1. 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

2. 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

4. 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

5. 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

6. 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

7. RESULT

8. Total n=730 (985 FNABs) > > > < = >

9. = = > > >

11. 2 5 2 4 Thyroidectomy

12. Total n=32

13. 19%

14. 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