GS Journal Reading

Reporter / R2 姜冠宇Supervisor / VS 鄭世平

Background

Thyroid nodules

Normal or elevated serum TSH

Ultrasound-guided fine-needle aspiration (FNA)

Background

Not FlawlessFalse-negative rate is not negligible

Interval remains uncertain

Serial ultrasound & FNA: 6–18 months after an initial benign FNA.

The American Thyroid Association Expert opinion

Materials and Methods

2283 patients thyroid nodule > 1 cm-sized

Brigham and Women’s Hospital Between 1995 and 2003

Thinking Process

False-negative cases detected in repeat examination gain the Interval

Cohort

Thyroid Nodule > 1cm

Thyroidectomy

Thyroid scintigraphy-No longer included

FNA

TSH decreased <0.5uU/ml

TSH normal or elevated

Malignancy

Benign *Repeat

The follow-up interval stopping point

* Death : 30 patients (2%),* Thyroidectomy : 325 (24%). * Remaining 1014 patients (74%)

2283

1549 1369

Results

Results (follow-up interval)

30% 27%

44%

Results

5.3

8.5

4.2

4.518 (1.3%)

(range 0.3–10 y)

Results

18 cases are false negative

Results

11 false-negative FNA results 5 (45%) within 5 years 9 (82%) within 8 years 11 (100%) within 10 years

ResultsDetected10 (56%) within 5 years16 (89%) within 8 years 18 (100%) within 10 years

Frequent ultrasound follow-up?

Minimal benefit to repeat follow-up ultrasound

ultrasound follow-up 2 yrs 3 yrs 4 yrs

< 2, 3, or 4 yrs 7.5% 7.8% 8.2%> 2, 3, or 4 yrs 7.4% 6.6%, 4.5%P value 0.97 0.74 0.41

Discussion

Slow nodule growth is common Symptomatic enlargement may be more

frequent than initially assumed

Discussion

Large nodules don’t convey increased risk

Conclusion

Malignancies at a mean 4.5 years after falsely benign FNA Negligable mortality risk during long-term follow-

up

Recommendation: 2–4 years repeat evaluation after the initial benign

FNA