Journal Article Meta-Analysis Systematic Review Epublish 19 citations
PubMed: 34313606 DOI: 10.1530/EJE-21-0330
Outcomes of repeat fineneedle aspiration biopsy for AUS/FLUS thyroid nodules.
Eur J Endocrinol 185(4):497-506
Authors: Ane Bayona, Patricia Benavent, Alfonso Muriel, Cesar Abuchaibe, Susan C Sharpe, Valentina Tarasova, Bryan McIver, Pablo Valderrabano
Affiliations
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
- Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER de EpidemiologÃa y Salud Pública (CIBERESP), Department of Nursing and Physiotherapy, Universidad de Alcalá de Henares, Madrid, Spain.
- Division of Endocrinology, Diabetes and Bone disease, Department of Internal Medicine, Mount Sinai - Icahn School of Medicine, New York, New York, USA.
- Biomedical Library, Tampa, Florida, USA.
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
Abstract
OBJECTIVE
To determine the proportion of aspirates reclassified into each Bethesda category and to assess the rates of malignancy in each of them on repeat fine-needle aspiration biopsy (RFNA) following an AUS/FLUS diagnosis.
DESIGN
Systematic review and meta-analysis.
METHODS
On February 2019, Pubmed/MEDLINE, EMBASE, WoS, and the Cochrane Library were searched for articles published from January 1, 2007. All studies published in English describing RFNA outcomes in AUS/FLUS nodules were included. PRISMA and MOOSE guidelines were followed. Five investigators independently assessed the eligibility of the studies. Two investigators extracted summary data and assessed the risk of bias. Data were pooled using a random-effects model. The rate of malignancy was calculated on resected nodules only (upper limit of true value); and considering all unresected nodules were benign (lower limit of true value). The protocol was registered in PROSPERO (CRD42019123114).
RESULTS
Of 2937 retrieved studies, 27 were eligible. The meta-analysis was conducted on summary data of 3932 AUS/FLUS thyroid nodules with RFNA. RFNA cytology would reclassify into categories I through VI of Bethesda: 4% (3%, 5%), 48% (43%, 54%), 26% (20%, 32%), 4% (3%, 6%), 5% (3%, 6%), and 2% (1%, 2%) of AUS/FLUS nodules. Malignancy rates of resected nodules were 24% (9%, 38%), 4% (1%, 7%), 40% (28%, 52%), 37% (27%, 47%), 79% (69%, 90%), and 99% (95%, 100%) for categories I through VI of Bethesda. There was high heterogeneity in these data.
CONCLUSIONS
RFNA reclassified two-thirds of the AUS/FLUS specimens into a more definitive cytological category, with a benign call rate of nearly 50% and a negative predictive value greater than 96%.
MeSH
Thyroid Nodule, Endocrine Glands, Hormones, Biopsy, Endocrine System Diseases, Thyroid Gland
Cited by
- Diagnostic Accuracy of Fine-Needle Biopsy in the Detection of Thyroid Malignancy: A Systematic Review and Meta-analysis. JAMA Surg, 2022
- Current controversies in the management of patients with indeterminate thyroid nodules. Saudi Med J, 2023
- Malignancy in Thyroid Nodules with Bethesda III Category on Repeat Fine Needle Aspiration Biopsy. J ASEAN Fed Endocr Soc, 2023
- An economically efficient strategy for diagnosing atypia of undetermined significance or follicular lesion of undetermined significance thyroid nodules with ultrasound-based risk stratification systems and testing. Quant Imaging Med Surg, 2024
- 2023 European Thyroid Association Clinical Practice Guidelines for thyroid nodule management. Eur Thyroid J, 2023