Low Malignancy Rates in Fine-Needle Aspiration Cytologies in a Primary Care Setting in Germany

Autor: Bassam Amro, Katharina Böhme, Maha Ullmann, Günther Klaushenke, Dieter Graf, Fabian Görke, Gerald Kluge, Gregor Tönshoff, Ralf Paschke, Markus Eszlinger, Eberhard Bell, Thomas Molwitz, Christoph Hartenstein, Berit Feldmann, Christian Landvogt, Andreas Kögler, Catharina Bullmann, Sabine Adam, Ilka Ruschenburg, Antje Wefer, Reinhard Santen, Velimir Ivancevic, Bernd Lorenz, Rainer Niemann, Christiane Franzius, Anja Hach
Rok vydání: 2017
Předmět:
Thyroid nodules
Adult
Male
medicine.medical_specialty
Adolescent
Endocrinology
Diabetes and Metabolism
Bethesda system
Biopsy
Fine-Needle
030209 endocrinology & metabolism
Malignancy
03 medical and health sciences
Young Adult
0302 clinical medicine
Endocrinology
Predictive Value of Tests
Risk Factors
Cytology
Germany
medicine
Humans
False Positive Reactions
Thyroid Neoplasms
Thyroid Nodule
Child
Radionuclide Imaging
Aged
Retrospective Studies
Ultrasonography
Aged
80 and over
medicine.diagnostic_test
Primary Health Care
business.industry
Cysts
General surgery
Thyroid
Reproducibility of Results
Retrospective cohort study
Nodule (medicine)
Middle Aged
medicine.disease
Prognosis
body regions
medicine.anatomical_structure
Fine-needle aspiration
030220 oncology & carcinogenesis
Female
Radiology
medicine.symptom
business
Zdroj: Thyroid : official journal of the American Thyroid Association. 27(11)
ISSN: 1557-9077
Popis: Reported results for thyroid nodule fine-needle aspiration (FNA) cytology mainly originate from tertiary centers. However, thyroid nodule FNA cytology is mainly performed in primary care settings for which the distribution of FNA Bethesda categories and their respective malignancy rates are largely unknown. Therefore, this study investigated FNA cytology malignancy rates of a large primary care setting to determine to what extent current evidence-based strategies for the malignancy risk stratification of thyroid nodules are applied and applicable in such primary care settings.In a primary care setting, 9460 FNAs of thyroid nodules were retrospectively analyzed from 8380 patients evaluated by one cytologist (I.R.) during a period of two years. The 8380 FNA cytologies were performed by 64 physicians in different private practices throughout Germany in primary care settings.The cytopathologic results were classified according to the Bethesda System as non-diagnostic in 19%, cyst/cystic nodule in 21%, benign (including thyroiditis) in 48%, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 6%, follicular neoplasms/suspicious for follicular neoplasm (FN/SFN) in 4%, suspicious for malignancy (SFM) in 1%, and malignant in 1%. The proportion of patients proceeding to surgery or with a follow-up of at least one year and the observed risks of malignancy were 22%/8% for AUS/FLUS, 69%/17% for FN/SFN, 78%/86% for SFM, and 71%/98% for malignant. For 112 cytologically suspicious and malignant FNAs, there were 102 true positives and 10 false positives, considering histology as gold standard.At variance with other data mostly originating from tertiary centers, these data demonstrate low percentages for malignant, SFM, FN/SFN, and AUS/FLUS, and high percentages for cysts/cystic nodules in this primary care setting in Germany. The risks of malignancy for malignant, SFM, AUS/FLUS, and FN/SFN FNA cytologies are according to Bethesda recommendations.
Databáze: OpenAIRE
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