Endocrine Abstracts

Background: Most thyroid nodules are benign, but they can also be associated with thyroid cancer. To be sure how to proceed with an ultrasound suspicious nodule (EU-TIRADS), it is recommended to perform a fine needle aspiration (FNA) biopsy and classify the nodule in the BETHESDA system.

Objectives: The aim of this study was to investigate whether we perform an excessive number of FNA according to the EU-TIRADS classification in order to reduce the number of unnecessary aspirations.

Methods: This retrospective analysis in the Department of Endocrinology, University Hospital Zagreb, included 351 FNA from January 2021 to March 2022. Five endocrinologists performed FNA in patients aged 18 to 83 years (median 53 years), 82% were women. Thyroid nodules were a median of 20 (6-77) mm in size.

Results: Most of the aspirated nodules were classified as EU-TIRADS 3 (48%), 22% as EU-TIRADS 5, 21% as EU-TIRADS 4, and 9% as EU-TIRADS 2. The majority of cytologic findings were BETHESDA 2 (46%) and BETHESDA 1 (40%). In addition, 43% of the EU-TIRADS 5 classified nodules were analysed as BETHESDA 1, only 4% as BETHESDA 5, and 8% as BETHESDA 6. Furthermore, the size of the nodules did not affect the BETHESDA results (P = 0.530). There was a significant statistical difference between patient age and BETHESDA findings (P = 0.027), the median age of patients classified as BETHESDA 1 was 56 years, while the median age of patients classified as BETHESDA 5 was 38 years. Twenty-two nodules underwent repeat FNA, and none were analysed as BETHESDA 4 or 5.

Conclusion: The high percentage of BETHESDA 1 and 2 findings may indicate that too many FNAs are being performed in our department, so we should redefine and calibrate the indications for performing an FNA and choose to continue to observe more patients rather than perform an FNA.