Is fine needle aspiration really not necessary in patients with thyroid nodules ≤ 1 cm with highly suspicious features on ultrasonography and candidates for active surveillance?

Rosário, Pedro Weslley; Silva, Alexandre Lemos; Calsolari, Maria Regina

doi:10.1002/dc.23673

Cited by 6 publications

(4 citation statements)

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“…In a Brazilian study on thyroid nodules 1 cm or less showing highly suspicious US features, which were apparently restricted to the thyroid, FNA was recommended before a decision on active surveillance. 12 Nevertheless, as described in our results, sub-centimetre nodules are associated with higher rates of unsatisfactory FNA sampling. 13 Therefore, more than one attempt should be made to define the nature of these particular nodules.…”

Section: Re Sultssupporting

confidence: 63%

Thyroid nodules 1 cm or less are related to Bethesda System nondiagnostic and suspicious for malignancy categories

2020

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There were 576 000 new cases of thyroid cancer worldwide in 2018. 1 In Brazil, it was estimated that in 2020 there will be 13 780 new cases of malignant thyroid neoplasia. 2 The increasing worldwide incidence is likely due to the evolution of screening methods and early diagnosis. 3 Frequently related factors are age, gender, exposure to radiation, and lack of iodine intake. 4,5 According to the American Thyroid Association, fine needle aspiration (FNA) is recommended for nodules 1 cm or greater with high or intermediate suspicion on ultrasound (US), for nodules 1.5 cm or greater with a low suspicious pattern on US, and even for nodules 2 cm or greater with a very low suspicious pattern on US. Sub-centimetre nodules generally do not require FNA evaluation and cytological investigation. 6 The European Thyroid Association recommends active surveillance for sub-centimetre nodules with at least one feature of high suspicion and the absence of abnormal lymph nodes. They also recommend FNA for nodules greater than 1 cm with high-risk features; however, there is no specific information for nodules measuring exactly 1 cm. 7 According to the Brazilian consensus, FNA is not indicated

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Section: Re Sultssupporting

confidence: 63%

Thyroid nodules 1 cm or less are related to Bethesda System nondiagnostic and suspicious for malignancy categories

2020

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“…At our institution, nodules with highly suspicious features on ultrasonography (US) are always submitted to FNA (irrespective of size) and the latter is repeated when cytology is commenced [3, 4]. We revised 181 patients with 198 nodules ≤1 cm that were highly suspicious and apparent ly restricted to the thyroid on US [5]. The initial cytology was benign in 76 nodules (38.4%), in which the repetition of FNA confirmed the benign nature in 59 (29.8%).…”

mentioning

confidence: 99%

“…The initial cytology was benign in 76 nodules (38.4%), in which the repetition of FNA confirmed the benign nature in 59 (29.8%). Thus, FNA changed the “presumptive” diagnosis of PMT in 30% of the nodules [5]. …”

mentioning

confidence: 99%

Nodules ≤1 cm with Highly Suspicious Ultrasound Features and Papillary Microcarcinoma of the Thyroid: Is Fine-Needle Aspiration Cytology Necessary before Deciding on Active Surveillance?

Rosário

2018

Eur Thyroid J

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“…Also, among those inconsistent cases (false negative: cytological category of benign, but histologically malignant), PTMC accounted for the majority of cases 14. Rosario et al recently specifically addressed the FNA results for a subgroup of “highly suspicious” thyroid nodules (≤10 mm, highly suspicious US features, restricted to the thyroid) in patients who are candidates for active surveillance according to ATA 29. They reviewed a total of 198 nodules and found a very high rate of malignancy on histology for nodules with suspicious/malignant (100%) and indeterminate (81.4%) cytology results.…”

Section: Discussionmentioning

confidence: 99%

<p>Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules <10 mm in the maximum diameter: does size matter?</p>

Lyu¹,

Shen²,

Yan³

et al. 2019

CMAR

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ObjectiveUltrasound-guided fine-needle aspiration biopsy (US-FNAB) is a safe and effective method of screening malignant thyroid nodules such as papillary thyroid carcinoma. However, not much data are available regarding the diagnostic efficacy of US-FNAB for papillary thyroid microcarcinoma (≤10 mm in diameter). We aim to compare the diagnostic efficacy of US-FNAB on thyroid nodules between two groups divided by a diameter of 10 mm by correlating the cytological results of US-FNAB with the histopathologic diagnoses in selected patients.Patients and methodsEight hundred twenty-two thyroid nodules (Group A: diameter ≤10 mm, n=620; Group B: diameter >10 mm, n=202) from 797 patients treated between March 2014 and June 2017 were retrospectively evaluated. Only nodules with Thyroid Imaging Reporting and Data System (TIRADS) categories 4–6 were enrolled and sampled by US-FNAB, followed by surgical resection.ResultsAccording to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) diagnostic categories, 94 thyroid nodules were classified as I, III and IV, and were excluded from the analysis. The resultant 728 thyroid nodules from 721 patients were analyzed. The malignant tendency (TBSRTC V and VI) rates on US-FNAB were 88.2% and 84.6% (P=0.202) in Group A and Group B, respectively, and the malignant rates were 89.5% and 86.9% (P=0.330), respectively, on histopathology. There was a high concordance between cytology and histopathology diagnoses (kappa value =0.797), and no statistical difference in terms of US-FNAB accuracy was found between the two groups (P=0.533).ConclusionFor thyroid nodules of TIRADS category 4–6, the diagnostic efficacy of US-FNAB is similar for thyroid nodules either smaller or greater than 10 mm in their maximum diameter.

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Is fine needle aspiration really not necessary in patients with thyroid nodules ≤ 1 cm with highly suspicious features on ultrasonography and candidates for active surveillance?

Abstract: FNA changed the "presumptive" diagnosis of PMT in 30% of nodules. Diagn. Cytopathol. 2017;45:294-296. © 2016 Wiley Periodicals, Inc.

Cited by 6 publications

References 10 publications

Thyroid nodules 1 cm or less are related to Bethesda System nondiagnostic and suspicious for malignancy categories

Thyroid nodules 1 cm or less are related to Bethesda System nondiagnostic and suspicious for malignancy categories

Nodules ≤1 cm with Highly Suspicious Ultrasound Features and Papillary Microcarcinoma of the Thyroid: Is Fine-Needle Aspiration Cytology Necessary before Deciding on Active Surveillance?

<p>Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules <10 mm in the maximum diameter: does size matter?</p>

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Is fine needle aspiration really not necessary in patients with thyroid nodules ≤ 1 cm with highly suspicious features on ultrasonography and candidates for active surveillance?

Abstract: FNA changed the "presumptive" diagnosis of PMT in 30% of nodules. Diagn. Cytopathol. 2017;45:294-296. © 2016 Wiley Periodicals, Inc.

Cited by 6 publications

References 10 publications

Thyroid nodules 1 cm or less are related to Bethesda System nondiagnostic and suspicious for malignancy categories

Thyroid nodules 1 cm or less are related to Bethesda System nondiagnostic and suspicious for malignancy categories

Nodules ≤1 cm with Highly Suspicious Ultrasound Features and Papillary Microcarcinoma of the Thyroid: Is Fine-Needle Aspiration Cytology Necessary before Deciding on Active Surveillance?

<p>Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules &lt;10 mm in the maximum diameter: does size matter?</p>

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<p>Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules <10 mm in the maximum diameter: does size matter?</p>