Rene Gerhard1, Scott L Boerner. 1. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Second-opinion diagnosis (SOD) on pathological material is an accepted practice before definitive therapy is considered for referred patients. The thyroid gland is an anatomical site prone to diagnostic disagreement between pathologists. We performed a review of the literature that addressed the role of interinstitutional SOD on thyroid fine-needle aspirations (FNAs). METHODS: Nine studies comprising second opinions on thyroid FNAs were selected. The parameters analyzed included: discordances between the initial diagnoses (IDs) and SODs; cytohistologic correlation; changes in the clinical management of the patients with thyroid nodules after SOD. The same parameters were applied to the "indeterminate" diagnostic category comprising cases initially reported as "atypia," "atypia of undetermined significance/follicular lesion of undetermined significance," "suspicious for a follicular neoplasm," "follicular neoplasm," "suspicious," and "suspicious for malignancy." RESULTS: A total of 7154 thyroid FNAs were retrieved, showing an overall discordance rate between ID and SOD of 28.6%. In general, SOD was better supported by clinical follow-up and histological diagnosis, showing higher diagnostic accuracy in comparison with ID. Almost one-third (30.4%) of the discordant cases resulted in changes in the clinical management of patients with thyroid nodules. Numerous thyroid FNAs initially categorized as "indeterminate" were definitively classified as benign or malignant by SOD, with an overall diagnostic resolution rate of 42.5%, sensitivity of 97.9%, and diagnostic accuracy of 73.7%. CONCLUSIONS: Second-opinion review of thyroid FNA improves diagnostic accuracy and potentially changes clinical management. SOD also demonstrates a significative rate of diagnostic resolution for thyroid FNAs originally diagnosed as "indeterminate."
BACKGROUND: Second-opinion diagnosis (SOD) on pathological material is an accepted practice before definitive therapy is considered for referred patients. The thyroid gland is an anatomical site prone to diagnostic disagreement between pathologists. We performed a review of the literature that addressed the role of interinstitutional SOD on thyroid fine-needle aspirations (FNAs). METHODS: Nine studies comprising second opinions on thyroid FNAs were selected. The parameters analyzed included: discordances between the initial diagnoses (IDs) and SODs; cytohistologic correlation; changes in the clinical management of the patients with thyroid nodules after SOD. The same parameters were applied to the "indeterminate" diagnostic category comprising cases initially reported as "atypia," "atypia of undetermined significance/follicular lesion of undetermined significance," "suspicious for a follicular neoplasm," "follicular neoplasm," "suspicious," and "suspicious for malignancy." RESULTS: A total of 7154 thyroid FNAs were retrieved, showing an overall discordance rate between ID and SOD of 28.6%. In general, SOD was better supported by clinical follow-up and histological diagnosis, showing higher diagnostic accuracy in comparison with ID. Almost one-third (30.4%) of the discordant cases resulted in changes in the clinical management of patients with thyroid nodules. Numerous thyroid FNAs initially categorized as "indeterminate" were definitively classified as benign or malignant by SOD, with an overall diagnostic resolution rate of 42.5%, sensitivity of 97.9%, and diagnostic accuracy of 73.7%. CONCLUSIONS: Second-opinion review of thyroid FNA improves diagnostic accuracy and potentially changes clinical management. SOD also demonstrates a significative rate of diagnostic resolution for thyroid FNAs originally diagnosed as "indeterminate."
Authors: Pablo Valderrabano; Laila Khazai; Zachary J Thompson; Marino E Leon; Kristen J Otto; Julie E Hallanger-Johnson; J Trad Wadsworth; Bruce M Wenig; Christine H Chung; Barbara A Centeno; Bryan McIver Journal: Thyroid Date: 2017-09-14 Impact factor: 6.568
Authors: Rupendra T Shrestha; Maria R Evasovich; Khalid Amin; Angela Radulescu; Tina S Sanghvi; Andrew C Nelson; Maryam Shahi; Lynn A Burmeister Journal: Thyroid Date: 2016-07-12 Impact factor: 6.568
Authors: Lorenzo Scappaticcio; Pierpaolo Trimboli; Sergio Iorio; Maria Ida Maiorino; Miriam Longo; Laura Croce; Marcello Filograna Pignatelli; Sonia Ferrandes; Immacolata Cozzolino; Marco Montella; Andrea Ronchi; Renato Franco; Mario Rotondi; Giovanni Docimo; Katherine Esposito; Giuseppe Bellastella Journal: Front Endocrinol (Lausanne) Date: 2022-09-15 Impact factor: 6.055