Abstract
ObjectiveTo determine the malignancy rate in the non-diagnostic (ND) category of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) based on a different approach in relation to histopathology diagnoses.Study DesignAll ND fine needle aspirations (FNAs) that were performed under ultrasound guidance by an interventional radiologist with rapid on-site evaluation were included in the study. Slides were reevaluated to identify the cause of inadequacy as “qualitative” or “quantitative.” The malignancy rate of the ND category was assessed. Nodule/patient characteristics were compared between benign and malignant cases within the study cohort.ResultsThe study cohort consisted of 192 ND aspirations. Overall there were 156 (81.3%) women and 36 (18.7%) men with a mean age of 50.6 years (range 24–82 years). The malignancy rate was 4.7%. None of the nodules (size, consistency, and number) or patient characteristics (gender and age) were found to be predictive of malignancy.ConclusionThe malignancy rate of the ND category was high when compared to BSRTC predictions, but at the low end of the reported malignancy rates in the literature. Our results revealed that cyto-histopathologic correlation and method of malignancy rate estimation could have an effect on a wide range of reported malignancy rates. Furthermore, patient/nodule dependent factors were not statistically found to be predictive of malignancy.
Highlights
The most accurate and cost-effective combination for differentiating malignant from benign thyroid nodules is measurement of serum thyroid stimulating hormone, thyroid ultrasound, and fine-needle aspiration (FNA) [1]
The malignancy rate of the ND category was high when compared to Bethesda System for Reporting Thyroid Cytopathology (BSRTC) predictions, but at the low end of the reported malignancy rates in the literature
Our results revealed that cyto-histopathologic correlation and method of malignancy rate estimation could have an effect on a wide range of reported malignancy rates
Summary
The most accurate and cost-effective combination for differentiating malignant from benign thyroid nodules is measurement of serum thyroid stimulating hormone, thyroid ultrasound, and fine-needle aspiration (FNA) [1]. Considering FNA, obtaining inadequate specimen is a well-known limitation that is referred to as non-diagnostic (ND) according to the Bethesda System for Reporting Thyroid Cytopathology (BSRTC). Excluding samples composed exclusively of cystic content, it should be limited to less than 10% of an institution’s thyroid FNA specimens [2]. It was reported as 0.7%-23% in the literature, which is higher than the recommended percentage [1,2,3,4,5,6,7]. The American Thyroid Association (ATA) and American Association of Clinical Endocrinologists (AACE) recommend repeat FNA after an ND result. Surgical excision or close observation is considered based on sonographic pattern and accompanying clinical risk factors for repeat ND nodules [1]
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