Management of Nodules with Initially Nondiagnostic Results of Thyroid Fine-Needle Aspiration: Can We Avoid Repeat Biopsy?
Autor: | Grayson L. Baird, John J. Cronan, Thomas J. T. Anderson, Michael K. Atalay, David J. Grand, Michael D. Beland |
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Rok vydání: | 2014 |
Předmět: |
Adult
Male medicine.medical_specialty Adolescent Unnecessary Procedures Malignancy Sensitivity and Specificity Young Adult medicine Humans Radiology Nuclear Medicine and imaging Thyroid Nodule Child skin and connective tissue diseases Endoscopic Ultrasound-Guided Fine Needle Aspiration False Negative Reactions neoplasms Aged Aged 80 and over medicine.diagnostic_test Repeat biopsy business.industry Thyroid Reproducibility of Results Middle Aged medicine.disease body regions surgical procedures operative medicine.anatomical_structure Fine-needle aspiration Female Radiology business |
Zdroj: | Radiology. 272:777-784 |
ISSN: | 1527-1315 0033-8419 |
Popis: | To identify demographic and ultrasonographic (US) features associated with malignancy after initially nondiagnostic results of fine-needle aspiration (FNA) to help clarify the role of repeat FNA, surgical excision, or serial US in these nodules.This study was HIPAA compliant and institutional review board approved; informed consent was waived. Thyroid nodules (n = 5349) that underwent US-guided FNA in 2004-2012 were identified; 393 were single nodules with nondiagnostic FNA results but adequate cytologic, surgical, or US follow-up. Demographic information and diameters and volume at US at first biopsy were modeled with malignancy as outcome through medical record review. Exact logistic regression was used to model malignancy outcomes, demographic comparisons with age were made (Student t test, Satterthwaite test), and proportion confidence intervals (CIs) were estimated (Clopper-Pearson method).Of 393 nodules with initially nondiagnostic results, nine malignancies (2.3%) were subsequently diagnosed with repeat FNA (n = 2, 0.5%) or surgical pathologic examination (n = 7, 1.8%), 330 (84.0%) were benign, and 54 (13.7%) were stable or decreased in size at serial US (mean follow-up, 3.0 years; median, 2.5 years; range, 1.0-7.8 years). Patients with malignancies were significantly older (mean age, 62.7 years; median, 64 years; range, 47-77 years) than those without (mean age, 55.4 years; median, 57 years; range, 12-94 years; P = .0392). Odds of malignancy were 4.2 times higher for men versus women (P = .045) and increased significantly for each 1-cm increase in anteroposterior, minimum, and mean nodule diameter (1.78, 2.10, and 1.96, respectively). In 393 nodules, no malignancies were detected in cystic or spongiform nodules (both, n = 11, 2.8%; 95% CI: 1.4%, 5.0%), nodules with eggshell calcifications (n = 9, 2.3%; 95% CI: 1.1%, 4.3%), or indeterminate echogenic foci (n = 39, 9.9%; 95% CI: 7.2%, 13.3%).Very few malignancies were diagnosed with repeat FNA following nondiagnostic FNA results (two of 336, 0.6%); therefore, clinical and US follow-up may be more appropriate than repeat FNA following nondiagnostic biopsy results. |
Databáze: | OpenAIRE |
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