Abstract
Objectives In 2016, the American Association of Clinical Endocrinologists (AACE) and Associazione Medici Endocrinologi (AME) released updated guidelines for the diagnosis and management of thyroid nodules. The aim of this study was to evaluate the AACE/AME recommendations for FNA in clinical practice, by comparing the (US) stratification risk and indications for FNA with cytologic results. Methods From May to December 2016, we collected the cytologic results from FNAs of nodules that were classified using a three-tier US category system (low, intermediate, and high risk). Results We obtained 859 FNAs from 598 patients: 341 (39.7%) from low, 489 (56.9%) from intermediate, and 29 (3.4%) from high risk nodules. Of these, 88.5% and 74.9% of low and intermediate risk nodules, respectively, were cytologically benign, whereas 84.6% of high risk nodules had a moderate-to-elevated risk of malignancy or were malignant. If FNAs had been limited to intermediate risk nodules >20 mm, we would have missed 13/17 (76.5%) nodules that had moderate-to-elevated risk of malignancy or were malignant (11/13 were malignant based on histology). Conclusions A nonnegligible number of cytologically malignant nodules or nodules that were suspected to be malignant would be missed if intermediate US risk nodules <20 mm were not biopsied.
Highlights
Thyroid nodules are a common finding in endocrinology
The fine needle aspiration (FNA) is recommended for the following cases: “high US risk thyroid lesions ≥10 mm”; “intermediate US risk thyroid lesions >20 mm”; “low US risk thyroid lesions only when >20 mm and increasing in size or associated with a risk history Journal of Thyroid Research and before thyroid surgery or minimally invasive ablation therapy”; “subcapsular or paratracheal lesions”; “suspicious lymph nodes or extrathyroid spread”; “positive personal or family history of thyroid cancer”; and “coexistent suspicious clinical findings.”
There were 859 FNAs performed in 598 patients (493 females and 105 males), with 215/598 (36%) patients having more than one nodule biopsied
Summary
Thyroid nodules are a common finding in endocrinology. The widespread use of ultrasound (US) (unrelated to suspected thyroid disease), CT scan, MRI, and 18F-fluorodeoxyglucose has tremendously increased the number of patients suffering from a disease that is often benign and asymptomatic [1,2,3,4]. The recognition of a thyroid nodule entails a complete assessment that includes functional status (based on thyroidstimulating hormone), a dedicated thyroid US, and fine needle aspiration (FNA), when necessary [5,6,7]. The reason for these evaluations, other than discovering any possible dysfunction (often subclinical), is to rule out malignancy. The FNA is recommended for the following cases: “high US risk thyroid lesions ≥10 mm”; “intermediate US risk thyroid lesions >20 mm”; “low US risk thyroid lesions only when >20 mm and increasing in size or associated with a risk history
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