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Y IELD OF REPEAT FINE - NEEDLE ASPIRATION BIOPSY AND RATE OF MALIGNANCY IN PATIENTS WITH ATYPIA OR FOLLICULAR LESION OF UNDETERMINED SIGNIFICANCE : T HE IMPACT OF THE B ETHESDA S YSTEM FOR R EPORTING T HYROID C YTOPATHOLOGY Joy C. Chen, MD, MS, S. Carter Pace, MD, Boris A. Chen, BS, Amer Khiyami, MD, and Christopher R. McHenry, MD, Cleveland, OH R2 JAE HUN PARK / Pf. Sang Ouk Chin
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INTRODUCTION FINE-NEEDLE ASPIRATION BIOPSY (FNAB) Diagnostic modality of choice for evaluating a thyroid nodule Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in 2008 standardize the terminology for diagnosis of nodular thyroid disease recommendations for management based on the risk of malignancy
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INTRODUCTION Atypia or follicular lesion of undetermined significance(A/FLUS) (2007) neither definitively benign nor definitively neoplastic not sufficient for an interpretation of follicular or H€urthle cell neoplasm or malignancy repeat biopsy be performed in 3 to 6 months with subsequent operative therapy rate of malignancy : 5–15% To determine the effect of the BSRTC on the results of FNAB, the frequency of repeat FNAB, the rates of thyroidectomy, the yield of malignancy in A/FLUS deciding when to recommend thyroidectomy
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METHODS Institutional Review Board at MetroHealth Medical Center Pre-BSRTC group(2006.1.1~2009.7.1) benign, follicular/H€urthle cell neoplasm, suspicious for malignancy, malignant, nondiagnostic BSRTC group(2010.1.1~2011.10.26) benign, A/FLUS, suspicious for follicular/H€urthle cell neoplasm (FN/HCN), suspicious for malignancy, malignant, nondiagnostic 6-month transition period(2009.7~2009.12.31) excluded from the study
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METHODS The rate of repeat biopsy the number of patients who underwent one or more subsequent biopsies of the same nodule The rate of malignancy for patients with A/FLUS the number of cases with final histopathology Same techniques used to perform FNAB between the pre-BSRTC and BSRTC groups US-guided FNABs were performed by a radiologist Nonimage-guided FNABs by endocrinologists and an endocrine surgeon
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RESULT
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Total n=730 (985 FNABs) > > > < = >
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= = > > >
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2 5 2 4 Thyroidectomy
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Total n=32
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19%
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CONCLUSION Thyroid nodule and A/FLUS FNAB thyroidectomy associated clinical factors that increase the likelihood of malignancy If not, a repeat FNAB in 3–6 months Thyroidectomy is indicated repeat FNAB is nondiagnostic persistent A/FLUS cytologic result a/w greater malignant potential Clinical observation when repeat FNAB is benign
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