Journal des troubles thyroïdiens et de la thérapie
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The Use of Surgeon Performed Ultrasound in the Assessment of Indeterminate Thyroid Nodules

Oded Cohen, Moshe Yehuda, Judith Diment, Yonatan Lahav and Doron Halperin

Introduction: Indeterminate thyroid nodules (category 3 and 4 by the Bethesda System for Reporting Thyroid Cytopathology - BSRTC) hold a therapeutic dilemma. Our objective was to evaluate the clinical importance of surgeon performed ultrasound (SUS) in assessing thyroid lesions with BSRTC 3 and 4.

Materials and methods: All data of all patients referred for a thyroid nodule work-up, including SUS and FNA, between July 2010 and December 2012 was recorded. All patients were treated according to accepted clinical guidelines. 105 patients were diagnosed with indeterminate cytology. 43 patients were referred to surgery, and 62 were referred to further follow up. In this retrospective chart review, all clinical, sonographical, cytopathological and histopathlogical data in this group was analyzed. Patients were subdivided according to follow up and outcome. Correlation between ultrasound features and final pathology was analyzed.

Results: Malignancy rate was 35% (15/43) in the operated group, with 37% in BSRTC category 3 (10/27), and 31% of category 4 (5/16). Benign disease on histology or repeated cytology was found in 80% (40/50) of all BSRTC 3, and 72% (17/22) of 4. The presence of two or more known sonographic features to be associated with malignancy were significantly higher in the malignant group (43% vs. 23%, p=0.035).

Conclusions: SUS allows a better patient selection for non-surgical follow up, reducing unnecessary operations.