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Low Malignancy Rates in Fine-Needle Aspiration Cytologies in a Primary Care Setting in Germany
Markus Eszlinger1, Maha Ullmann2, Ilka Ruschenburg3
11 Departments of Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada .
Thyroid : Official Journal of the American Thyroid Association
|October 7, 2017
Summary
This study analyzed thyroid nodule fine-needle aspiration (FNA) cytology in a German primary care setting. Results show lower malignancy rates and higher cyst percentages compared to tertiary centers, with risks aligning with Bethesda guidelines.
Area of Science:
- Cytopathology
- Endocrinology
- Primary Care Medicine
Background:
- Thyroid nodule fine-needle aspiration (FNA) cytology data primarily comes from specialized centers.
- The distribution of FNA Bethesda categories and malignancy rates in primary care settings are largely unknown.
- This study addresses the gap in understanding FNA cytology in primary care.
Purpose of the Study:
- To investigate thyroid nodule FNA cytology malignancy rates in a large German primary care setting.
- To assess the applicability of current evidence-based malignancy risk stratification strategies in primary care.
- To compare primary care FNA cytology data with findings from tertiary centers.
Main Methods:
- Retrospective analysis of 9460 thyroid nodule FNAs from 8380 patients.
- Data collected from 64 physicians in primary care practices over two years.
- Cytopathologic results classified using the Bethesda System for Thyroid Cytopathology.
Main Results:
- The distribution of Bethesda categories included: non-diagnostic (19%), cyst/cystic nodule (21%), benign (48%), atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (6%), follicular neoplasms/suspicious for follicular neoplasm (FN/SFN) (4%), suspicious for malignancy (SFM) (1%), and malignant (1%).
- Malignancy risks for AUS/FLUS, FN/SFN, SFM, and malignant categories were 8%, 17%, 86%, and 98% respectively, with corresponding surgery/follow-up rates of 22%, 69%, 78%, and 71%.
- Histology confirmed 102 true positives and 10 false positives among 112 cytologically suspicious and malignant FNAs.
Conclusions:
- Primary care settings in Germany show lower percentages of malignant, SFM, FN/SFN, and AUS/FLUS categories, and higher percentages of cysts compared to tertiary centers.
- The observed malignancy risks for key Bethesda categories align with current recommendations.
- Findings suggest that evidence-based risk stratification strategies are applicable in primary care settings for thyroid nodules.
