Fine-Needle Aspiration of Subcentimeter Thyroid Nodules in the Real-World Management

• Published in: Cancer management and research 2020-08, Vol.12, p.7611
• Main Authors: Jeong, Chaiho, Kim, Hyunsam, Lee, Jeongmin, Ha, Jeonghoon, Kim, Min-Hee, Kang, Moo II, Lim, Dong-Jun
• Format: Article
• Language: English
• Subjects: Associations; Practice guidelines (Medicine); Thyroid cancer
• ISSN: 1179-1322; 1179-1322
• DOI: 10.2l47/CMAR.S263451

Background: The Korea Thyroid Association published the revised guidelines for thyroid nodules in 2016. However, whether fine-needle aspiration is accurately performed based on indications and whether the results of this procedure are appropriately addressed according to clinical guidelines, particularly in subcentimeter nodules, are unclear. Methods: We retrospectively analyzed the fine-needle aspiration data of 331 thyroid nodules of patients who were referred to a tertiary hospital clinic for fine-needle aspiration. Each nodule was categorized according to ultrasonography findings based on the recommendations of the Korea Thyroid Association for fine-needle aspiration. Only nodules with a final pathological diagnosis of benign or malignant made using the Bethesda system were included. Results: Up to 32% of thyroid nodules that were not indicated for fine-needle aspiration were aspirated. Regarding subcentimeter nodules, only 28 of 123 (22.8%) aspirated nodules were indicated for fine-needle aspiration. Of the 49 malignant subcentimeter nodules, 33 (67.3%) underwent immediate surgery. Meanwhile, 14 (28.6%) nodules were lost to followup, and two (4.1%) were under active surveillance. Eighteen (36.7%) malignant subcentimeter nodules were not indicated for fine-needle aspiration but underwent surgical resection instead of active surveillance. Conclusion: Despite the recommendations in the revised guidelines, several thyroid nodules that do not meet the indications for FNA are aspirated in real-world practice. To reduce overtreatment, a widespread knowledge of the correct indications for fine-needle aspiration is important in clinical practice, particularly for subcentimeter nodules. Keywords: thyroid nodule, fine-needle aspiration, thyroid cancer, KTA guidelines