Department of Pathology, A.C. Camargo Cancer Center, São Paulo, Brazil.
Department of Epidemiology and Statistics, A.C. Camargo Cancer Center, São Paulo, Brazil.
Cytopathology. 2020 Nov;31(6):525-532. doi: 10.1111/cyt.12887. Epub 2020 Aug 9.
The Bethesda System recommends repeat fine needle aspiration (rFNA) as a management option for nodules classified under the non-diagnostic (ND) and atypia of undetermined significance (AUS/FLUS) categories. We evaluated the impact of an rFNA in diagnostic resolution and the role of early (≤3 months) vs delayed (more than 3 months) rFNA of nodules initially diagnosed as ND and AUS/FLUS.
We retrospectively collected all thyroid FNA performed in a 4-year period with repeat aspiration. For cases initially signed out as ND or AUS/FLUS, diagnostic resolution was defined as a change to a Bethesda System category other than these two on rFNA. Comparison and regression models were fitted to identify the impact of time of rFNA on diagnostic resolution.
In total, 184 cases were initially assigned as ND and 143 as AUS/FLUS, with overall diagnostic resolution rates for the reassessment of these nodules calculated at 70.1% and 62.9%, respectively. For ND cases, time of rFNA was not significantly associated with diagnostic resolution (P > .05). For AUS/FLUS nodules, however, repeat aspiration performed in more than 3 months after the initial diagnosis was 2.5 times more likely to achieve a resolution in diagnosis than early rFNA (P = .024).
Repeat aspiration of ND and AUS/FLUS nodules helped define diagnosis for the majority of cases, being highly effective in determining correct patient management. For AUS/FLUS nodules, repeat aspiration performed more than 3 months after the initial diagnosis was associated with a higher diagnostic resolution.
贝塞斯达系统建议对非诊断性（ND）和意义未明的非典型性（AUS/FLUS）类别进行分类的结节进行重复细针抽吸（rFNA）作为管理选择。我们评估了 rFNA 对诊断分辨率的影响，以及对最初诊断为 ND 和 AUS/FLUS 的结节进行早期（≤3 个月）与延迟（超过 3 个月）rFNA 的作用。
我们回顾性收集了在 4 年期间进行的所有甲状腺 FNA 重复抽吸的病例。对于最初诊断为 ND 或 AUS/FLUS 的病例，诊断分辨率定义为 rFNA 后分类为除这两种以外的贝塞斯达系统类别。拟合比较和回归模型以确定 rFNA 时间对诊断分辨率的影响。
共有 184 例最初被归类为 ND，143 例被归类为 AUS/FLUS，这些结节的重新评估总体诊断分辨率率分别为 70.1%和 62.9%。对于 ND 病例，rFNA 时间与诊断分辨率无显著相关性（P>.05）。然而，对于 AUS/FLUS 结节，在初始诊断后 3 个月以上进行重复抽吸，诊断分辨率的可能性是早期 rFNA 的 2.5 倍（P=0.024）。
重复抽吸 ND 和 AUS/FLUS 结节有助于确定大多数病例的诊断，对确定正确的患者管理非常有效。对于 AUS/FLUS 结节，在初始诊断后 3 个月以上进行重复抽吸与更高的诊断分辨率相关。
