What are the keys to successful thyroid FNA interpretation?

Area of Science:

• Endocrinology
• Pathology
• Oncology

Background:

• Concerns exist regarding the predictive power of thyroid fine needle aspiration/biopsy (TFNAB) for thyroid nodules.
• Ultrasonography (US) and molecular testing have increased uncertainty in thyroid nodule diagnosis.
• Some suggest replacing TFNAB with molecular testing to reduce diagnostic ambiguity.

Purpose of the Study:

• To re-emphasize key principles for successful TFNAB evaluation of thyroid nodules.
• To clarify the role of molecular testing in managing thyroid nodules with uncertain cytological diagnoses.
• To provide a practical approach for confident patient management using TFNAB.

Main Methods:

• Review of literature on TFNAB and molecular testing for thyroid nodules.
• Emphasis on an integrated team approach involving experienced physicians.
• Focus on TFNAB cytological categories and understanding molecular test predictive ability.

Main Results:

• Target false-negative/positive rates for benign/malignant TFNABs are ≤1%.
• Target prevalence of indeterminate TFNAB results is ≤10%.
• Physicians can confidently manage ≥90% of patients without further testing beyond routine follow-up.

Conclusions:

• A practical approach to TFNAB, focusing on cytological categories and molecular testing's role, enables confident management.
• Molecular testing should be tailored for the 10% of cases with indeterminate results.
• The primary role of TFNAB is to reduce unnecessary surgical interventions for thyroid nodules, given their low mortality rate.