CLINICAL CHARACTERISTICS OF THYROID NODULES WITH INDETERMINATE CYTOLOGY
AACE ePoster Library. Grdinovac K. 05/13/15; 97812; 1005
Dr. Kristin Grdinovac
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Abstract
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Objective: To evaluate patient demographics, TSH values, radioactive iodide scan (I-scan) results, and ultrasound (US) characteristics of indeterminate thyroid nodules.
Methods: A retrospective chart review was conducted at a Midwest academic medical center. Over two years, 883 ultrasound-guided fine needle aspiration (UGFNA) biopsies of thyroid nodules were performed. Results of 200 biopsies were randomly selected for evaluation, and of those, 34 patients had indeterminate findings. We evaluated multiple clinical measures for each indeterminate result, including family history, TSH values, I-scan results, and US features.
Results: Of the 200 biopsies that underwent UGFNA, there were 37 indeterminate nodules. The majority of these patients were female (82%), Caucasian (74%), and had no significant co-morbidities. TSH was documented in 28 nodules (82%) and was <5.0. Characteristics and echogenicity were documented in about half of US reports. Of those, 16 (84%) of the nodules were solid while 3 (16%) were of mixed character. In addition, 10 (56%) were hypoechoic, 5 (28%) were isoechoic, and 3 (17%) were hyperechoic. Nine cases (47%) had infiltrative margins, and no abnormal lymph nodes were noted. Surgical excision was performed for 23 nodules (62%). Of those, 9 (39%) were malignant and 14 (61%) were benign.
Discussion: According to current guidelines, evaluation of thyroid nodules starts with TSH values. A normal or high TSH prompts US evaluation. UGFNA is indicated for any nodule >1cm in diameter that is solid and hypoechoic or for any nodule >2cm that is mixed cystic-solid without worrisome US findings. If UGFNA result is indeterminate, an increased risk of malignancy is implied, but controversy remains regarding the next step in management among these patients. In our study, 28 (90%) had normal TSH values and US evaluation was performed in 19 (51%). US characteristics of thyroid nodules were documented in half of the US reports, and of these, 56% of the patients had hypoechoic nodules and 47% had infiltrative margins. Of the 23 surgical excisions, less than half of the nodules were malignant, indicating surgery could have been avoided in more than half of the cases.
Conclusion: It appears there is a disparity between current patient care and the clinical guidelines for the evaluation of thyroid nodules. Thorough descriptions of thyroid nodules are important in US evaluation, as certain features can suggest malignancy. Our findings show inconsistencies from guidelines due to lack of US documentation and incomplete description of important characteristics. Further studies are needed to examine adherence to current practice guidelines for the management of thyroid nodules.
Methods: A retrospective chart review was conducted at a Midwest academic medical center. Over two years, 883 ultrasound-guided fine needle aspiration (UGFNA) biopsies of thyroid nodules were performed. Results of 200 biopsies were randomly selected for evaluation, and of those, 34 patients had indeterminate findings. We evaluated multiple clinical measures for each indeterminate result, including family history, TSH values, I-scan results, and US features.
Results: Of the 200 biopsies that underwent UGFNA, there were 37 indeterminate nodules. The majority of these patients were female (82%), Caucasian (74%), and had no significant co-morbidities. TSH was documented in 28 nodules (82%) and was <5.0. Characteristics and echogenicity were documented in about half of US reports. Of those, 16 (84%) of the nodules were solid while 3 (16%) were of mixed character. In addition, 10 (56%) were hypoechoic, 5 (28%) were isoechoic, and 3 (17%) were hyperechoic. Nine cases (47%) had infiltrative margins, and no abnormal lymph nodes were noted. Surgical excision was performed for 23 nodules (62%). Of those, 9 (39%) were malignant and 14 (61%) were benign.
Discussion: According to current guidelines, evaluation of thyroid nodules starts with TSH values. A normal or high TSH prompts US evaluation. UGFNA is indicated for any nodule >1cm in diameter that is solid and hypoechoic or for any nodule >2cm that is mixed cystic-solid without worrisome US findings. If UGFNA result is indeterminate, an increased risk of malignancy is implied, but controversy remains regarding the next step in management among these patients. In our study, 28 (90%) had normal TSH values and US evaluation was performed in 19 (51%). US characteristics of thyroid nodules were documented in half of the US reports, and of these, 56% of the patients had hypoechoic nodules and 47% had infiltrative margins. Of the 23 surgical excisions, less than half of the nodules were malignant, indicating surgery could have been avoided in more than half of the cases.
Conclusion: It appears there is a disparity between current patient care and the clinical guidelines for the evaluation of thyroid nodules. Thorough descriptions of thyroid nodules are important in US evaluation, as certain features can suggest malignancy. Our findings show inconsistencies from guidelines due to lack of US documentation and incomplete description of important characteristics. Further studies are needed to examine adherence to current practice guidelines for the management of thyroid nodules.
Objective: To evaluate patient demographics, TSH values, radioactive iodide scan (I-scan) results, and ultrasound (US) characteristics of indeterminate thyroid nodules.
Methods: A retrospective chart review was conducted at a Midwest academic medical center. Over two years, 883 ultrasound-guided fine needle aspiration (UGFNA) biopsies of thyroid nodules were performed. Results of 200 biopsies were randomly selected for evaluation, and of those, 34 patients had indeterminate findings. We evaluated multiple clinical measures for each indeterminate result, including family history, TSH values, I-scan results, and US features.
Results: Of the 200 biopsies that underwent UGFNA, there were 37 indeterminate nodules. The majority of these patients were female (82%), Caucasian (74%), and had no significant co-morbidities. TSH was documented in 28 nodules (82%) and was <5.0. Characteristics and echogenicity were documented in about half of US reports. Of those, 16 (84%) of the nodules were solid while 3 (16%) were of mixed character. In addition, 10 (56%) were hypoechoic, 5 (28%) were isoechoic, and 3 (17%) were hyperechoic. Nine cases (47%) had infiltrative margins, and no abnormal lymph nodes were noted. Surgical excision was performed for 23 nodules (62%). Of those, 9 (39%) were malignant and 14 (61%) were benign.
Discussion: According to current guidelines, evaluation of thyroid nodules starts with TSH values. A normal or high TSH prompts US evaluation. UGFNA is indicated for any nodule >1cm in diameter that is solid and hypoechoic or for any nodule >2cm that is mixed cystic-solid without worrisome US findings. If UGFNA result is indeterminate, an increased risk of malignancy is implied, but controversy remains regarding the next step in management among these patients. In our study, 28 (90%) had normal TSH values and US evaluation was performed in 19 (51%). US characteristics of thyroid nodules were documented in half of the US reports, and of these, 56% of the patients had hypoechoic nodules and 47% had infiltrative margins. Of the 23 surgical excisions, less than half of the nodules were malignant, indicating surgery could have been avoided in more than half of the cases.
Conclusion: It appears there is a disparity between current patient care and the clinical guidelines for the evaluation of thyroid nodules. Thorough descriptions of thyroid nodules are important in US evaluation, as certain features can suggest malignancy. Our findings show inconsistencies from guidelines due to lack of US documentation and incomplete description of important characteristics. Further studies are needed to examine adherence to current practice guidelines for the management of thyroid nodules.
Methods: A retrospective chart review was conducted at a Midwest academic medical center. Over two years, 883 ultrasound-guided fine needle aspiration (UGFNA) biopsies of thyroid nodules were performed. Results of 200 biopsies were randomly selected for evaluation, and of those, 34 patients had indeterminate findings. We evaluated multiple clinical measures for each indeterminate result, including family history, TSH values, I-scan results, and US features.
Results: Of the 200 biopsies that underwent UGFNA, there were 37 indeterminate nodules. The majority of these patients were female (82%), Caucasian (74%), and had no significant co-morbidities. TSH was documented in 28 nodules (82%) and was <5.0. Characteristics and echogenicity were documented in about half of US reports. Of those, 16 (84%) of the nodules were solid while 3 (16%) were of mixed character. In addition, 10 (56%) were hypoechoic, 5 (28%) were isoechoic, and 3 (17%) were hyperechoic. Nine cases (47%) had infiltrative margins, and no abnormal lymph nodes were noted. Surgical excision was performed for 23 nodules (62%). Of those, 9 (39%) were malignant and 14 (61%) were benign.
Discussion: According to current guidelines, evaluation of thyroid nodules starts with TSH values. A normal or high TSH prompts US evaluation. UGFNA is indicated for any nodule >1cm in diameter that is solid and hypoechoic or for any nodule >2cm that is mixed cystic-solid without worrisome US findings. If UGFNA result is indeterminate, an increased risk of malignancy is implied, but controversy remains regarding the next step in management among these patients. In our study, 28 (90%) had normal TSH values and US evaluation was performed in 19 (51%). US characteristics of thyroid nodules were documented in half of the US reports, and of these, 56% of the patients had hypoechoic nodules and 47% had infiltrative margins. Of the 23 surgical excisions, less than half of the nodules were malignant, indicating surgery could have been avoided in more than half of the cases.
Conclusion: It appears there is a disparity between current patient care and the clinical guidelines for the evaluation of thyroid nodules. Thorough descriptions of thyroid nodules are important in US evaluation, as certain features can suggest malignancy. Our findings show inconsistencies from guidelines due to lack of US documentation and incomplete description of important characteristics. Further studies are needed to examine adherence to current practice guidelines for the management of thyroid nodules.
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