Background: The 2015 American Thyroid Association (ATA) Guidelines recommend the following size cut-offs based on sonographic appearances for subjecting nodules to fine-needle aspiration (FNA) biopsy: low risk: 15 mm and intermediate risk and high risk: 10 mm.Objective: We conducted a "real-world' study evaluating the diagnostic performance of the ATA cut-offs against increased thresholds, in the interest of safely limiting FNAs.Methods: We performed a retrospective analysis of prospectively collected data on 604 nodules which were sonographically risk-stratified as per the ATA Guidelines and subsequently subjected to ultrasound-guided FNA. Nodules were cytologically stratified into "benign' (Bethesda class 2) and "non-benign' (Bethesda classes 3-6). We obtained the negative predictive value (NPV), accuracy, FNAs that could be spared, missed "non-benign' cytologies and missed carcinomas on histology, according to the ATA cut-offs compared to higher cut-offs.Results: In low-risk nodules, the high performance of NPV (asymptotic to 91%) is unaffected by increasing the cut-off to 25 mm, and accuracy improves by 39.4%; 46.8% of FNAs could be spared at the expense of few missed B3-B6 cytologies (7.9%) and no missed carcinomas. In intermediate-risk nodules, a 15 mm cut-off increases the NPV by 11.3% and accuracy by 40.7%. The spared FNAs approach 50%, while B3-B6 cytologies are minimal, with no missed carcinomas. In high-risk nodules, low NPV (< 35%) and accuracy (< 46%) were obtained regardless of cut-off. Moreover, the spared FNAs achieved at higher cut-offs involved numerous missed "non-benign' cytologies and carcinomas.Conclusion: It would be clinically safe to increase the ATA cut-offs for FNA in low-risk nodules to 25 mm and in intermediate-risk nodules to 15 mm.

Real-world application of ATA Guidelines in over 600 aspirated thyroid nodules: is it time to change the size cut-offs for FNA? / S. Ioakim, A. A Syed, G. Zavros, M. Picolos, L. Persani, A. Kyriacou. - In: EUROPEAN THYROID JOURNAL. - ISSN 2235-0640. - 11:6(2022), pp. e220163.1-e220163.10. [10.1530/ETJ-22-0163]

Real-world application of ATA Guidelines in over 600 aspirated thyroid nodules: is it time to change the size cut-offs for FNA?

L. Persani
Penultimo
Writing – Review & Editing
;
2022

Abstract

Background: The 2015 American Thyroid Association (ATA) Guidelines recommend the following size cut-offs based on sonographic appearances for subjecting nodules to fine-needle aspiration (FNA) biopsy: low risk: 15 mm and intermediate risk and high risk: 10 mm.Objective: We conducted a "real-world' study evaluating the diagnostic performance of the ATA cut-offs against increased thresholds, in the interest of safely limiting FNAs.Methods: We performed a retrospective analysis of prospectively collected data on 604 nodules which were sonographically risk-stratified as per the ATA Guidelines and subsequently subjected to ultrasound-guided FNA. Nodules were cytologically stratified into "benign' (Bethesda class 2) and "non-benign' (Bethesda classes 3-6). We obtained the negative predictive value (NPV), accuracy, FNAs that could be spared, missed "non-benign' cytologies and missed carcinomas on histology, according to the ATA cut-offs compared to higher cut-offs.Results: In low-risk nodules, the high performance of NPV (asymptotic to 91%) is unaffected by increasing the cut-off to 25 mm, and accuracy improves by 39.4%; 46.8% of FNAs could be spared at the expense of few missed B3-B6 cytologies (7.9%) and no missed carcinomas. In intermediate-risk nodules, a 15 mm cut-off increases the NPV by 11.3% and accuracy by 40.7%. The spared FNAs approach 50%, while B3-B6 cytologies are minimal, with no missed carcinomas. In high-risk nodules, low NPV (< 35%) and accuracy (< 46%) were obtained regardless of cut-off. Moreover, the spared FNAs achieved at higher cut-offs involved numerous missed "non-benign' cytologies and carcinomas.Conclusion: It would be clinically safe to increase the ATA cut-offs for FNA in low-risk nodules to 25 mm and in intermediate-risk nodules to 15 mm.
fine-needle aspiration biopsy; papillary thyroid carcinoma; size cut-offs; size limits; thyroid cancer; thyroid carcinoma; thyroid malignancy; thyroid nodules; ultrasound risk stratification
Settore MED/13 - Endocrinologia
2022
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/971734
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