title: The role of repeat fine needle aspiration in the management of indeterminate thyroid nodules.
abstract: BACKGROUND
  Management decisions are not straightforward when the Ultrasound Guided Fine Needle Aspiration (USFNA) demonstrates a Bethesda score of either category III or IV, and a diagnostic hemi-thyroidectomy or a repeat USFNA (r-USFNA) could be performed. The aim of this study is to assess the effectiveness of r-USFNA in the management of indeterminate thyroid nodules by evaluating the likelihood of obtaining a definite diagnosis.
  
  
  METHODS
  We reviewed the medical records of all patients with thyroid nodules between 2011 and 2015 at the Jewish General Hospital (Montreal, Canada). Three hundred fifty-one patients who had undergone a surgical procedure (hemi or total thyroidectomy) and a diagnosis of B3 or B4 on the primary USFNA (p-USFNA) were included in the study. Ninety-six of the included patients also had a repeat USFNA prior to the surgery. Demographic data, type of procedure, and McGill Thyroid Nodule Score (MTNS) were obtained from the medical records. Malignancy rates were calculated based on the final surgical histopathology report.
  
  
  RESULTS
  Upon r-USFNA, an average 76 % of patients did not change Bethesda categories, 7.4 % downgraded to a benign category. The results showed that, on an average 17.3 % of patients with p-USFNA of B3 and 20 % of patients with p-USFNA of B4, upgraded to a malignant or suspicious for malignancy category, thus changing the clinical management to total thyroidectomy. Our data demonstrates that r-USFNA facilitates choosing the correct surgery of total thyroidectomy in about 20 % of nodules that have upgraded from B3/B4 to a more definite malignant category.
  
  
  CONCLUSIONS
  r-USFNA in patients with indeterminate diagnoses (B3 or B4) increases categorization into more definite categories. Approximately 20 % of patients are found to have malignant thyroid nodules and suspicious for malignancy thyroid nodules upon repeating the biopsy, hence a diagnostic hemi-thyroidectomy was avoided and a more definitive surgery could be performed. Furthermore, repeat USFNA results in a fewer number of hemi-thyroidectomy and completion thyroidectomy procedures.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada.
authors.forename: Alborz
authors.initials: A
authors.lastname: Jooya
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada.
authors.forename: Joe
authors.initials: J
authors.lastname: Saliba
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada.
authors.forename: Audrey
authors.initials: A
authors.lastname: Blackburn
authors.affiliation: Division of Endocrinology, Jewish General Hospital - McGill University, Montreal, QC, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Tamilia
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Hier
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Mlynarek
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada.
authors.forename: Véronique-Isabelle
authors.initials: VI
authors.lastname: Forest
authors.affiliation: Department of Pathology, Jewish General Hospital - McGill University, Montreal, QC, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Rochon
authors.affiliation: Department of Pathology, Jewish General Hospital - McGill University, Montreal, QC, Canada.
authors.forename: Anca
authors.initials: A
authors.lastname: Florea
authors.affiliation: Department of Pathology, Jewish General Hospital - McGill University, Montreal, QC, Canada.
authors.forename: Hangjun
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada. rkpayne@sympatico.ca.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Payne
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D016606:Thyroid Nodule / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy
keywords: Bethesda; FNA; Repeat FNA; Ultrasound Guided Fine Needle Aspiration