Outcomes of repeat fineneedle aspiration biopsy for AUS/FLUS thyroid nodules

Abstract

Objective: To determine the proportion of aspirates reclassified into each Bethesda category; and to assess the rates of malignancy in each of them on repeat fine needle aspiration biopsy (RFNA) following an AUS/FLUS diagnosis. Design: Systematic review and meta-analysis Methods: On February 2019, Pubmed/MEDLINE, EMBASE, WoS and the Cochrane Library were searched for articles published from January 1, 2007. All studies published in English describing RFNA outcomes in AUS/FLUS nodules were included. PRISMA and MOOSE guidelines were followed. Five investigators independently assessed the eligibility of the studies. Two investigators extracted summary data and assessed risk of bias. Data were pooled using a random-effects model. The rate of malignancy was calculated on resected nodules only (upper limit of true value); and considering benign all unresected nodules (lower limit of true value). The protocol was registered in PROSPERO (CRD42019123114). Results: Of 2937 retrieved studies, 27 were eligible. The meta-analysis was conducted on summary data of 3932 AUS/FLUS thyroid nodules with RFNA. RFNA cytology would reclassify into categories I through VI of Bethesda: 4% (3%,5%); 48% (43%,54%); 26% (20%,32%); 4% (3%,6%); 5% (3%,6%); and 2% (1%,2%) of AUS/FLUS nodules. Malignancy rates of resected nodules were 24% (9%,38%), 4% (1%,7%), 40% (28%,52%), 37% (27%,47%), 79% (69%,90%) and 99% (95%,100%) for categories I through VI of Bethesda. There was high heterogeneity in these data. Conclusions: RFNA reclassified two thirds of the AUS/FLUS specimens into a more definitive cytological category, with a benign call rate of nearly 50% and a negative predictive value greater than 96%.

Performance of repeat cytology with reflex ThyroSeq genomic classifier for indeterminant thyroid cytology

“…The rate of repeat indeterminant cytology in this study was slightly higher than what was reported in a recent meta-analysis of repeat cytology. 8 Potential sources of this discrepancy could be differences in patient populations (data taken from a major referral center) or differences in the availability and use of ancillary molecular testing at these other institutions.…”

“…One option for managing an indeterminant nodule is to perform a repeat biopsy (rebiopsy), which reportedly renders a more definitive diagnosis for between 55% and 76% of initially indeterminant nodules. [6][7][8][9] A more recently developed approach is to use ancillary molecular testing to risk-stratify these cytologically indeterminant lesions. The latest version of 1 such test (ThyroSeq version 3 [v3]) assesses 112 genes using nextgeneration sequencing technology to identify point mutations, gene fusions, copy number alterations, and gene expression alterations associated with neoplasia.…”

Clinical value of molecular markers as diagnostic and prognostic tools to guide treatment of thyroid cancer

“…Furthermore, a recent meta-analysis showed that repeating a fine needle-aspiration biopsy in atypia/follicular lesions of undetermined significance reclassifies 50% of them as benign with a negative predictive value greater than 96%; and reclassifies another 15% of the nodules into higher suspicion categories. 69 These results are at least as good as those achieved by current molecular tests. 47 Therefore, it remains unclear what is the incremental benefit of molecular tests in this category; and whether it is cost-effective.…”

“…Therefore, longer follow‐up data in nodules with benign/negative molecular tests' results is necessary to validate their real‐world negative predictive value. Furthermore, a recent meta‐analysis showed that repeating a fine needle‐aspiration biopsy in atypia/follicular lesions of undetermined significance reclassifies 50% of them as benign with a negative predictive value greater than 96%; and reclassifies another 15% of the nodules into higher suspicion categories 69 . These results are at least as good as those achieved by current molecular tests 47 .…”

Efficacy analysis between ultrasound and cytology criteria in the differentiation of malignant and benign thyroid nodules: TIRADS versus BETHESDA

“…The limitations and diagnostic difficulties of FNAB may cause false-negative and falsepositive results. Even if the initial cytological results are benign, it has been reported that the risk of malignancy is as high in TN with suspicious USG (12,13).…”