Utility of repeat cytological assessment of thyroid nodules initially classified as benign: clinical insights from multidisciplinary care in an Irish tertiary referral centre

Abstract

BackgroundFine needle aspiration biopsy (FNAB) is the tool of choice for evaluating thyroid nodules with the majority classified as benign following initial assessment. However, concern remains about false negative results and some guidelines have recommended routine repeat aspirates. We aimed to assess the utility of routine repeat FNAB for nodules classified as benign on initial biopsy and to examine the impact of establishing a multidisciplinary team for the care of these patients.MethodsWe performed a retrospective review of 400 consecutive patients (413 nodules) who underwent FNAB of a thyroid nodule at our hospital between July 2008 and July 2011. Data recorded included demographic, clinical, histological and radiological variables.ResultsThree hundred and fifty seven patients (89 %) were female. Median follow-up was 5.5 years. Two hundred and fifty eight (63 %) nodules were diagnosed as benign. The rate of routine repeat biopsy increased significantly over the time course of the study (p for trend = 0.012). Nine Thy 2 nodules were classified differently on the basis of routine repeat biopsy; one patient was classified as malignant on repeat biopsy and was diagnosed with papillary thyroid carcinoma. Eight were classified as a follicular lesions on repeat biopsy—six diagnosed as benign following lobectomy; two declined lobectomy and were followed radiologically with no nodule size increase.ConclusionsThe false negative rate of an initial benign cytology result, from a thyroid nodule aspirate, is low. In the setting of an experienced multidisciplinary thyroid team, routine repeat aspiration is not justified.

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

“…It can be seen that exclusion of Thy1c cystic lesions does have an impact on Thy1 rates. If Thy1c cystic lesions are excluded according to the published literature the rate of Thy1 aspirates falls; in Gill et al from 26.3% to 20.9%, in Glynn et al from 15.2% to 8.7%% and in Parkinson et al from 23.3% to 12.7%.…”

“…In these 25 studies, the total number of fine needle aspirates (FNAs) was 18 920 and the overall number of Thy1 aspirates reported was 2540 (13.4%); the range of Thy1 percentages in the individual studies was 3.0%‐43.3%. In three studies (Gill et al, Glynn et al and Parkinson et al), it was possible to calculate number and/or percentage of Thy1c cystic aspirates. In the Gill et al study, the percentage of Thy1c was 5.4%, in Glynn et al 6.5% and in Parkinson et al 10.6%.…”

“…This literature review relied on the authors’ methodology as published in the relevant articles. Of the 25 studies, 22 indicated whether or not ROSE was undertaken. If ROSE was not specifically mentioned in the methods section or elsewhere in the article it was assumed that ROSE was not undertaken.…”

Risk of malignancy in the various categories of the UK Royal College of Pathologists Thy terminology for thyroid FNA cytology: A systematic review and meta‐analysis

“…Alexander [11], Mihai [12], Tysome [13], Dutta [14], Lakhani [15], Pagni [16], Wong [17], Rago [18], Brophy [19], Trombetta [20], Giusti [21], Khalil [22]. Finally, 13 articles; Agrawal [23], Dallari [24], Deandrea [25], Doddi [26], Fadda [27], Gill [28], Glynn [29], Kelly [30], Lobo [31], Mehanna [32], Montgomery [33], Mullen [34] and Parkinson [35] were included in the present systematic review and meta-analysis. These 13 studies describe a total of 3910 nodules with histological diagnosis and preoperative FNAC assessment according to The RCPath Thy terminology.…”

Papillary Thyroid Carcinoma With Cystic Changes in a Patient With Prior History of Toxic Nodule

“…If a nodule is Bethesda II, the false-negative rate is low. Glynn et al 11 studied 400 patients, 63% were benign thyroid nodules and the negative predictive value of an initial benign cytology was 99%. However, in the case presented in this article, the patient had a cytology classified as Bethesda II, and 4 years later, FNA was Bethesda III, and her histology was positive for PTC.…”