The Diagnostic Utility of Repeat Fine-needle Aspirations of Benign Thyroid Nodules.

IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Rachelle Mendoza, Richard Cody Simon, Nicole A Cipriani, Tatjana Antic
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Abstract

Objective This study aims to analyze the diagnostic utility of multiple repeat FNA on thyroid nodules with initially benign diagnosis. Methods In a 5-year period, 1658 thyroid nodules with initially benign FNAs were retrospectively reviewed and followed for subsequent resection and repeat biopsy. Results Out of 2150 thyroid nodules, 1658 (77.1%) were diagnosed as benign on FNAs. The average age was 57.4 years (range 11-93 years), and most were females (83.8%). Repeat FNA was performed on 183 benign nodules, of which 141 (8.5%) were sampled a second time and 42 (2.5%) had 2 or more repeat samplings. For the benign nodules without repeat FNAs, 124 had benign resection. Of cases with one-time repeat FNA, most (n=101) remained benign on repeat FNAs, 13 of which were benign on resection. Eleven had atypical repeat FNAs, 5 were resected, 4 of which were benign and one was atypical follicular neoplasm with HRAS and TERT promoter mutations. Of cases with multiple repeat FNA, most (n=35) were still benign on repeat FNAs, one had benign resection. Two had atypical repeat biopsies, one was PTC on resection with CCD6::RET fusion. The positive predictive value significantly decreased from 41.1% on single FNA to 8.3% on one-time repeat (p<0.001) and 16.7% on multiple repeat (p=0.002). The total cost for workup of previously benign nodules was $285,454. Conclusions Repeat FNA biopsies did not provide an additional diagnostic value in the evaluation of benign thyroid nodules, and often led to unwarranted follow-up procedures and significantly increased health care cost.

重复甲状腺良性结节细针穿刺的诊断作用
目的 本研究旨在分析对最初诊断为良性的甲状腺结节进行多次重复 FNA 的诊断效用。方法 对 5 年内 1658 个最初为良性 FNA 的甲状腺结节进行回顾性研究,并对随后的切除和重复活检进行跟踪。结果 在 2150 个甲状腺结节中,1658 个(77.1%)经 FNA 诊断为良性。患者平均年龄为 57.4 岁(11-93 岁不等),大多数为女性(83.8%)。对 183 个良性结节进行了重复 FNA,其中 141 个(8.5%)进行了第二次取样,42 个(2.5%)进行了 2 次或更多次重复取样。在没有重复 FNA 的良性结节中,124 个进行了良性切除。在一次性重复 FNA 的病例中,大多数(n=101)在重复 FNA 时仍为良性,其中 13 例在切除时为良性。11例非典型重复FNA,5例切除,其中4例为良性,1例为HRAS和TERT启动子突变的非典型滤泡性肿瘤。在多次重复 FNA 的病例中,大多数(n=35)在重复 FNA 时仍为良性,1 例良性切除。2例重复活检结果不典型,1例切除后为PTC,伴有CCD6::RET融合。阳性预测值从单次 FNA 的 41.1%大幅下降到一次性重复活检的 8.3%(p
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来源期刊
European Thyroid Journal
European Thyroid Journal Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
6.70
自引率
2.10%
发文量
156
期刊介绍: The ''European Thyroid Journal'' publishes papers reporting original research in basic, translational and clinical thyroidology. Original contributions cover all aspects of the field, from molecular and cellular biology to immunology and biochemistry, from physiology to pathology, and from pediatric to adult thyroid diseases with a special focus on thyroid cancer. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research. The journal will further publish formal guidelines in the field, produced and endorsed by the European Thyroid Association.
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