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2018 ; 7
(1
): 39-43
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Indeterminate Thyroid Nodules: A Pragmatic Approach
#MMPMID29594053
Khalil AB
; Dina R
; Meeran K
; Bakir AM
; Naqvi S
; Al Tikritti A
; Lessan N
; Barakat MT
Eur Thyroid J
2018[Jan]; 7
(1
): 39-43
PMID29594053
show ga
BACKGROUND: Fine needle aspiration (FNA) cytology fails to provide a conclusive
diagnosis in a subset of thyroid lesions labeled as "indeterminate" (Thy3). In
this study, we aimed at ascertaining the prevalence of Thy3 thyroid nodules in a
hitherto unreported ethnic group (residents of the United Arab Emirates).
METHODS: We retrospectively examined 688 FNA of the thyroid performed on 584
patients. Samples were reported using the Royal College of Physicians' (RCP) Thy
classification. The results of the FNA were correlated with the final surgical
specimens. Ultrasonography (US) risk stratification was calculated using a
web-based US risk of malignancy calculator. RESULTS: Overall sample adequacy was
97%. The indeterminate group Thy3 was found in 7% of the samples. The overall
risk of malignancy in the Thy3 category was 20%. This risk was very similar in
the 2 subgroups of Thy3 (17% in Thy 3a and 22% in Thy3f). Subdividing the Thy3
group into subgroups becomes less necessary if the US scoring is <24.5% since the
negative predictive value, in this case, is 100%. Applying this criterion to our
population would have had the potential of reducing the percentage of patients
referred to surgery from 61 to 43%. CONCLUSIONS: Proper risk stratification of
Thy3 lesions should be based on the combined risk assessment of clinical,
cytological, radiological, and molecular data. Such a pragmatic approach is
expected to reduce the percentage of inappropriate referrals to surgery.
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