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The role of repeat fine needle aspiration in the management of indeterminate thyroid nodules

BACKGROUND: Management decisions are not straightforward when the Ultrasound Guided Fine Needle Aspiration (USFNA) demonstrates a Bethesda score of either category III or IV, and a diagnostic hemi-thyroidectomy or a repeat USFNA (r-USFNA) could be performed. The aim of this study is to assess the ef...

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Autores principales: Jooya, Alborz, Saliba, Joe, Blackburn, Audrey, Tamilia, Michael, Hier, Michael P., Mlynarek, Alex, Forest, Véronique-Isabelle, Rochon, Louise, Florea, Anca, Wang, Hangjun, Payne, Richard J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070180/
https://www.ncbi.nlm.nih.gov/pubmed/27756425
http://dx.doi.org/10.1186/s40463-016-0164-0
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author Jooya, Alborz
Saliba, Joe
Blackburn, Audrey
Tamilia, Michael
Hier, Michael P.
Mlynarek, Alex
Forest, Véronique-Isabelle
Rochon, Louise
Florea, Anca
Wang, Hangjun
Payne, Richard J.
author_facet Jooya, Alborz
Saliba, Joe
Blackburn, Audrey
Tamilia, Michael
Hier, Michael P.
Mlynarek, Alex
Forest, Véronique-Isabelle
Rochon, Louise
Florea, Anca
Wang, Hangjun
Payne, Richard J.
author_sort Jooya, Alborz
collection PubMed
description BACKGROUND: Management decisions are not straightforward when the Ultrasound Guided Fine Needle Aspiration (USFNA) demonstrates a Bethesda score of either category III or IV, and a diagnostic hemi-thyroidectomy or a repeat USFNA (r-USFNA) could be performed. The aim of this study is to assess the effectiveness of r-USFNA in the management of indeterminate thyroid nodules by evaluating the likelihood of obtaining a definite diagnosis. METHODS: We reviewed the medical records of all patients with thyroid nodules between 2011 and 2015 at the Jewish General Hospital (Montreal, Canada). Three hundred fifty-one patients who had undergone a surgical procedure (hemi or total thyroidectomy) and a diagnosis of B3 or B4 on the primary USFNA (p-USFNA) were included in the study. Ninety-six of the included patients also had a repeat USFNA prior to the surgery. Demographic data, type of procedure, and McGill Thyroid Nodule Score (MTNS) were obtained from the medical records. Malignancy rates were calculated based on the final surgical histopathology report. RESULTS: Upon r-USFNA, an average 76 % of patients did not change Bethesda categories, 7.4 % downgraded to a benign category. The results showed that, on an average 17.3 % of patients with p-USFNA of B3 and 20 % of patients with p-USFNA of B4, upgraded to a malignant or suspicious for malignancy category, thus changing the clinical management to total thyroidectomy. Our data demonstrates that r-USFNA facilitates choosing the correct surgery of total thyroidectomy in about 20 % of nodules that have upgraded from B3/B4 to a more definite malignant category. CONCLUSIONS: r-USFNA in patients with indeterminate diagnoses (B3 or B4) increases categorization into more definite categories. Approximately 20 % of patients are found to have malignant thyroid nodules and suspicious for malignancy thyroid nodules upon repeating the biopsy, hence a diagnostic hemi-thyroidectomy was avoided and a more definitive surgery could be performed. Furthermore, repeat USFNA results in a fewer number of hemi-thyroidectomy and completion thyroidectomy procedures.
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spelling pubmed-50701802016-10-24 The role of repeat fine needle aspiration in the management of indeterminate thyroid nodules Jooya, Alborz Saliba, Joe Blackburn, Audrey Tamilia, Michael Hier, Michael P. Mlynarek, Alex Forest, Véronique-Isabelle Rochon, Louise Florea, Anca Wang, Hangjun Payne, Richard J. J Otolaryngol Head Neck Surg Original Research Article BACKGROUND: Management decisions are not straightforward when the Ultrasound Guided Fine Needle Aspiration (USFNA) demonstrates a Bethesda score of either category III or IV, and a diagnostic hemi-thyroidectomy or a repeat USFNA (r-USFNA) could be performed. The aim of this study is to assess the effectiveness of r-USFNA in the management of indeterminate thyroid nodules by evaluating the likelihood of obtaining a definite diagnosis. METHODS: We reviewed the medical records of all patients with thyroid nodules between 2011 and 2015 at the Jewish General Hospital (Montreal, Canada). Three hundred fifty-one patients who had undergone a surgical procedure (hemi or total thyroidectomy) and a diagnosis of B3 or B4 on the primary USFNA (p-USFNA) were included in the study. Ninety-six of the included patients also had a repeat USFNA prior to the surgery. Demographic data, type of procedure, and McGill Thyroid Nodule Score (MTNS) were obtained from the medical records. Malignancy rates were calculated based on the final surgical histopathology report. RESULTS: Upon r-USFNA, an average 76 % of patients did not change Bethesda categories, 7.4 % downgraded to a benign category. The results showed that, on an average 17.3 % of patients with p-USFNA of B3 and 20 % of patients with p-USFNA of B4, upgraded to a malignant or suspicious for malignancy category, thus changing the clinical management to total thyroidectomy. Our data demonstrates that r-USFNA facilitates choosing the correct surgery of total thyroidectomy in about 20 % of nodules that have upgraded from B3/B4 to a more definite malignant category. CONCLUSIONS: r-USFNA in patients with indeterminate diagnoses (B3 or B4) increases categorization into more definite categories. Approximately 20 % of patients are found to have malignant thyroid nodules and suspicious for malignancy thyroid nodules upon repeating the biopsy, hence a diagnostic hemi-thyroidectomy was avoided and a more definitive surgery could be performed. Furthermore, repeat USFNA results in a fewer number of hemi-thyroidectomy and completion thyroidectomy procedures. BioMed Central 2016-10-18 /pmc/articles/PMC5070180/ /pubmed/27756425 http://dx.doi.org/10.1186/s40463-016-0164-0 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Research Article
Jooya, Alborz
Saliba, Joe
Blackburn, Audrey
Tamilia, Michael
Hier, Michael P.
Mlynarek, Alex
Forest, Véronique-Isabelle
Rochon, Louise
Florea, Anca
Wang, Hangjun
Payne, Richard J.
The role of repeat fine needle aspiration in the management of indeterminate thyroid nodules
title The role of repeat fine needle aspiration in the management of indeterminate thyroid nodules
title_full The role of repeat fine needle aspiration in the management of indeterminate thyroid nodules
title_fullStr The role of repeat fine needle aspiration in the management of indeterminate thyroid nodules
title_full_unstemmed The role of repeat fine needle aspiration in the management of indeterminate thyroid nodules
title_short The role of repeat fine needle aspiration in the management of indeterminate thyroid nodules
title_sort role of repeat fine needle aspiration in the management of indeterminate thyroid nodules
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070180/
https://www.ncbi.nlm.nih.gov/pubmed/27756425
http://dx.doi.org/10.1186/s40463-016-0164-0
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