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Reducing indeterminate thyroid FNAs
Author(s) -
Renshaw Andrew A.,
Gould Edwin W.
Publication year - 2015
Publication title -
cancer cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.29
H-Index - 57
eISSN - 1934-6638
pISSN - 1934-662X
DOI - 10.1002/cncy.21520
Subject(s) - indeterminate , medicine , malignancy , bethesda system , thyroid cancer , medical diagnosis , carcinoma , cancer , gynecology , thyroid , pathology , mathematics , pure mathematics
BACKGROUND The Bethesda System recommends limiting the percentage of cases diagnosed as indeterminate in thyroid fine‐needle aspirations (TFNAs). However, studies are lacking that document how to decrease the rate of indeterminate TFNAs and its effects. METHODS The authors modified the Bethesda criteria to reduce the rate of indeterminate TFNAs (“atypical cells of undetermined significance” and “suspicious for a follicular/Hurthle cell neoplasm”) by reassigning cases that may have been categorized as indeterminate to “suspicious for papillary carcinoma” or “favor benign” for an 18‐month period and correlated this with histologic follow‐up. RESULTS The indeterminate rate decreased from 14.4% (Bethesda) to 8.2% (modified Bethesda; P < .001). There was no significant difference in the risk of malignancy for the 2 groups (23.6% vs 17.3%, respectively; chi‐square P = .39). There were 6 false‐positive diagnoses in the Bethesda group compared with none in the modified Bethesda group ( P = .06). In the Bethesda group, but not in the modified Bethesda group, the indeterminate rate was correlated with the overall rate of malignant and suspicious for papillary carcinoma diagnoses. CONCLUSIONS Modifying the Bethesda criteria can decrease indeterminate TFNAs diagnoses without a significant decrease in the risk of malignancy. The modified Bethesda criteria, but not the Bethesda criteria, are independent of the malignancy rate. Cancer (Cancer Cytopathol) 2015;123:237–243. © 2015 American Cancer Society.