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Discordance between cytologic results in multiple thyroid nodules within the same patient
Jonathan N Levenson1, Idalia Santaella, Mitchell S Wachtel
1Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
Acta Cytologica
|October 26, 2010
Summary
Nearly 40% of patients showed discordant results when multiple thyroid nodules were biopsied. This finding supports biopsying all suspicious thyroid nodules, not just the largest one, for accurate diagnosis.
Area of Science:
- Endocrinology
- Cytopathology
- Oncology
Background:
- Thyroid nodules are common, and fine-needle aspiration (FNA) biopsy is crucial for diagnosis.
- When multiple nodules are present, decisions on which to biopsy can be challenging.
- Understanding discordance rates is key to optimizing diagnostic strategies.
Purpose of the Study:
- To determine the frequency of discordant cytologic results among multiple thyroid nodules biopsied within the same patient.
- To evaluate factors influencing this discordance.
Main Methods:
- Retrospective chart review of 441 patients undergoing thyroid nodule biopsies.
- Cytologic classification into four categories (colloid only, benign, Hashimoto's, neoplasm/suspicious).
- Discordance defined as at least two different cytologic categories within a single patient.
Main Results:
- Of 326 patients with evaluable multiple nodules, 126 (38.7%) exhibited discordant cytologic results.
- Discordance rates increased with the number of nodules biopsied, ranging from 29.1% for 2 nodules to over 60% for 4 nodules.
- No specific demographic, laboratory, or ultrasound factors were strongly associated with discordance.
Conclusions:
- A significant rate of cytologic discordance exists between multiple thyroid nodules in the same patient.
- This high discordance rate supports the recommendation to biopsy all thyroid nodules meeting biopsy criteria, irrespective of size.
- Comprehensive evaluation of all biopsied nodules is essential for accurate thyroid cancer diagnosis and management.
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