Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan;7(1):39-43.
doi: 10.1159/000484600. Epub 2017 Nov 21.

Indeterminate Thyroid Nodules: A Pragmatic Approach

Aly Bernard Khalil  1 , Roberto Dina  2 , Karim Meeran  2 , Ali M Bakir  1 , Saf Naqvi  1 , Alia Al Tikritti  1 , Nader Lessan  1 , Maha T Barakat  1
Affiliations

Indeterminate Thyroid Nodules: A Pragmatic Approach

Aly Bernard Khalil et al. Eur Thyroid J. 2018 Jan.

Abstract

Background: Fine needle aspiration (FNA) cytology fails to provide a conclusive diagnosis in a subset of thyroid lesions labeled as "indeterminate" (Thy3). In this study, we aimed at ascertaining the prevalence of Thy3 thyroid nodules in a hitherto unreported ethnic group (residents of the United Arab Emirates).

Methods: We retrospectively examined 688 FNA of the thyroid performed on 584 patients. Samples were reported using the Royal College of Physicians' (RCP) Thy classification. The results of the FNA were correlated with the final surgical specimens. Ultrasonography (US) risk stratification was calculated using a web-based US risk of malignancy calculator.

Results: Overall sample adequacy was 97%. The indeterminate group Thy3 was found in 7% of the samples. The overall risk of malignancy in the Thy3 category was 20%. This risk was very similar in the 2 subgroups of Thy3 (17% in Thy 3a and 22% in Thy3f). Subdividing the Thy3 group into subgroups becomes less necessary if the US scoring is <24.5% since the negative predictive value, in this case, is 100%. Applying this criterion to our population would have had the potential of reducing the percentage of patients referred to surgery from 61 to 43%.

Conclusions: Proper risk stratification of Thy3 lesions should be based on the combined risk assessment of clinical, cytological, radiological, and molecular data. Such a pragmatic approach is expected to reduce the percentage of inappropriate referrals to surgery.

Keywords: Fine needle aspiration of the thyroid; Thyroid nodule; Ultrasound of the thyroid; Ultrasound risk stratification.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Follow-up of patients with Thy2 lesions. Average follow-up time: 16 months (range 1–41).
See this image and copyright information in PMC

References

    1. Mazzaferri EL. Management of a solitary thyroid nodule. New Engl J Med. 1993;328:553–559. - PubMed
    1. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1–133. - PMC - PubMed
    1. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedus L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules – 2016 Update. Endocr Pract. 2016;22:622–639. - PubMed
    1. Alexander EK. Approach to the patient with a cytologically indeterminate thyroid nodule. J Clin Endocrinol Metab. 2008;93:4175–4182. - PubMed
    1. Alexander EK, Heering JP, Benson CB, Frates MC, Doubilet PM, Cibas ES, et al. Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab. 2002;87:4924–4927. - PubMed