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Evolutionary analysis of indeterminate cytology and risk of malignancy in a thyroid nodule unit.
Alvarez-Mancha, Ana Isabel; Mancha-Doblas, Isabel; Molina-Vega, María; Fernández-García, Diego; Gómez-Pérez, Ana María; Gallego, Elena; Ortega-Jiménez, María Victoria; Hierro-Martín, Isabel; Tinahones, Francisco J.
Afiliación
  • Alvarez-Mancha AI; A Alvarez-Mancha, Department of Medicine, University of Malaga, 29010 Malaga, Spain. b, University of Malaga, Malaga, Spain.
  • Mancha-Doblas I; I Mancha-Doblas, Department of Medicine, University of Malaga, 29010 Malaga, Spain. , University of Malaga, Malaga, Spain.
  • Molina-Vega M; M Molina-Vega, Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain, University Hospital Virgen de la Victoria, Malaga, Spain.
  • Fernández-García D; D Fernández-García, Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain, University Hospital Virgen de la Victoria, Malaga, Spain.
  • Gómez-Pérez AM; A Gómez-Pérez, Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain, University Hospital Virgen de la Victoria, Malaga, Spain.
  • Gallego E; E Gallego, Department of Medicine, University of Malaga, 29010 Malaga, Spain, University of Malaga, Malaga, Spain.
  • Ortega-Jiménez MV; M Ortega-Jiménez , Department of Medicine, University of Malaga, 29010 Malaga, Spain, University of Malaga, Malaga, Spain.
  • Hierro-Martín I; I Hierro-Martín, Department of Pathology, Virgen de la Victoria University Hospital, University Hospital Virgen de la Victoria, Malaga, Spain.
  • Tinahones FJ; F Tinahones, Department of Medicine, University of Malaga, 29010 Malaga, Spain, University of Malaga, Malaga, Spain.
Eur Thyroid J ; 2024 May 01.
Article en En | MEDLINE | ID: mdl-38743822
ABSTRACT

OBJECTIVE:

The objective of this study was to analyze the evolution in the diagnosis and management of indeterminate thyroid nodules over three time periods.

METHODS:

3020 patients with thyroid nodules underwent cytological evaluation during three periods (2006-2008, 2012-2014, 2017-2019). Distribution of diagnostic cytologies, risk of malignancy, diagnostic performance indices of FNA, and cytologic-histologic correlation in indeterminate cytologies were analyzed.

RESULTS:

only 2.2% of cytology tests were insufficient for a diagnosis. 86.9% cytologies were benign, 1.7% malignant, and 11.4% indeterminate. Indeterminate cytology rates were 15.9% (2006-2008), 10.1% (2012-2014), and 10% (2017-2019). Surgery was performed in 13% of benign cytology, result-ing in malignant histology in 2.7%. All malignant and suspicious cytologies underwent surgery malig-nancy confirmed in 98% and 77% of cases, respectively. All 'indeterminate with atypia' cytologies (2006-2008) and Bethesda IV (2012-2014; 2017-2019) un-derwent surgery, with malignancy confirmed in 19.6%, 43.8%, and 25.7%, respectively. In the 'inde-terminate without atypia' category (2006-2008) and Bethesda III (2012-2014; 2017-2019), diagnostic surgery was performed in 57.7%, 78.6%, and 59.4%, respectively, with malignancy confirmed in 3.3%, 20.5%, and 31.6%. The FNA sensitivity was 91.6% with a negative predictive value greater than 96% in all periods. The specificity exceeded 75% in the last two periods.

CONCLUSION:

Bethesda system reduces indeterminate cytologies and improves the accuracy of FNA diagnosis. We reported a higher proportion of malignancy than expected in Bethesda III, underscoring the importance of having institution-specific data to guide decision-making. However, there is a need for risk stratification tools that allow for conservative management in low-risk cases.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Eur Thyroid J Año: 2024 Tipo del documento: Article País de afiliación: España Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Eur Thyroid J Año: 2024 Tipo del documento: Article País de afiliación: España Pais de publicación: Reino Unido