Accuracy of Fine-Needle Aspiration for Cytologic Categorization of Thyroid Nodules—Incremental Progress vs Quantum Improvement
A partir d'une revue systématique de la littérature publiée entre 1975 et 2020 (36 études), cette méta-analyse évalue la précision d'une biopsie à l'aiguille fine pour détecter un cancer de la thyroïde
Evaluation of patients with thyroid nodules is designed to separate the few malignant or hyperfunctioning nodules that require treatment from the many benign nodules that can be monitored without intervention. Functional status of a nodule is typically simple to ascertain; however, identifying malignant nodules entrains multiple threads of evidence. Nodules with sufficient risk of malignancy based on size and ultrasonography findings, often codified through Thyroid Imaging Reporting and Data System (TI-RADS) scoring, are sampled by fine-needle aspiration (FNA) for cytologic categorization.Historically, benign or malignant cytology results have been reliable, and typically followed by interval follow-up for benign nodules or cancer treatment after malignant results. The challenge has been improving management after indeterminate cytology results, now separated into 3 groups by the Bethesda thyroid cytology system—Bethesda-3 atypia of uncertain significance (B-3), Bethesda-4 follicular neoplasm (B-4), and Bethesda-5 suspicious for malignancy (B-5). These groups together make up 15% to 25% of cytology results and have a risk of malignancy of about 30% overall, ranging from about 15% for B-3 to 75% for B-5. These form a dissatisfying group of patients who typically require diagnostic thyroidectomy to resolve the uncertainty.
JAMA Surgery , éditorial, 2021