Markus Eszlinger1, Maha Ullmann2, Ilka Ruschenburg3, Katharina Böhme2, Fabian Görke2, Christiane Franzius4, Sabine Adam5, Thomas Molwitz6, Christian Landvogt7, Bassam Amro8, Anja Hach9, Berit Feldmann10, Dieter Graf11, Antje Wefer12, Rainer Niemann13, Catharina Bullmann14, Günther Klaushenke15, Reinhard Santen16, Gregor Tönshoff17, Velimir Ivancevic18, Andreas Kögler18, Eberhard Bell19, Bernd Lorenz20, Gerald Kluge21, Christoph Hartenstein22, Ralf Paschke1,23. 1. 1 Departments of Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada . 2. 2 Divisions of Endocrinology and Nephrology, Department of Internal Medicine, Neurology, and Dermatology, University of Leipzig, Leipzig, Germany . 3. 3 MVZ wagnerstibbe für Gynäkologie, Reproduktionsmedizin, Zytologie, Pathologie, und Innere Medizin GmbH , Einbeck, Germany . 4. 4 Zentrum für Nuklearmedizin und PET/CT , Bremen, Germany . 5. 5 Radiologie Hoheluft , Hamburg, Germany . 6. 6 Klinik Dr. Hancken , Stade, Germany . 7. 7 Praxis für Nuklearmedizin, PET-CT Zentrum , Wiesbaden, Germany . 8. 8 Praxis für Nuklearmedizin , Oldenburg, Germany . 9. 9 Institut für Radiologie und Nuklearmedizin , Bremerhaven, Germany . 10. 10 Endokrinologie und Diabetologie im Zentrum , Stuttgart, Germany . 11. 11 Praxisgemeinschaft Auf dem Meere , Lüneburg, Germany . 12. 12 Radiologie und Nuklearmedizin in der Gottorpstraße , Oldenburg, Germany . 13. 13 Radiologie Oldenburg, Praxis Stehen und Partner GbR , Oldenburg, Germany . 14. 14 Amedes MVZ Hamburg , Germany . 15. 15 Nuklearmedizinische Praxis Dr.med.Klaushenke , Cloppenburg, Germany . 16. 16 Endokrinologische Gemeinschaftspraxis, Zentrum für Hormon- und Stoffwechselstörungen , Frankfurt/Main, Germany . 17. 17 Röntgenpraxis Georgstraße , Hannover, Germany . 18. 18 Radiologisch-Nuklearmedizinische Gemeinschaftspraxis , Celle, Germany . 19. 19 MVZ Westerwald GmbH , Dernbach, Germany . 20. 20 Schilddrüsen- und Hormon-Praxis , Gera, Germany . 21. 21 Diagnostisches Zentrum Göttingen, Gemeinschaftspraxis für Radiologie und Nuklearmedizin , Göttingen, Germany . 22. 22 Schilddrüse Stuttgart, Fachärzte für Innere Medizin und Nuklearmedizinische Schilddrüsendiagnostik , Stuttgart, Germany . 23. 23 Division of Endocrinology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada .
Abstract
BACKGROUND: Reported results for thyroid nodule fine-needle aspiration (FNA) cytology mainly originate from tertiary centers. However, thyroid nodule FNA cytology is mainly performed in primary care settings for which the distribution of FNA Bethesda categories and their respective malignancy rates are largely unknown. Therefore, this study investigated FNA cytology malignancy rates of a large primary care setting to determine to what extent current evidence-based strategies for the malignancy risk stratification of thyroid nodules are applied and applicable in such primary care settings. METHODS: In a primary care setting, 9460 FNAs of thyroid nodules were retrospectively analyzed from 8380 patients evaluated by one cytologist (I.R.) during a period of two years. The 8380 FNA cytologies were performed by 64 physicians in different private practices throughout Germany in primary care settings. RESULTS: The cytopathologic results were classified according to the Bethesda System as non-diagnostic in 19%, cyst/cystic nodule in 21%, benign (including thyroiditis) in 48%, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 6%, follicular neoplasms/suspicious for follicular neoplasm (FN/SFN) in 4%, suspicious for malignancy (SFM) in 1%, and malignant in 1%. The proportion of patients proceeding to surgery or with a follow-up of at least one year and the observed risks of malignancy were 22%/8% for AUS/FLUS, 69%/17% for FN/SFN, 78%/86% for SFM, and 71%/98% for malignant. For 112 cytologically suspicious and malignant FNAs, there were 102 true positives and 10 false positives, considering histology as gold standard. CONCLUSION: At variance with other data mostly originating from tertiary centers, these data demonstrate low percentages for malignant, SFM, FN/SFN, and AUS/FLUS, and high percentages for cysts/cystic nodules in this primary care setting in Germany. The risks of malignancy for malignant, SFM, AUS/FLUS, and FN/SFN FNA cytologies are according to Bethesda recommendations.
BACKGROUND: Reported results for thyroid nodule fine-needle aspiration (FNA) cytology mainly originate from tertiary centers. However, thyroid nodule FNA cytology is mainly performed in primary care settings for which the distribution of FNA Bethesda categories and their respective malignancy rates are largely unknown. Therefore, this study investigated FNA cytology malignancy rates of a large primary care setting to determine to what extent current evidence-based strategies for the malignancy risk stratification of thyroid nodules are applied and applicable in such primary care settings. METHODS: In a primary care setting, 9460 FNAs of thyroid nodules were retrospectively analyzed from 8380 patients evaluated by one cytologist (I.R.) during a period of two years. The 8380 FNA cytologies were performed by 64 physicians in different private practices throughout Germany in primary care settings. RESULTS: The cytopathologic results were classified according to the Bethesda System as non-diagnostic in 19%, cyst/cystic nodule in 21%, benign (including thyroiditis) in 48%, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 6%, follicular neoplasms/suspicious for follicular neoplasm (FN/SFN) in 4%, suspicious for malignancy (SFM) in 1%, and malignant in 1%. The proportion of patients proceeding to surgery or with a follow-up of at least one year and the observed risks of malignancy were 22%/8% for AUS/FLUS, 69%/17% for FN/SFN, 78%/86% for SFM, and 71%/98% for malignant. For 112 cytologically suspicious and malignant FNAs, there were 102 true positives and 10 false positives, considering histology as gold standard. CONCLUSION: At variance with other data mostly originating from tertiary centers, these data demonstrate low percentages for malignant, SFM, FN/SFN, and AUS/FLUS, and high percentages for cysts/cystic nodules in this primary care setting in Germany. The risks of malignancy for malignant, SFM, AUS/FLUS, and FN/SFN FNA cytologies are according to Bethesda recommendations.
Authors: Manuela Petersen; Simone A Schenke; Michael Zimny; Rainer Görges; Michael Grunert; Daniel Groener; Philipp Seifert; Peter E Stömmer; Michael C Kreissl; Alexander R Stahl Journal: J Clin Med Date: 2022-05-01 Impact factor: 4.964