title: Predictive value of cytologic atypia in indeterminate thyroid fine-needle aspirate biopsies.
abstract: BACKGROUND
  Fine-needle aspiration (FNA) biopsies are the most accurate method for diagnosis of thyroid nodules. Unfortunately, biopsies are indeterminate 15-30% of the time and surgery is thus required for a definitive diagnosis. We aimed to determine whether specific descriptors of cytologic atypia mentioned in indeterminate FNA reports were associated with malignancy on final histopathology.
  
  
  METHODS
  Retrospective review of 1000 surgery patients identified 466 indeterminate FNA lesions that underwent either a hemi- or total thyroidectomy between 1998 and 2009. We screened FNA reports for specific descriptors of nuclear atypia. Univariate and multivariate analyses were performed to evaluate the independent effect of cytologic atypia descriptors on the risk of malignancy.
  
  
  RESULTS
  Nuclear atypia on FNA conferred a risk of malignancy of 42% (P < 0.0001). Risk of malignancy increased from 17% for zero descriptors to 81.2% when four or more descriptors of atypia were described. Nuclear grooves and inclusions together conferred a risk of malignancy, specificity, and false positive rate of 79.3%, 98.2% and 1.8% respectively.
  
  
  CONCLUSIONS
  The presence of four or more descriptors of cytologic atypia or the presence of both nuclear inclusions and grooves together confers a high risk of malignancy on final histopathology and a low false positive rate. These findings should be taken into consideration when interpreting FNA reports and total thyroidectomy should be considered for those patients at higher risk.
authors.affiliation: Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA.
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Kato
authors.forename: Daniel
authors.initials: D
authors.lastname: Buitrago
authors.forename: Tracy-Ann
authors.initials: TA
authors.lastname: Moo
authors.forename: Xavier M
authors.initials: XM
authors.lastname: Keutgen
authors.forename: Raza S
authors.initials: RS
authors.lastname: Hoda
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Ricci
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Christos
authors.forename: Grace
authors.initials: G
authors.lastname: Yang
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fahey
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000601:surgery; D016606:Thyroid Nodule / Q000145:classification / Q000175:diagnosis* / Q000601:surgery; D013965:Thyroidectomy; D055815:Young Adult