@article{TEXTUAL,
      recid = {13107},
      author = {Storozuk, Tanner and Biernacka, Anna and Lastra, Ricardo  and Mueller, Jeffrey and Olivas, Andrea and Reeves, Ward  and Yassan, Lindsay and Antic, Tatjana},
      title = {Fate of nondiagnostic thyroid fine needle aspirations},
      journal = {Diagnostic Cytopathology},
      address = {2024-07-25},
      number = {TEXTUAL},
      abstract = {&lt;p&gt;Background: Thyroid nodules may be detected during the  workup of thyroid hormone abnormalities and as incidental  findings during unrelated imaging studies. The diagnosis of  a thyroid nodule is mainly established by performing fine  needle aspiration (FNA) under ultrasound guidance. Thyroid  nodules are classified as nondiagnostic, defined in the  Bethesda System for Reporting Thyroid Cytopathology as  samples with excess blood, cyst fluid only, and lack of  thyroid follicular cells. The current study evaluates a  series of nondiagnostic FNAs to assess whether repeat  sampling improves yield and what patient management, and  outcomes are after a nondiagnostic FNA.&lt;/p&gt; &lt;p&gt;Methods:  Thyroid FNAs from 2016 to 2023 were retrieved from our  institution archives. All cases were performed under  ultrasound guidance and with rapid on-site evaluation.  Cases were assigned the Bethesda System Category.  Nondiagnostic FNAs were further reviewed for repeat FNA  procedures, potential molecular testing, or diagnostic  resections.&lt;/p&gt; &lt;p&gt;Results: In total 3104 thyroid FNAs were  reviewed, with 153 (4.9%) being nondiagnostic. Of the 154  FNAs, there were 129 patients with an average age of 60 and  a male-to-female ratio of 1:3.2. Of the 130 patients, there  were 50 patients who underwent 55 repeat FNAs. Thirty-seven  (67%) of the repeats were benign, 13 (24%) were  nondiagnostic again, and 5 (9%) were atypia of undetermined  significance (AUS). Molecular testing was performed on  repeat FNAs diagnosed AUS. Four cases showed no mutations  and had a high likelihood of being benign. One case did  have an NRAS Q61R mutation, and resection revealed a  noninvasive follicular thyroid neoplasm with papillary-like  nuclear features. Seventeen (13% of all cases) with  nondiagnostic FNA were resected. Twelve (71%)  thyroidectomies showed benign adenomatous nodules. The  remainder showed incidental papillary thyroid  microcarcinoma (0.1 cm), an infarcted follicular adenoma, a  noninvasive follicular thyroid neoplasm with papillary-like  nuclear features, and metastatic renal cell carcinoma  (2×).&lt;/p&gt; &lt;p&gt;Conclusion: Thyroid nodules with nondiagnostic  cytology are reassuring of being highly likely a benign  nodule. Only 5 of the 55 (9%) repeat FNAs yielded  abnormalities, with only one of those being truly a  follicular neoplasm (confirmed by molecular testing and  resection). No primary thyroid malignancies have been  identified in follow-up (repeat FNA or surgery). Clinical  and ultrasound follow-up may be more appropriate management  for nondiagnostic thyroid FNAs.&lt;/p&gt;},
      url = {http://knowledge.uchicago.edu/record/13107},
}