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Value of repeated US-guided fine-needle aspiration (US-FNAB) in the follow-up of benign thyroid nodules: a real-life study based on the MoCyThy (Modena’s Cytology of the Thyroid) DATABASE with a revision of the literature

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Abstract

Purpose

The utility of repeating ultrasound-guided fine-needle aspiration (US-FNAB) in the follow-up of benign (THY2) thyroid nodules is still debated. The aim of this study was to retrospectively investigate the diagnostic value of re-biopsy of thyroid nodules following an initially benign result.

Methods

We retrospectively analyzed US-FNABs performed at the Unit of Endocrinology of Modena from 2006 to 2009. The firstly benign cytological result was compared with the cytological results of subsequent US-FNABs (2nd and/or 3rd) executed on the same nodule.

Results

Among 10449 US-FNABs, 6270 (60%) received a THY2 cytological categorization. Of them, 278 (4.43%) underwent a subsequent US-FNAB: 86.7% maintained the same cytology, 32 (11.5%) changed to THY3 (indeterminate) and 5 (1.8%) to THY4 (suspicious of malignancy). Among the 24 nodules addressed to surgery, 9 (37%) were histologically malignant, with an overall miss rate of 3.2%. Male patients had higher risk of discordant results at subsequent US-FNAB (p = 0.005, OR:3.59, 95%CI:1.453–7.769) while dimensional increase above 5 mm was predictive of concordant benign cytology (p = 0.036, OR:0.249, 95%CI:0.068–0.915). Age, suspicious US characteristics, and distance between US-FNABs resulted not predictive.

Conclusions

Re-biopsy of benign nodules confirmed the benign nature in most cases. In case of discordant cytology, relocation in indeterminate category was the most common. The histological diagnosis of cancer occurred in one quarter of nodules surgically removed, with a low overall clinically significant miss rate. Thus, a small percentage of false negatives exists; males and subjects with US suspicious nodules should be carefully followed-up, considering case by case re-biopsy possibility.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We are grateful to Dr. Katia Cioni and Prof. Cesare Carani (Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena ItalyUnit of Endocrinology, Department of Medical Specialties, Azienza Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy) for their contribution in the realization of the MoCyThy database.

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by S.D.V. and V.R. The first draft of the manuscript was written by S.D.V., G.B., and V.R. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy

    Sara De Vincentis, Giulia Brigante, Serena Belli, Manuela Simoni & Vincenzo Rochira

  2. Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy

    Sara De Vincentis, Giulia Brigante, Anna Ansaloni, Bruno Madeo, Lucia Zirilli, Chiara Diazzi, Manuela Simoni & Vincenzo Rochira

  3. Endocrinology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Silvia Vezzani

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  1. Sara De Vincentis
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Correspondence to Vincenzo Rochira.

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De Vincentis, S., Brigante, G., Ansaloni, A. et al. Value of repeated US-guided fine-needle aspiration (US-FNAB) in the follow-up of benign thyroid nodules: a real-life study based on the MoCyThy (Modena’s Cytology of the Thyroid) DATABASE with a revision of the literature. Endocrine 84, 193–202 (2024). https://doi.org/10.1007/s12020-023-03641-y

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