Routine second-opinion cytopathology review of thyroid fine needle aspiration biopsies reduces diagnostic thyroidectomy

Introducing the reporting system for thyroid fine-needle aspiration cytology according to the new guidelines of the Japan Thyroid Association [Review]

“…To improve diagnostic concordance and accuracy, particularly in the indeterminate category, Davidov et al reported that routine second-opinion cytological review of indeterminate FNAs avoided diagnostic operation in 25% of cases [37], and Olson et al concluded that a second review resulted in changes of clinical and surgical management in 32% of cases and a second review may be of potential benefit, particularly in the indeterminate category [84]. Since cytological diagnoses are based on subjective evaluation of morphological characteristics, inter-observer and intra-observer variability may be unavoidable.…”

“…It includes cases with equivocal features of PTC (Fig. 3), features suggestive of chronic thyroiditis and malig- ciently select patients with thyroid nodules for surgery because the risk of malignancy of follicular neoplasm was within the range of baseline risk of malignancy, which was estimated to be about 10-20% in Western countries and 12.4-15.9% in Japan [6,7,[37][38][39][40]. Among a series of 1044 surgically treated patients at Kuma Hospital, Kobe, Japan, in 2000, Mori et al reported that the risk of FTC was 7.9% (22/279) in cases with nodular thyroid diseases (other types of malignancy were excluded) and incidental PTC was found in 7.2% (20/277) of patients with benign nodular disease, with the total risk of malignancy (risk of FTC in index nodule and risk of incidental PTC) in patients with a thyroid nodule (other types of malignancy were excluded) being 14.0% (42/299) [39].…”

“…Many cytopathologists and cytotechnologists are concerned about the poor reproducibility in the subclassification of the indeterminate category and the subclassification of follicular neoplasm because, even among experts, significant interobserver and intraobserver variability has been pointed out [37,49,61,[82][83][84][85][86][87]. It was 18% by Tan et al before Bethesda system was introduced [82].…”

Clinical Workup of Nodular and Mass Lesions of the Endocrine Organs

“…Each diagnostic category conveys specific risks of malignancy, which offers guidance for patient management. Routine second opinion review of indeterminate thyroid FNA biopsies can potentially obviate the need for diagnostic thyroidectomy in 25% of patients without increases in false negatives (Davidov, Trooskin et al 2010). Routine second opinion review of FNA specimens increases sensitivity, specificity, positive predictive value, and negative predictive value (Tan, Kebebew et al 2007).…”

The role of qualitative elastography in thyroid nodule evaluation: exploring its target populations

“…Moreover, the different outcomes could be based on the high heterogeneity of the included studies in the meta-analysis by Trimboli. This might be caused by publication bias, as suggested by the authors, but as well by the classification of nodules as indeterminate, since several studies showed that FNA cytopathology is complicated and requires expertise [8]. The included indeterminate nodules could be influenced by this phenomenon and, therefore, not be as homogeneous as desirable.…”