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How to approach thyroid nodules with indeterminate cytology
Jung Hyun Yoon1, Jin Young Kwak, Eun-Kyung Kim
1Research Institute of Radiological Science, Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea.
Annals of Surgical Oncology
|March 11, 2010
Summary
Ultrasound (US) and intraoperative frozen sections (FS) can help predict malignancy in thyroid nodules with indeterminate fine-needle aspiration biopsy (FNAB) cytology. These methods support clinical decisions for thyroid nodule management.
Area of Science:
- Endocrinology
- Oncology
- Radiology
Background:
- Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is standard for thyroid nodule diagnosis.
- Indeterminate cytology results are a significant limitation of US-FNAB.
- This study evaluated predictors of malignancy and the role of intraoperative frozen sections (FS) for indeterminate thyroid nodules.
Purpose of the Study:
- To investigate clinical and US characteristics predicting malignancy in thyroid nodules with indeterminate FNAB cytology.
- To assess the utility of intraoperative FS in managing these nodules.
Main Methods:
- Retrospective review of 181 patients (185 nodules) with indeterminate FNAB cytology.
- Analysis of 99 surgically confirmed cases, including US findings, clinical data, and FS results.
- Comparison of preoperative and intraoperative findings with final surgical pathology.
Main Results:
- 19.2% of indeterminate nodules were malignant.
- Male gender, microlobulated/ill-defined margins, microcalcifications, and taller-than-wide shape on US were associated with malignancy.
- Intraoperative FS showed high specificity in predicting malignancy, though 37.2% of FS results were deferred.
Conclusions:
- Ultrasound is effective in predicting malignancy for thyroid nodules with indeterminate FNAB cytology.
- Intraoperative FS is a valuable supportive tool with high specificity for guiding treatment decisions.
- Combined US and FS can improve the management of indeterminate thyroid nodules.
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