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Repeat Diagnoses of Bethesda Category III Thyroid Nodules: What To Do Next?

Yoo MR, Gweon HM, Park AY, Cho KE, Kim JA, Youk JH, Son EJ - PLoS ONE (2015)

Bottom Line: There were 67 nodules classified a second time as Bethesda category III on repeat FNA.And in the repeat Bethesda III group, clinicopathologic and US variables were compared between benign and malignant nodules.However, none of the variables were significantly different between the initial Bethesda category III group and the repeat Bethesda category III group (p > 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.

ABSTRACT

Objectives: To assess the malignancy rates of thyroid nodules repeatedly classified as Bethesda category III on fine needle aspiration (FNA), and to suggest management guidelines for these lesions.

Methods: This is a retrospective study that included 395 thyroid nodules categorized as Bethesda III undergone either surgery or ultrasound (US) follow-up. There were 67 nodules classified a second time as Bethesda category III on repeat FNA. We compared malignancy rates, clinicopathologic and ultrasonographic characteristics between direct surgery and repeat FNA groups and between the initial and repeat Bethesda category III groups, each. And in the repeat Bethesda III group, clinicopathologic and US variables were compared between benign and malignant nodules.

Results: Incidence of concurrent cancer, underlying thyroiditis and positive BRAF mutation were significantly higher in 142 nodules with direct surgery than 243 nodules with repeat FNA (p < 0.05). Of the 395 nodules with Bethesda category III cytology on initial FNA, the malignancy rate was 59.5%. In 67 nodules with repeat Bethesda III classification, however, the malignancy rate was 73.1% (p < 0.05). However, none of the variables were significantly different between the initial Bethesda category III group and the repeat Bethesda category III group (p > 0.05). In the repeat Bethesda category III group, solid consistency, irregular/microlobulated margins, nonparallel shape, and number of suspicious findings or "suspicious malignant" US assessments were associated with a high malignancy rate (p < 0.05). On multivariate logistic regression analysis, the factor associated with malignancy in the repeat Bethesda category III group was irregular/microlobulated margin (odds ratio = 15.576; 95% CI, 2.097-115.6804, p = 0.007) with a sensitivity, specificity, positive and negative predictive values, and accuracy of 81.6%, 83.3%, 93.0%, 62.5% and 82.1%, respectively.

Conclusion: Thyroid nodules with repeated Bethesda category III classification and irregular/microlobulated margins on US are at increased risk of malignancy, and operative management should be considered as opposed to repeat FNA.

No MeSH data available.


Related in: MedlinePlus

Diagnostic outcomes of 772 thyroid nodules with Bethesda category III cytology.f/u, follow-up; US, ultrasound; FNA, fine needle aspiration.
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pone.0130138.g001: Diagnostic outcomes of 772 thyroid nodules with Bethesda category III cytology.f/u, follow-up; US, ultrasound; FNA, fine needle aspiration.

Mentions: Among the 395 thyroid nodules classified as Bethesda category III on initial FNA, 234 (59.2%) were diagnosed as malignant on surgical histopathology. Of these 395 nodules, 142 (35.9%) underwent direct surgery and 243 (61.5%) underwent repeat FNA. When comparing clinicopathologic and US features between the direct surgery group and the repeat FNA group, incidence of concurrent cancer, underlying thyroiditis and positive BRAF mutation were significantly higher in direct surgery group (p < 0.05) (Table 1). Of the 243 nodules undergone second FNA, 42.8% (104/243) were Bethesda category II, 27.6% (67/243) were Bethesda III, and 29.6% (72/243) were Bethesda category IV, V, or VI (Fig 1).


Repeat Diagnoses of Bethesda Category III Thyroid Nodules: What To Do Next?

Yoo MR, Gweon HM, Park AY, Cho KE, Kim JA, Youk JH, Son EJ - PLoS ONE (2015)

Diagnostic outcomes of 772 thyroid nodules with Bethesda category III cytology.f/u, follow-up; US, ultrasound; FNA, fine needle aspiration.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482684&req=5

pone.0130138.g001: Diagnostic outcomes of 772 thyroid nodules with Bethesda category III cytology.f/u, follow-up; US, ultrasound; FNA, fine needle aspiration.
Mentions: Among the 395 thyroid nodules classified as Bethesda category III on initial FNA, 234 (59.2%) were diagnosed as malignant on surgical histopathology. Of these 395 nodules, 142 (35.9%) underwent direct surgery and 243 (61.5%) underwent repeat FNA. When comparing clinicopathologic and US features between the direct surgery group and the repeat FNA group, incidence of concurrent cancer, underlying thyroiditis and positive BRAF mutation were significantly higher in direct surgery group (p < 0.05) (Table 1). Of the 243 nodules undergone second FNA, 42.8% (104/243) were Bethesda category II, 27.6% (67/243) were Bethesda III, and 29.6% (72/243) were Bethesda category IV, V, or VI (Fig 1).

Bottom Line: There were 67 nodules classified a second time as Bethesda category III on repeat FNA.And in the repeat Bethesda III group, clinicopathologic and US variables were compared between benign and malignant nodules.However, none of the variables were significantly different between the initial Bethesda category III group and the repeat Bethesda category III group (p > 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.

ABSTRACT

Objectives: To assess the malignancy rates of thyroid nodules repeatedly classified as Bethesda category III on fine needle aspiration (FNA), and to suggest management guidelines for these lesions.

Methods: This is a retrospective study that included 395 thyroid nodules categorized as Bethesda III undergone either surgery or ultrasound (US) follow-up. There were 67 nodules classified a second time as Bethesda category III on repeat FNA. We compared malignancy rates, clinicopathologic and ultrasonographic characteristics between direct surgery and repeat FNA groups and between the initial and repeat Bethesda category III groups, each. And in the repeat Bethesda III group, clinicopathologic and US variables were compared between benign and malignant nodules.

Results: Incidence of concurrent cancer, underlying thyroiditis and positive BRAF mutation were significantly higher in 142 nodules with direct surgery than 243 nodules with repeat FNA (p < 0.05). Of the 395 nodules with Bethesda category III cytology on initial FNA, the malignancy rate was 59.5%. In 67 nodules with repeat Bethesda III classification, however, the malignancy rate was 73.1% (p < 0.05). However, none of the variables were significantly different between the initial Bethesda category III group and the repeat Bethesda category III group (p > 0.05). In the repeat Bethesda category III group, solid consistency, irregular/microlobulated margins, nonparallel shape, and number of suspicious findings or "suspicious malignant" US assessments were associated with a high malignancy rate (p < 0.05). On multivariate logistic regression analysis, the factor associated with malignancy in the repeat Bethesda category III group was irregular/microlobulated margin (odds ratio = 15.576; 95% CI, 2.097-115.6804, p = 0.007) with a sensitivity, specificity, positive and negative predictive values, and accuracy of 81.6%, 83.3%, 93.0%, 62.5% and 82.1%, respectively.

Conclusion: Thyroid nodules with repeated Bethesda category III classification and irregular/microlobulated margins on US are at increased risk of malignancy, and operative management should be considered as opposed to repeat FNA.

No MeSH data available.


Related in: MedlinePlus