Improving prediction of malignancy of cytologically indeterminate thyroid nodules.
BACKGROUND
Fine-needle aspiration (FNA) is essential in the investigation of thyroid nodules. The British Thyroid Association guidelines recommend clarification of whether follicular nodules are probable follicular neoplasms that require surgical excision. This study assessed the value of the subclassification of cytologically indeterminate thyroid nodules into either follicular neoplasms or other pathology.


METHODS
The cytology reports of all thyroid FNAs performed between November 2005 and December 2007 at a single institution reported as Thy 3 (follicular lesions) were reviewed. They were reclassified as Thy 3A (probable follicular neoplasm) or Thy 3B (probable non-neoplastic lesion), and subsequently correlated with final clinical outcome to determine the predictive value of this subclassification.


RESULTS
Forty-nine specimens were categorized as Thy 3A and 55 as Thy 3B. Of excised lesions, 14 (29 per cent) of 48 Thy 3A and 4 (10 per cent) of 42 Thy 3B nodules were malignant. If Thy 3A were to predict malignancy and Thy 3B benign disease, the sensitivity of the classification was 88 per cent, with a specificity of 55 per cent and negative predictive value of 91 per cent.


CONCLUSIONS
Subclassification of Thy 3 nodules into Thy 3A and Thy 3B improves the assessment of risk for thyroid malignancy.
Tysome
J R
JR
Department of Otolaryngology - Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK. jamestysome@yahoo.com
Chandra
A
A
Chang
F
F
Puwanarajah
P
P
Elliott
M
M
Caroll
P
P
Powrie
J
J
Hubbard
J G
JG
Clarke
S E M
SE
Jeannon
J P
JP
Simo
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods / Q000592:standards; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards; D006801:Humans; D008485:Medical Audit; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000473:pathology*; D016606:Thyroid Nodule / Q000473:pathology*; D055815:Young Adult