IS REPEAT FNAB NECESSARY FOR THYROID NODULES WITH ND / UNS CYTOLOGY?

Area of Science:

• Endocrinology
• Oncology
• Pathology

Background:

• Standard management for non-diagnostic (ND) / insufficient (UNS) thyroid nodules involves repeat fine-needle aspiration biopsy (rFNAB).
• Recurrent FNABs can also yield non-diagnostic results, necessitating alternative diagnostic or management strategies.
• Evaluating clinical-radiological-pathological parameters may offer a pathway to manage these challenging nodules without repeated procedures.

Purpose of the Study:

• To investigate the efficacy of repeat fine-needle aspiration biopsy (rFNAB) in non-diagnostic (ND) / insufficient (UNS) thyroid nodules.
• To identify clinical and radiological predictors for malignancy in ND/UNS thyroid nodules.
• To assess the feasibility of managing ND/UNS thyroid nodules without rFNAB based on specific parameters.

Main Methods:

• Retrospective analysis of 275 ND/UNS thyroid nodules from 264 patients with definitive post-surgical pathological diagnoses.
• Comparison of clinical-radiological parameters between nodules that underwent rFNAB and those that did not.
• Statistical analysis to identify significant predictors of malignancy and correlations with rFNAB results.

Main Results:

• Malignancy incidence was significantly higher in nodules without rFNAB (p=0.036) and in specific Bethesda categories (BC-1, p=0.009).
• Nodule size <10 mm and irregular borders were significant predictors of malignancy (p<0.020, p<0.002).
• rFNAB results correlated significantly with female gender, solid composition, hypoechogenicity, irregular borders, and halo loss in higher-risk Bethesda categories (BC-4,5,6).

Conclusions:

• Repeat fine-needle aspiration biopsy (rFNAB) did not consistently improve diagnostic yield for ND/UNS thyroid nodules.
• Direct surgical excision is recommended for nodules exhibiting irregular borders, solid components, halo loss, and hypoechogenicity, particularly in female patients.
• Clinical and radiological assessment can guide management decisions, potentially obviating the need for rFNAB in select ND/UNS thyroid nodules.