Thyroid Nodule 101: What are the risk of cancer with a negative cytology but the presence of three suspicious ultrasound features? 5% vs <1% means there is a need for a second biopsy.
PLoS ONE 8(5): e63834. doi:10.1371/journal.pone.0063834
Yoon Jung Choi et al
- Management for thyroid nodules with benign cytology using US features from data collected from 7 institutions.
- 700 focal thyroid nodules in 673 consecutive patients were collected from 7 university-affiliated hospitals.
- This study included nodules that were diagnosed as benign at initial cytologic evaluation and that underwent pathologic or follow-up study.
- The risk of malignancy was compared according to the US assessments of each institution as well as looking at all the nodules together as a whole.
- Of the 700 nodules, 688 (98.3%) were benign and 12 (1.7%) were malignant.
- If initial cytologic results were benign, the likelihood of the nodule actually being malignant was from 1 to 3%, varying by institution.
- The likelihood of a cytologically benign nodule with positive US being malignant (4.7%, 8/169) was higher than that of one without positive US (0.8%, 4/531) (P = .002).
- Based on our multicenter study, repeat FNA should be performed in thyroid nodules with initial benign cytology showing suspicious US features in order to decrease the number of false negative cases
- Suspicious malignant gray scale US features included marked hypoechogenicity,
- and taller than wide shape.
- When thyroid nodules showed one or more of the above suspicious malignant gray scale US features, they were assessed as ‘‘positive’’. When thyroid nodules showed no suspicious features, they were assessed as ‘‘negative’’ [15,17–19,21].
- In conclusion, based on our multicenter study, repeat FNA should be performed in thyroid nodules with initial benign cytology showing suspicious US features in order to decrease the number of false negative cases.
- Great study and it leaves you knowing the risk for cancer is higher if there are these ultrasound features and a benign cytology.
- Richard Guttler MD,FACE,ECNU