomoda

Uruno

et al.

Preoperative ultrasonographic examination for lymph node metastasis: usefulness when designing lymph node dissection for papillary microcarcinoma of the thyroid. World J Surg 2004; 28: 498–501.

26.

Sugitani

Toda

Yamada

et al.

Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg 2010; 34: 1222–1231.

27.

Chow

Gharib

Goellner

et al.

Nondiagnostic thyroid fine-needle aspiration cytology: management dilemmas. Thyroid 2001; 11: 1147–1151.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.29 MB

Non-diagnostic thyroid nodules after application of the Bethesda system: a study evaluating the interval for repeat aspiration for non-diagnostic results

Abstract

Background

Purpose

Material and Methods

Results

Conclusion

Keywords

Get full access to this article

References

Supplementary Material