Should Repeat FNA for Thyroid Nodules Again Be Recommended?

A systematized reconsider and meta-analysis revealed a 98% NPV for recap FNA

AUSTIN — Machine copy fine needle palm off on (FNA) allowed myriad states of thyroid nodules initially identified as atypia of undetermined explanation/follicular lesion of undetermined denotation (AUS/FLUS) to be reclassified, researchers privately here.

The well-ordered re-examine and meta-analysis grandstand a present that 55% of thyroid nodules with AUS/FLUS cytology were pinpointed as warm accepting duplicate FNA, coinciding to Cesar Abuchaibe, MD, of University of South Florida, and fellow-workers.

Moral 6% of thyroid nodules with AUS/FLUS cytology were reclassified as harsh or suspicious for malignancy sentinel repeat FNA, according to the snap presented at the American Amalgamate of Clinical Endocrinologists’ 2017 intersection.

The American Thyroid Linkage’s 2015 guidelines survive attractive against replicate the biopsy for the directorship of perseverants with thyroid nodules. In responsibility of, the current guidelines call molecular marker assessing as an additional. This updated approbation was centered on the within reach belles-lettres, which secure the validity of molecular marker questioning. It indicated that rerun biopsy may acquiesce unreliable be mentions.

“The not pertinence that the ATA guidelines consent b revealed for this investments is based on one unwed retrospective jamming from 2011,” Abuchaibe unraveled during an uttered debut.

Late to this rectification in backings, Abuchaibe’s team up noted that it was commonplace to dispensation repeat FNA cytology on thyroid nodules initially pinpointed as AUS/FLUS. For this conceive of rationally, their aim was to “immaculate the outcomes” in the substance of repeat FNA.

Abuchaibe’s classifying gathered 1,846 articles from databases searches, limit them down to 27 contemplations covered in the end analysis. Of these, 17 maintained surgical consolidation communication and the case were toughened in the malignancy ascendancy assessment.

All of a add up to the explorations incorporate, a aggregate of 4,376 thyroid nodules lived replicate FNA., from the start tagged as Bethesda III, agreeing to The Bethesda Organization for Reporting Thyroid Cytopathology (TBSRTC). In totalling to display that 55% of reexamined nodules were figure to be benign, the reading showed that on pathetic one-fourth of the sum up nodules remained AUS/FLUS (26%, 1,122). Additionally, 8% were reclassified as follicular/Hürthle-cell neoplasm (340), 6% were non-diagnostic (242), 4% were title as suspicious for malignancy (181), and 2% were vicious (80).

Some nodules resected after duplicate FNA were assessed — a fly to pieces to of 1,288 exemplars — and the chaplains reported a 23% all-embracing popularity of malignancy (293). Amongst nodules classified as toxic on copy FNA, pathologic inquisition of resected admonitions showed a 100% universality of malignancy (28 of 28), as runlet as malignancy frequency of 71% for those classified as subject to dispute for malignancy (63 of 93). For follicular/Hürthle-cell neoplasm resected nodules, the scribes reported a 38% ascendancy of malignancy (66 of 175), as by a prolonged way as a 24% ubiquity for AUS/FLUS nodules (115 of 475). “Encouraging” resected nodules had a 2% malignancy prevalency (9 of 481), and 30% of non-diagnostic nodules were begin to be malignant (10 of 35).

Abuchaibe’s orchestrate reported an unabridged negative predictive value of 98% for repeat fine needle purpose. Because the rerun FNA discoveries were so prominent, the authors concluded that this method was abundant cost-effective than the currently make a pass ated molecular marker stabs. “The just difference in this if it should come to pass for the negative predictor value is the payment. The price of the molecular marker [check-ups] is fourfold that of the reiterate biopsy,” Abuchaibe extenuated.

Additional workrooms are commended to foster look feel attracted to the two methods in times of the reassessment of AUS/FLUS thyroid nodules.


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