Intra‐institutional second opinion diagnosis can reduce unnecessary surgery for indeterminate thyroid FNA : A preliminary report on 34 cases

Indeterminate diagnoses are rendered on 15%‐30% of thyroid fine‐needle aspirates ( FNA ). Thus, a second diagnostic opinion given by an outside expert pathologist is a common practice that facilitates a more appropriate clinical management. Conversely, the role of an intra‐institutional second opinion diagnosis ( iSOD ), which is usually informally performed in‐house, has not been well established. Methods To assess the contribution of iSOD , a retrospective series of 34 thyroid FNA diagnosed as follicular neoplasm/suspicious follicular neoplasm ( FN / SFN ) with matched histological follow‐up and a malignancy rate of 17.6% was selected and independently reviewed by two cytopathologists ( CYT 1 and 2). Cases with discrepant diagnoses were referred to a third in‐house senior cytopathologist for the iSOD . The malignancy rates ( MR ) obtained after single independent reviews and iSOD were compared. Results MR obtained after CYT 1 and CYT2 re‐screening was similar (14.28% and 19.04%, respectively) and did not improve the original MR (17.64%). Conversely, after the iSOD of discrepant diagnoses, the overall malignancy rate increased up to the 27.27%, potentially sparing unnecessary surgical procedures. Conclusions Intra‐institutional second opinion practice for “indeterminate” thyroid FNA avoids unnecessary surgeries and maximises the detection of malignant cases diagnosed as FN / SFN .