Evolutionary analysis of indeterminate cytology and risk of malignancy in a thyroid nodule unit
Authors' conclusion
Bethesda system reduces indeterminate cytologies and improves the accuracy of FNA diagnosis. We reported a higher proportion of malignancy than expected in Bethesda III, underscoring the importance of having institution-specific data to guide decision-making. However, there is a need for risk stratification tools that allow for conservative management in low-risk cases.
Study context
- Population
- Patients with thyroid nodules undergoing cytological evaluation in a thyroid nodule unit
- Participants
- 3,020 patients
- Exposure
- Indeterminate thyroid cytology diagnosis and management across three periods
- Outcome
- Evolution in diagnosis and management of indeterminate thyroid nodules: distribution of cytologies, risk of malignancy, FNA diagnostic performance, cytologic-histologic correlation
Methodological detailsthree time periods (2006-2008, 2012-2014, 2017-2019)
- Three time periods (2006-2008, 2012-2014, 2017-2019)
Main finding
As reported in the abstract
- Insufficient cytology
- 2.2%
- Benign cytology
- 86.9%
- Malignant cytology
- 1.7%
- Indeterminate cytology overall
- 11.4%
Observational data: associations, not effects.
Further findings
Malignancy after surgery in 'indeterminate with atypia' (2006-2008) / Bethesda IV (later periods); all operated
Diagnostic surgery in 'indeterminate without atypia' (2006-2008) / Bethesda III (later periods)
Malignancy confirmed in 'indeterminate without atypia' / Bethesda III
Surgery and malignancy in benign, malignant and suspicious cytology
- Surgery in benign cytology
- 13%
- Malignant histology after surgery for benign cytology
- 2.7%
- Malignancy confirmed, malignant cytology (all operated)
- 98%
- Malignancy confirmed, suspicious cytology (all operated)
- 77%
FNA diagnostic performance
- Sensitivity
- 91.6%
- NPV in all periods
- greater than 96%
- Specificity in the last two periods
- exceeded 75%
Original publication
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