The Changing Panorama of Thyroid FNA; Is Change Good?
Vicki J Schnadig, Manoj K Kathuria. University of Texas Medical Branch, Galveston, TX
Background: Use of imaging studies for work-up of non-specific symptoms, cancer staging and other screening has increased. Concomitantly increasing are thyroid “incidentaloma” detection and ultrasound (US) studies. Guidelines have recommended needle aspiration (FNA) of thyroid nodules that are > 1cm. The clinical and demographic data of thyroid FNA performed during the years 1997-98 is compared with those performed during 2009-10.
Design: Computer-search and review of FNA databases were used to find thyroid and total FNA statistics. Chart review was done to determine rate of incidentalomas, mode of aspiration (US vs palpation) and follow-up. Number and percentage of nodules resected and resection diagnoses were compared for the 97-98 and 09-10 periods. Incidentalomas are defined as lesions detected during imaging, such as CT, MRI or US, for problems not related to thyroid.
Results: Total FNA in 97-98 was more than twice that of the 09-10 period, but thyroid FNA increased. In 97-98, 256 thyroid aspirates were done on 232 patients, 9% of 2718 total FNA; 40% of patients were older than 50, and 93% of FNA were done by palpation. Twenty-four patients had repeat FNA but not multiple nodule FNA. During 09-10, there were 281 thyroid FNA on 205 patients, 22% of 1267 total FNA; 60% of patients were older than 50; 96% FNA were US-guided, and 41% of patients had incidentalomas. Radiologist comments encouraging FNA or US evaluation were found in 34% of incidentaloma patients. Multiple nodule aspiration was common. Two nodules were aspirated concomitantly in 60 patients and 3 nodules in 8 patients. Repeat FNA was done in 8 patients. During 97-98, 93 patients (40%) had resections with 26 (28%) adenomas and 20 (21%) cancers (16 DTC, 2 non-thyroid, 1 Hurthle and 1 poorly differentiated). During 09-10, 47 (23%) were resected with 14 (30%) adenomas and 6 (13%) cancers. All cancers were papillary, none were incidentalomas, and 4/6 were younger than 40 years.
Conclusions: There is a trend toward increased US-guided biopsy of incidentally discovered thyroid nodules, often of multiple nodules in an older age group. Resections show predominantly non-invasive neoplasms or other benign conditions, and a very small number of carcinomas are detected. Reported DTC deaths are less than 0.5/100.000. Current guidelines and comments by radiologists may be contributing to an epidemic of US-guided thyroid FNA and follow-up US. We need to acquire unbiased data proving patient benefit.
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 27, Tuesday Afternoon