Hemithyroidectomy is the preferred initial operative approach for an indeterminate fine needle aspiration biopsy diagnosis

Abstract

Hemithyroidectomy is the preferred initial operative approach for an indeterminate fine needle aspiration biopsy diagnosis Background: Fine needle aspiration biopsy represents the critical initial diagnostic test used for evaluation of thyroid nodules. Our objectives were to determine the cytological distribution, the utility of clinicopathologic characteristics for predicting malignancy and the true proportion of cancer among individuals who presented with indeterminate cytology and had undergone thyroid surgery for suspicion of cancer. Methods:We retrospectively reviewed 1040 consecutive primary thyroid operations carried out over an 8-year period at a tertiary care endocrine referral centre. Follicular neoplasm (FN), Hürthle cell neoplasm (HN), neoplasms suspicious for but not diagnostic of papillary carcinoma (IP) and neoplasms with cellular atypia (IA) were reviewed. Results:In all, 380 individuals presented with cytologically indeterminate thyroid nodules. Of these, 252 (66%) patients had FN, 47 (12%) HN, 44 (12%) IP, 26 (7%) IA and 11 (4%) had mixed diagnoses. Biopsied lesions were found to be malignant on pathological evaluation in 102 (27%) patients: 49 (19%) with FN, 11 (23%) HN, 28 (64%) IP and 9 (35%) with IA. Hemithyroidectomy was adequate definitive treatment in 196 of 225 (87%) patients with FN and 39 of 42 (93%) with HN. Significant associations with a cancer diagnosis were identified for smaller tumour size in patients with FN (p = 0.004) and right thyroid lobe location in patients with IP (p = 0.012), although these factors were nonsignificant in the corrected analyses for multiple comparisons. Conclusion:In a review of the experience at a Canadian centre, 4 operations were carried out to identify each cancer, and hemithyroidectomy was the optimal initial and definitive surgical approach for most patients.Contexte : La biopsie par aspiration à l'aiguille fine représente un test diagnostique initial crucial pour évaluer les nodules de la thyroïde. Nos objectifs consistaient à déter-miner la distribution cytologique, l'utilité des caractéristiques clinico-pathologiques pour la prédiction des cancers et la proportion réelle de cancers chez des personnes dont les résultats cytologiques étaient indéterminés et qui ont subi une chirurgie de la thyroïde pour un cancer présumé. Méthodes :Nous avons passé en revue de façon rétrospective 1040 interventions thyroïdiennes primaires consécutives effectuées sur une période de 8 ans dans un centre de soins endocriniens tertiaires. Nous avons examiné les cas de néoplasie folliculaire (NF), de néoplasie à cellules de Hürthle (NCH), de néoplasies papillaires présumées mais non avérées (indéterminées, NPI), de même que les néoplasies à cellules atypiques (NCA).Résultats : En tout, 380 patients ont présenté des nodules thyroïdiens indéterminés à la cytologie. Parmi eux, 252 (66 %) présentaient une NF, 47 (12 %) une NCH, 44 (12 %) une NPI, 26 (7 %) une NCA et 11 (4 %) présentaient un diagnostic mixte. Les lésions soumises à la biopsie se sont révélées malignes à l'...

Introducing the reporting system for thyroid fine-needle aspiration cytology according to the new guidelines of the Japan Thyroid Association [Review]

“…From the cytological report of indeterminate A (follicular neoplasm), surgeons and endocrinologists in Japan will apply other clinical examinations useful for decision-making in clinical management of a patient [26][27][28][29][30][31][32][33][34][35][36]. This is because FNA cytology alone did not effi-cases of follicular neoplasm, and when these 27 cases were divided into two groups (with or without atypical cells), 28.6% (2/7 cases) were malignant in the group with atypia and 10% (2/20 cases) were malignant in the other group [42].…”

“…One involves combination into a single group as follicular neoplasm, which can undergo diagnostic lobectomy for a final conclusion unselectively because cytological examination alone cannot achieve a conclusive diagnosis. This was the standard approach in most of the guidelines in Western countries [1-14, [28][29][30][31][32][33][34][35][36]. The other approach is grading of follicular neoplasms into several subcategories depending on cytological characteristics using cellular atypia, loss of cellular polarity, loss of cellular cohesiveness and structural abnormality, which may be linked to the probability of malignancy [1-14, 28-36, 59] (Figs.…”

“…The therapeutic strategy for patients with DTC in Japan differs from that in Western countries [26][27][28][29][30][31][32][33][34][35][36]. Total thyroidectomy followed by radioactive iodine (RAI) ablation has been standard therapy for DTC in Western countries, while limited thyroidectomy has been widely accepted in Japan [1- 10,[26][27][28][29][30][31][32][33][34][35][36].…”

“…Total thyroidectomy followed by radioactive iodine (RAI) ablation has been standard therapy for DTC in Western countries, while limited thyroidectomy has been widely accepted in Japan [1- 10,[26][27][28][29][30][31][32][33][34][35][36]. For PTC in the recent guidelines by the JSTS and the Japanese Association of Endocrine Surgeons (JAES), hemithyroidectomy is acceptable for T1N0M0 patients.…”

Comparison of the efficacy of three different methods of explaining the surgical procedure of hemithyroidectomy

“…Hemithyroidectomy, is an optimal and definitive surgical approach for patients with benign solitary thyroid nodules, and is also applicable as an initial procedure for patients with an indeterminate diagnosis from fine-needle aspiration biopsy. [ 5 6 ] Therefore, the aim of this study was to evaluate the efficiency of three different methods for explaining the procedure of hemithyroidectomy.…”