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Predictive Value of Cytologic Atypia in Indeterminate Thyroid Fine-Needle Aspirate Biopsies

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Fine-needle aspiration (FNA) biopsies are the most accurate method for diagnosis of thyroid nodules. Unfortunately, biopsies are indeterminate 15–30% of the time and surgery is thus required for a definitive diagnosis. We aimed to determine whether specific descriptors of cytologic atypia mentioned in indeterminate FNA reports were associated with malignancy on final histopathology.

Methods

Retrospective review of 1000 surgery patients identified 466 indeterminate FNA lesions that underwent either a hemi- or total thyroidectomy between 1998 and 2009. We screened FNA reports for specific descriptors of nuclear atypia. Univariate and multivariate analyses were performed to evaluate the independent effect of cytologic atypia descriptors on the risk of malignancy.

Results

Nuclear atypia on FNA conferred a risk of malignancy of 42% (P < 0.0001). Risk of malignancy increased from 17% for zero descriptors to 81.2% when four or more descriptors of atypia were described. Nuclear grooves and inclusions together conferred a risk of malignancy, specificity, and false positive rate of 79.3%, 98.2% and 1.8% respectively.

Conclusions

The presence of four or more descriptors of cytologic atypia or the presence of both nuclear inclusions and grooves together confers a high risk of malignancy on final histopathology and a low false positive rate. These findings should be taken into consideration when interpreting FNA reports and total thyroidectomy should be considered for those patients at higher risk.

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Acknowledgment

P.C. was partially supported by the Clinical Translational Science Center (CTSC) (UL1-RR024996). We are grateful to Orlo H. Clark, Michael J Crowley, Naman Desai, and Stephen M. Seedial for their help with this project.

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Authors and Affiliations

  1. Department of Surgery, New York Presbyterian Hospital–Weill Cornell Medical College, New York, NY, USA

    Meredith A. Kato MD, Daniel Buitrago MD, Tracy-Ann Moo MD, Xavier M. Keutgen MD, Raza S. Hoda MD, Joseph A. Ricci MD, Thomas J. Fahey III MD & Rasa Zarnegar MD

  2. Department of Public Health, Weill Cornell Medical College, New York, NY, USA

    Paul J. Christos

  3. Department of Pathology, New York Presbyterian Hospital–Weill Cornell Medical College, New York, NY, USA

    Grace Yang MD

Authors
  1. Meredith A. Kato MD
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  2. Daniel Buitrago MD
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  3. Tracy-Ann Moo MD
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  4. Xavier M. Keutgen MD
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  5. Raza S. Hoda MD
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  6. Joseph A. Ricci MD
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  7. Paul J. Christos
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  8. Grace Yang MD
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  9. Thomas J. Fahey III MD
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  10. Rasa Zarnegar MD
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Corresponding author

Correspondence to Rasa Zarnegar MD.

Additional information

The first two authors contributed equally to this work.

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Kato, M.A., Buitrago, D., Moo, TA. et al. Predictive Value of Cytologic Atypia in Indeterminate Thyroid Fine-Needle Aspirate Biopsies. Ann Surg Oncol 18, 2893–2898 (2011). https://doi.org/10.1245/s10434-011-1635-1

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  • DOI: https://doi.org/10.1245/s10434-011-1635-1

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