Dr.Guttler’s Patient Thyroid Blog Post #14: Large Nodules Need more studies than class II cytology

Dr.Guttler’s comments:

1. >4 cm nodules that are cytology class II should have molecular marker testing due to high rate of false negative cytology on big nodules.
2. Suspicious thyroid nodules ≥4 cm require diagnostic lobectomy if the moleicular is suspicious regardless of their benign fine needle aspiration results.
3. Large nodules need more than just a Class II cytology to avoid surgery. Molecular Classifier should be benign as well.
4. Call me for evaluation before you feel safe with a large >4 cm nodule called benign by cytology.
5. 310-393-8860 or email to thyroid.manager@thyroid.com.
6. Ask for Alicia.
7. Dr.G.

• September 2021
• Asian Journal of Surgery
• Hyeung Kyoo Kim et al

• DOI:
• 10.1016/j.asjsur.2021.08.005

Abstract

The diagnostic accuracy of fine needle aspiration biopsy (FNAB) seems limited in large thyroid nodules with Bethesda Cat. 2 result. We aimed to determine the incidence of carcinoma with benign cytology and the reason for the high false-positive rate in thyroid nodules ≥4 cm. Methods The records of 103 patients with thyroid nodules ≥4 cm with preoperative cytological diagnosis of Bethesda Cat. 2 who underwent thyroidectomy were consecutively reviewed. Characteristics between patients with malignant vs. benign pathology were compared. Results Forty patients (38.8%) had malignancy. Malignancy was subclassified into follicular variant of papillary thyroid carcinoma (43%), minimally invasive follicular thyroid carcinoma (20.0%), and minimally invasive Hurthle cell thyroid carcinoma (10.9%). Patients with malignant cytology had significantly more suspicious ultrasound findings than those with benign cytology (p = 0.001). Conclusions Preoperative FNAB showed high false-negative rates in patients with thyroid nodules ≥4 cm with benign cytology. These nodules have a high malignancy rate with suspicious ultrasound findings.