The Role of Repeat Fine Needle Aspiration in Improving Diagnostic Accuracy in Thyroid Masses
1
Laura Allen, Ayham Al Afif, Matthew H Rigby, Martin J Bullock, Jonathan Trites,
2
2
S Mark Taylor, Robert D Hart
2
2
3
2
Faculty of Medicine, Division of Otolaryngology Head & Neck Surgery,
3
Department of Pathology, Dalhousie University, Halifax, NS
1
2
Introduction
Results
Background
Fine needle aspiration (FNA) is an important
tool in diagnosing thyroid masses.
The Bethesda System for Reporting Thyroid
Cytopathology (BSRTC) recommends repeat
FNA (rFNA) when initial FNA results are
unsatisfactory (Category I), Atypia of
Undetermined Significance/Follicular Lesion of
Undetermined Significance (AUS/FLUS)
(Category III) 1.
It is unclear how often rFNA provides further
diagnostic information1-5.
malignant
n=4 (2%)
malignant
n=4 (9%)
benign n=13
(30%)
SFN/SFM
n=3 (2%)
Table I. BSRTC Categories
Conclusions
Our study suggests that rFNA
may have a role in providing
diagnostic information following
indeterminate FNA cytology.
Objectives
Does repeat FNA following indeterminate initial
cytology improve diagnostic accuracy in patients
with thyroid masses?
Future directions include
obtaining a larger sample size to
clarify the impact of rFNA on
clinical decision making.
Methods
Summary
Key findings
rFNA following an initial unsatisfactory FNA provided a new
diagnosis in 65% of patients.
39% of patients with initial AUS/FLUS cytology had a definitive
diagnosis on rFNA (benign or malignant).
In total, 36% of patients who had rFNA underwent surgery.
Of those patients with a result of AUS/FLUS on rFNA, 15%
underwent surgery.
Of those patients who had both initial and rFNA results of
Unsatisfactory, 25% had surgery.
Key points
rFNA following indeterminate cytology (Unsatisfactory or
AUS/FLUS) of thyroid mass may play a role in providing more
definitive diagnostic information.
The impact of rFNA on clinical/surgical outcomes remains
unknown.
Acknowledgements
Department of Otolaryngology & Dr. Gerry
Johnston Dr. James S. Hammerling Summer
Research Studentship
References
(1) Cibas, E. S., & Ali, S. Z. (2009). The Bethesda system for
reporting thyroid cytopathology. American journal of clinical
pathology, 132(5), 658-665.
(2) Gerhard, R., & Boerner, S. L. (2015). Evaluation of
Indeterminate Thyroid Cytology by Second-Opinion Diagnosis
or Repeat Fine-Needle Aspiration: Which Is the Best
Approach. Acta cytologica, 59(1), 43-50.
(3) Na, D. G., Kim, J. H., Sung, J. Y., Baek, J. H., Jung, K. C., Lee, H., &
Yoo, H. (2012). Core-needle biopsy is more useful than repeat
fine-needle aspiration in thyroid nodules read as nondiagnostic
or atypia of undetermined significance by the Bethesda system
for reporting thyroid cytopathology.Thyroid, 22(5), 468-475.
(4) Cibas, E. S., & Ali, S. Z. (2009). The Bethesda system for
reporting thyroid cytopathology. American journal of clinical
pathology, 132(5), 658-665.
(5) Chen, J. C., Pace, S. C., Chen, B. A., Khiyami, A., & McHenry, C.
R. (2012). Yield of repeat fine-needle aspiration biopsy and rate
of malignancy in patients with atypia or follicular lesion of
undetermined significance: the impact of the Bethesda System
for Reporting Thyroid Cytopathology.Surgery, 152(6), 10371044.
Contact
Laura Allen, BHSc.
MD Candidate 2019
[email protected]
