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Annals of Surgical Oncology

, Volume 18, Issue 5, pp 1282–1289 | Cite as

Inadequate Cytology in Thyroid Nodules: Should We Repeat Aspiration or Follow-Up?

  • Jung Hyun Yoon
  • Hee Jung Moon
  • Eun-Kyung Kim
  • Jin Young Kwak
Endocrine Tumors

Abstract

Background

To evaluate how to correctly manage thyroid nodules showing inadequate cytology after ultrasound (US)-guided fine-needle aspiration biopsy (US-FNAB).

Materials and Methods

A total of 393 thyroid nodules with inadequate cytology in 351 patients (M:F = 40:311, mean age: 49.3 years) with surgery or follow-up US-FNAB for at least 1 year were included in this study. Among them, 293 (74.6%) were benign and 100 (25.4%) were malignant on final reference results. Clinical characteristics and US features were reviewed and compared.

Results

Malignancy rates (39.5%) of nodules having suspicious US feature were significantly higher than those (10.9%) of nodules without any suspicious US feature (P < .001). Malignancy rates of solid nodules, mainly solid nodules, and mainly cystic nodules were 29.2, 16.7, and 9.5%, respectively, with significant differences (P = .016). Malignancy rates of nodules assessed as suspicious malignant to probably benign in composition are: 39.1–12.8% (P < .001) in solid nodules, 42.1–9.2% (P = .001) in mainly solid nodules, and 50.0–5.3% (P = .04) in mainly cystic nodules.

Conclusions

In nodules with inadequate cytology, follow-up US can be considered over repeat aspiration if there are no suspicious US features present, especially in mainly cystic nodules.

Keywords

Nodule Papillary Thyroid Carcinoma Thyroid Nodule Malignant Nodule Malignancy Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Pinchot SN, Al-Wagih H, Schaefer S, Sippel R, Chen H. Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. Arch Surg. 2009;144:649–55.PubMedCrossRefGoogle Scholar
  2. 2.
    McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery. 2007;142:837–44; discussion 44 e1–3.PubMedCrossRefGoogle Scholar
  3. 3.
    Tee YY, Lowe AJ, Brand CA, Judson RT. Fine-needle aspiration may miss a third of all malignancy in palpable thyroid nodules: a comprehensive literature review. Ann Surg. 2007;246:714–20.PubMedCrossRefGoogle Scholar
  4. 4.
    Schmidt T, Riggs MW, Speights VO, Jr. Significance of nondiagnostic fine-needle aspiration of the thyroid. South Med J. 1997;90:1183–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Cibas ES, Ali SZ. The Bethesda System for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132:658–65.PubMedCrossRefGoogle Scholar
  6. 6.
    Richards ML, Bohnenblust E, Sirinek K, Bingener J. Nondiagnostic thyroid fine-needle aspiration biopsies are no longer a dilemma. Am J Surg. 2008;196:398–402.PubMedCrossRefGoogle Scholar
  7. 7.
    Alexander EK, Heering JP, Benson CB, Frates MC, Doubilet PM, Cibas ES, et al. Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab. 2002;87:4924–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Chow LS, Gharib H, Goellner JR, van Heerden JA. Nondiagnostic thyroid fine-needle aspiration cytology: management dilemmas. Thyroid. 2001;11:1147–51.PubMedCrossRefGoogle Scholar
  9. 9.
    Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med. 1993;118:282–9.PubMedGoogle Scholar
  10. 10.
    MacDonald L, Yazdi HM. Nondiagnostic fine needle aspiration biopsy of the thyroid gland: a diagnostic dilemma. Acta Cytol. 1996;40:423–8.PubMedGoogle Scholar
  11. 11.
    McHenry CR, Walfish PG, Rosen IB. Non-diagnostic fine needle aspiration biopsy: a dilemma in management of nodular thyroid disease. Am Surg. 1993;59:415–9.PubMedGoogle Scholar
  12. 12.
    Cibas ES, Ali SZ. The Bethesda System for reporting thyroid cytopathology. Thyroid. 2009;19:1159–65.PubMedCrossRefGoogle Scholar
  13. 13.
    Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol. 2002;178:687–91.PubMedGoogle Scholar
  14. 14.
    Yoon JH, Kwak JY, Kim EK, Moon HJ, Kim MJ, Kim JY, et al. How to approach thyroid nodules with indeterminate cytology. Ann Surg Oncol. 2010;17:2147–55.PubMedCrossRefGoogle Scholar
  15. 15.
    Kwak JY, Kim EK, Kim HJ, Kim MJ, Son EJ, Moon HJ. How to combine ultrasound and cytological information in decision making about thyroid nodules. Eur Radiol. 2009;19:1923–31.PubMedCrossRefGoogle Scholar
  16. 16.
    Moon HJ, Kwak JY, Kim EK, Kim MJ, Park CS, Chung WY, et al. The combined role of ultrasound and frozen section in surgical management of thyroid nodules read as suspicious for papillary thyroid carcinoma on fine needle aspiration biopsy: a retrospective study. World J Surg. 2009;33:950–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Kwak JY, Kim EK, Kim MJ, Hong SW, Choi SH, Son EJ, et al. The role of ultrasound in thyroid nodules with a cytology reading of “suspicious for papillary thyroid carcinoma”. Thyroid. 2008;18:517–22.PubMedCrossRefGoogle Scholar
  18. 18.
    Baloch ZW, Sack MJ, Yu GH, Livolsi VA, Gupta PK. Fine-needle aspiration of thyroid: an institutional experience. Thyroid. 1998;8:565–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A, Dottorini ME, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2006;12:63–102.PubMedGoogle Scholar
  20. 20.
    Baloch Z, LiVolsi VA, Jain P, Jain R, Aljada I, Mandel S, et al. Role of repeat fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules. Diagn Cytopathol. 2003;29:203–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedus L, 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. Endocr Pract. 2010;16:1–43.PubMedCrossRefGoogle Scholar
  22. 22.
    Ogilvie JB, Piatigorsky EJ, Clark OH. Current status of fine needle aspiration for thyroid nodules. Adv Surg. 2006;40:223–38.PubMedCrossRefGoogle Scholar
  23. 23.
    Porterfield JR, Jr., Grant CS, Dean DS, Thompson GB, Farley DR, Richards ML, et al. Reliability of benign fine needle aspiration cytology of large thyroid nodules. Surgery. 2008;144:963–8; discussion 8–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Ahn SS, Kim EK, Kang DR, Lim SK, Kwak JY, Kim MJ. Biopsy of thyroid nodules: comparison of three sets of guidelines. AJR Am J Roentgenol. 2010;194:31–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Management of thyroid nodules detected at US: society of radiologists in ultrasound consensus conference statement. Radiology. 2005;237:794–800.PubMedCrossRefGoogle Scholar
  26. 26.
    Kim SJ, Moon WK, Cho N. Sonographic criteria for fine-needle aspiration cytology in a Korean female population undergoing thyroid ultrasound screening. Acta Radiol. 2010;51:475–81.PubMedCrossRefGoogle Scholar
  27. 27.
    Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab. 2002;87:1941–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.PubMedCrossRefGoogle Scholar
  29. 29.
    Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16:109–42.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Jung Hyun Yoon
    • 1
    • 2
  • Hee Jung Moon
    • 1
  • Eun-Kyung Kim
    • 1
  • Jin Young Kwak
    • 1
  1. 1.Department of Radiology, Research Institute of Radiological ScienceYonsei University College of MedicineSeoulSouth Korea
  2. 2.Department of Radiology, Bundang CHA HospitalPochon CHA UniversitySeongnamSouth Korea

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