Abstract
Purpose
Fine-needle aspiration cytology (FNAC) assists the diagnosis of thyroid malignancy. A ‘suspicious for malignancy’ on FNAC creates a management dilemma. The aims of this study were to investigate the malignancy rate for patients with suspicious cytology, and to describe a management approach for those with a suspicious result.
Methodology
A retrospective review of prospectively collected data in an endocrine surgery database was undertaken. Patients undergoing thyroidectomy with preoperative FNAC from 1992 to 2012 were analysed.
Results
Preoperative FNAC was undertaken in 2,692 patients, and the FNAC result was ‘suspicious for malignancy’ in 94 (3.5 %) patients. Of these, 53 (56.4 %) were malignant, with the majority 44 (83.0 %) being papillary thyroid cancer. 48 patients went straight to total thyroidectomy, 40 patients had an initial diagnostic hemithyroidectomy, and 1 patient had a diagnostic isthmusectomy. 5 patients required reoperative total thyroidectomy as an initial procedure. Of the 94 suspicious cases, 55 were reported by an unknown, presumably non-expert, thyroid cytopathologist. 38 of these cases were available for review and re-reporting by an experienced cytopathologist. On review, 28 (73.7 %) were reclassified as cytologically malignant, and all of these were confirmed as malignant on subsequent histopathology.
Conclusions
Suspicious cytology has a high risk of malignancy. Expert thyroid cytopathology can improve diagnostic accuracy and a preoperative malignant diagnosis should be pursued to enable one-stage surgery where possible.
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References
Gharib H, Goellner J, Johnson D. Fine-needle aspiration cytology of the thyroid: a 12-year experience with 11,000 biopsies. Clin Lab Med. 1993;13:699–709.
Hamming J, Vriens M, Goslings B, Songun I, Fleuren G, van de Velde C. Role of fine-needle aspiration biopsy and frozen section examination in determining the extent of thyroidectomy. World J Surg. 1998;22:575–80.
Wu H, Jones J, Osman J. Fine-needle aspiration cytology of the thyroid: ten years experience in a community teaching hospital. Diagn Cytopathol. 2006;34(2):93–6.
Orell S, Phillips J. Broadsheet number 57: problems in fine needle biopsy of the thyroid. Pathology. 2000;32(3):191–8.
Flanagan M, Ohori N, Carty S, Hunt J. Repeat thyroid nodule fine-needle aspiration in patients with initial benign cytologic results. Am J Clin Pathol. 2006;125:698–702.
Alexander E, Heering J, Benson C, Frates M, Doubilet P, Cibas E, et al. Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab. 2002;87(11):4924–7.
Raj M, Grodski S, Martin S, Yeung M, Serpell J. The role of fine-needle aspiration cytology in the surgical management of thyroid cancer. ANZ J Surg. 2010;80:827–30.
Nguyen G, Lee M, Ginsberg J, Wragg T, Bilodeau D. Fine-needle aspiration of the thyroid: an overview. Cytojournal. 2005;2:12.
Tsan C, Serpell J, Poh Y. The impact of synoptic cytology reporting on fine-needle aspiration cytology of thyroid nodules. ANZ J Surg. 2007;77:991–5.
Yang G, Liebeskind D, Messina A. Ultrasound-guided fine-needle aspiration of the thyroid assessed by ultrafast Papanicolaou stain: data from 1135 biopsies with a two- to six-year follow up. Thyroid. 2001;11:581–9.
Cibas E, Ali S. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132:658–65.
British Thyroid Association, Royal College of Physicians. Guidelines for the management of thyroid cancer (Perros P, ed.). 2nd edition. Report of the Thyroid Cancer Guidelines Update Group. London: Royal college of Physicians, 2007.
Bongiovanni M, Spitale A, Faquin W, Mazzucchelli L, Baloch Z. The Bethesda system for reporting thyroid cytopathology: a meta-analysis. Acta Cytologica. 2012;56:333–9.
Morgan J, Serpell J, Cheng M. Fine-needle aspiration cytology of thyroid nodules: how useful is it? ANZ J Surg. 2003;73:480–3.
Cooper D, Doherty G, Haugen B, Kloos R, Lee S, Mandel S, et al. Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–214.
Gharib H, Goellner J, Zinsmeiter A, Grant C, Van Heerden J. Fine-needle aspiration biopsy of the thyroid: the problem of suspicious cytologic findings. Ann Intern Med. 1984;101:25–8.
Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis. Acta Cytol. 2012;56(4):333–9.
Boyd L, Earnhardt R, Dunn J, Frierson H, Hanks J. Preoperative evaluation and predictive value of fine-needle aspiration and frozen section of thyroid nodules. J Am Coll Surg. 1998;187:494–502.
Poller D, Stelow E, Yiangou. Thyroid FNAC cytology: can we do it better? Cytopathology. 2008;19:4–10.
Baloch Z, Cibas E, Clark D, Layfield L, Ljung B, Pitman M, et al. The National Cancer Institute Thyroid fine needle aspiration state of the science conference: a summation. Cytojournal. 2008;5:6.
Kopald K, Layfield L, Mohrmann R, Foshag L, Giuliano A. Clarifying the role of fine-needle aspiration cytologic examination and frozen section in the operative management of thyroid cancer. Arch Surg. 1989;124:1201–5.
Cheng M, Morgan J, Serpell J. Does frozen section have a role in the intraoperative management of thyroid nodules? ANZ J Surg. 2002;72:570–2.
Alexander E, Kennedy G, Baloch Z, Cibas ES, Chudova D, Diggans J, et al. Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N Engl J Med. 2012;367:705–15.
Mekel M, Nucera C, Hodin R, Parangi S. Surgical implications of B-RafV600E mutation in fine-needle aspiration of thyroid nodules. Am J Surg. 2010;200:136–43.
Cohen Y, Rosenbaum E, Clark D, Zeiger M, Umbircht C, Tufano R, et al. Mutational analysis of BRAF in fine needle aspiration biopsies of the thyroid: a potential application for the preoperative assessment of thyroid nodules. Clin Cance Res. 2004;10:2761–5.
Sapio M, Posca D, Raggioli A, Guerra A, Marotta V, Deandrea M, et al. Detection of RET/PTC, TRK and BRAF mutations in preoperative diagnosis of thyroid nodules with indeterminate cytological findings. J Clin Endocrinol. 2007;66:678–83.
Marchetti I, Lessi F, Mazzanti C, Bertacca G, Elisei R, Coscio G, et al. A morpho-molecular diagnosis of papillary thyroid carcinoma: BRAF V600E detection as an important tool in preoperative evaluation of fine-needle aspirates. Thryoid. 2009;19(8):837–43.
Gharib H. Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clin Proc. 1994;69:44–9.
Dwarakanathan A, Ryan W, Staren E, Martirano M, Economou S. Fine-needle aspiration biopsy of the thyroid: diagnostic accuracy when performing a moderate number of such procedures. Arch Intern Med. 1989;149:2007–9.
El-Hag I, Koller S. Benign follicular thyroid lesions versus follicular variant of papillary carcinoma: differentiation by architectural pattern. Cytopathology. 2004;15:200–5.
Olson MT, Boonyaarunnate T, Aragon Han P, Umbricht CB, Ali SZ, Zeiger MA. A tertiary center’s experience with second review of 3885 thyroid cytopathology specimens. J Clin Endocrinol Metab. 2013;98 (4):1450–7.
Acknowledgment
The authors wish to thank Melissa Vereker for her assistance in the collection and extraction of data used in this study.
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Baynes, A.L., Del Rio, A., McLean, C. et al. Fine-Needle Aspiration of the Thyroid: Correlating Suspicious Cytology Results with Histological Outcomes. Ann Surg Oncol 21, 1653–1658 (2014). https://doi.org/10.1245/s10434-013-3448-x
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DOI: https://doi.org/10.1245/s10434-013-3448-x