Cancer Management and Research (Aug 2020)
Fine-Needle Aspiration of Subcentimeter Thyroid Nodules in the Real-World Management
Abstract
Chaiho Jeong,1 Hyunsam Kim,1 Jeongmin Lee,2 Jeonghoon Ha,1 Min-Hee Kim,2 Moo Il Kang,1 Dong-Jun Lim1 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of KoreaCorrespondence: Dong-Jun LimDivision of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul 06591, Republic of KoreaTel +82-2-2258-6009Fax +82-2-599-3589Email [email protected]: The Korea Thyroid Association published the revised guidelines for thyroid nodules in 2016. However, whether fine-needle aspiration is accurately performed based on indications and whether the results of this procedure are appropriately addressed according to clinical guidelines, particularly in subcentimeter nodules, are unclear.Methods: We retrospectively analyzed the fine-needle aspiration data of 331 thyroid nodules of patients who were referred to a tertiary hospital clinic for fine-needle aspiration. Each nodule was categorized according to ultrasonography findings based on the recommendations of the Korea Thyroid Association for fine-needle aspiration. Only nodules with a final pathological diagnosis of benign or malignant made using the Bethesda system were included.Results: Up to 32% of thyroid nodules that were not indicated for fine-needle aspiration were aspirated. Regarding subcentimeter nodules, only 28 of 123 (22.8%) aspirated nodules were indicated for fine-needle aspiration. Of the 49 malignant subcentimeter nodules, 33 (67.3%) underwent immediate surgery. Meanwhile, 14 (28.6%) nodules were lost to follow-up, and two (4.1%) were under active surveillance. Eighteen (36.7%) malignant subcentimeter nodules were not indicated for fine-needle aspiration but underwent surgical resection instead of active surveillance.Conclusion: Despite the recommendations in the revised guidelines, several thyroid nodules that do not meet the indications for FNA are aspirated in real-world practice. To reduce overtreatment, a widespread knowledge of the correct indications for fine-needle aspiration is important in clinical practice, particularly for subcentimeter nodules.Keywords: thyroid nodule, fine-needle aspiration, thyroid cancer, KTA guidelines
