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Repeat Diagnoses of Bethesda Category III Thyroid Nodules: What To Do Next?

 Mi Ri Yoo  ;  Hye Mi Gweon  ;  Ah Young Park  ;  Kyung Eun Cho  ;  Jeong-Ah Kim  ;  Ji Hyun Youk  ;  Eun Ju Son 
 PLOS ONE, Vol.10(6) : e0130138, 2015 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Biopsy, Fine-Needle ; Diagnosis, Differential ; Disease Management ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Neoplasms/diagnosis ; Thyroid Neoplasms/pathology ; Thyroid Neoplasms/surgery ; Thyroid Nodule/diagnosis* ; Thyroid Nodule/pathology* ; Thyroid Nodule/surgery ; Ultrasonography ; Young Adult
OBJECTIVES: To assess the malignancy rates of thyroid nodules repeatedly classified as Bethesda category III on fine needle aspiration (FNA), and to suggest management guidelines for these lesions. METHODS: This is a retrospective study that included 395 thyroid nodules categorized as Bethesda III undergone either surgery or ultrasound (US) follow-up. There were 67 nodules classified a second time as Bethesda category III on repeat FNA. We compared malignancy rates, clinicopathologic and ultrasonographic characteristics between direct surgery and repeat FNA groups and between the initial and repeat Bethesda category III groups, each. And in the repeat Bethesda III group, clinicopathologic and US variables were compared between benign and malignant nodules. RESULTS: Incidence of concurrent cancer, underlying thyroiditis and positive BRAF mutation were significantly higher in 142 nodules with direct surgery than 243 nodules with repeat FNA (p < 0.05). Of the 395 nodules with Bethesda category III cytology on initial FNA, the malignancy rate was 59.5%. In 67 nodules with repeat Bethesda III classification, however, the malignancy rate was 73.1% (p < 0.05). However, none of the variables were significantly different between the initial Bethesda category III group and the repeat Bethesda category III group (p > 0.05). In the repeat Bethesda category III group, solid consistency, irregular/microlobulated margins, nonparallel shape, and number of suspicious findings or "suspicious malignant" US assessments were associated with a high malignancy rate (p < 0.05). On multivariate logistic regression analysis, the factor associated with malignancy in the repeat Bethesda category III group was irregular/microlobulated margin (odds ratio = 15.576; 95% CI, 2.097-115.6804, p = 0.007) with a sensitivity, specificity, positive and negative predictive values, and accuracy of 81.6%, 83.3%, 93.0%, 62.5% and 82.1%, respectively. CONCLUSION: Thyroid nodules with repeated Bethesda category III classification and irregular/microlobulated margins on US are at increased risk of malignancy, and operative management should be considered as opposed to repeat FNA.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Gweon, Hye Mi(권혜미) ORCID logo https://orcid.org/0000-0002-3054-1532
Kim, Jeong Ah(김정아) ORCID logo https://orcid.org/0000-0003-4949-4913
Park, Ah Young(박아영)
Son, Eun Ju(손은주) ORCID logo https://orcid.org/0000-0002-7895-0335
Yoo, Mi Ri(유미리)
Youk, Ji Hyun(육지현) ORCID logo https://orcid.org/0000-0002-7787-780X
Cho, Kyung Eun(조경은)
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