Endocrine Abstracts

Background: The review of the Bethesda System Classification has brought some challenge to the clinical role of category III lesions. Repeating fine-needle aspiration (FNA) is time-consuming, painful, brings additional cost and sometimes does not change the clinical decision. Our aim was to prove if there is true benefit in repeating FNA.

Methods: Retrospective review of 4549 thyroid FNAs between January 2012 and June 2015, from which 671 classified as AUS/FLUS. SPSS was applied.

Results: 14.8% FNAs were initially classified as AUS/FLUS and selected for analysis. 64.8% repeated FNA. AUS/FLUS rate on second FNA was 40%. Mean time between FNAs was 3.1 months. In 195 cases there was follow-up histology. Time between FNAs was longer in second FNA revealing carcinoma. Risk of malignancy in AUS/FLUS FNAs versus rate of malignancy on operated patients were as follows: global risk – 8.6 vs 29.7%; after a single AUS/FLUS diagnosis – 11.5 vs 24.1%; with two successive AUS/FLUS diagnosis – 16.7 vs 29.2% and for patients with a benign cytologic interpretation following the initial AUS/FLUS diagnosis −2.6 vs 23.1%. Rate of malignancy of lobectomy vs total thyroidectomy was 27 vs 33.8%. Rate of reintervention was 87.1%.

Conclusion: The authors applied the rate of malignancy after a single diagnosis of AUS/FLUS (11.5%) to all patients who had to repeat FNA (335). The hypothesis of going directly to surgery instead of second FNA is in the same confidence interval, arguing against the role of repeating FNA.