Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: A systematic review and meta‐analysis

Abstract

There is increasing evidence showing that clinicians employ different management strategies in their use of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). In this meta-analysis, we investigated the differences in diagnosis frequency, resection rate (RR), and risk of malignancy (ROM) between Western (ie, American and European) and Asian cytopathology practices. We searched PubMed . Proportion and 95% CIs were calculated using a random-effect model. We used independent sample t tests to compare frequencies, RR, and ROM between Western and Asian practices. We analyzed a total of 38 studies with 145,066 fine-needle aspirations. Compared with Asian practice, Western series had a significantly lower ROM in most of TBSRTC categories, whereas the RR was not statistically different. Focusing on indeterminate nodules, the RR in Western series was significantly higher (51.3% vs 37.6%; P = .048), whereas the ROM was significantly lower (25.4% vs 41.9%; P = .002) compared with those in Asian series. The addition of Asian cohorts increased ROM for most of diagnostic categories compared with the original TBSRTC. In conclusion, this study demonstrates a difference in Western and Asian thyroid cytology practice, especially regarding the indeterminate categories. Lower RR and higher ROM suggest that Asian clinicians adopt a more conservative approach, whereas immediate diagnostic surgery is favored in Western practice for indeterminate nodules. The addition of Asian series into a meta-analysis of TBSRTC altered ROM for several categories, which should be considered in future revisions of TBSRTC.

Thyroid fine-needle aspiration cytology in Taiwan: a nationwide survey and literature update

“…The low rates of indeterminate diagnoses reflected the application of relatively strict criteria for using these categories to avoid clinical uncertainty in the overall management. Moreover, compared to the Western experience [16], the ROM in benign, AUS/FLUS, and FN/SFN in this survey was higher and the resection rate for these nodules were lower. These results suggested a more conservative approach and the application of other clinicoradiological parameters to select eligible patients for surgeries in our clinical practice.…”

“…These results suggested a more conservative approach and the application of other clinicoradiological parameters to select eligible patients for surgeries in our clinical practice. Nevertheless, the general characteristics of the thyroid FNA in Taiwan, including fewer malignant FNAs and lower ROMs of all resected nodules, were also different from other Asian countries [16] and deviated more towards the results for Western countries. This implies that the guidelines from Western countries were more closely followed by our clinicians.…”

Rates of Thy 1‐non‐diagnostic thyroid fine needle aspiration using the UK Royal College of Pathologists Thy Terminology. A systematic review of the literature comparing patients who undergo rapid on‐site evaluation and those who do not

“…Meta‐analyses of TBSRTC in western patients showed a pooled non‐diagnostic FNA rate of 12.9% and for Asian patients 12.2%, although neither meta‐analysis stratified patients according to ROSE utilization. A meta‐analysis of the risk of malignancy for patients with preoperative FNAC classified according to the UK Thy terminology showed comparable results to meta‐analyses of other internationally recognised reporting terminologies for pooled risk of malignancy for surgically excised nodules.…”

Diagnostic performances of the Afirma Gene Sequencing Classifier in comparison with the Gene Expression Classifier: A meta‐analysis

“…Thyroid nodules are common, particularly in females, and only approximately 10% to 15% of them are malignant 1,2 . Fine‐needle aspiration (FNA) is a helpful tool for triaging thyroid nodules and guiding clinical decisions.…”