What really is an indeterminate FNA thyroid nodule?

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COD: 2701_12_06_2017_AOP Categorie: , ,

Angela Pezzolla, Serafina Lattarulo, Andrea Madaro, Giovanni Docimo,
Emanuela Lacalendola, Francesco Prete, Rinaldo Marzaioli

Ann Ital Chir, Digital Edition 2017, 6
Epub Ahead of Print – June 12

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BACKGROUND: Thyroid nodules are usually benign; however, 5 to 15% prove to be malignant. Fine-needle aspiration
(FNA) has become the gold standard in the evaluation of thyroid nodules, especially in single nodule more than a centimeter
and / or in smaller nodule with ultrasound characters of malignancy.
METHODS: We evaluated retrospectively 179 patients with “undetermined” thyroid fine needle aspiration, undergoing
surgery. We compared cytology and histology and we evaluated sex, age, the presence of thyroiditis and dimension of the
indeterminate nodule as predictors of malignancy.
RESULTS: In 48 patients (26.8%) histological examination confirmed the indeterminate cytological diagnosis and this
means that the nodule underwent FNA was diagnosed in effects such as cancer. In 29 patients, on histological examination,
the nodule underwent FNA was not diagnosed as cancer, but one or more carcinomas were diagnosed in the
same lobe of indeterminate nodule, but in different location and / or in the contralateral lobe.
In 102 patients, the definitive histological examination did not confirm the suspected diagnosis and we found a significant
positive association only between male sex and histological malignancy.
CONCLUSIONS: The indeterminate FNA still remains a challenge for the surgeon because it is not yet possible to discriminate
patients who really need surgery from those that can be followed in follow-up. The potential of molecular
diagnostics for thyroid nodules with indeterminate cytology is promising, but many of these markers are too complex or
expensive for routine clinical use or are still poorly standardized.

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