Thyroid Fine Needle Aspiration: Successful Prospective Implementation of Strategies to Eliminate Unnecessary Biopsy in the Veteran Population

Publication date: Available online 6 January 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Sean D. Raj, Rohit Ram, David J. Sabbag, Mark A. Sultenfuss, Rebecca Matejowsky
ObjectiveThyroid nodules are prevalent in over half the general population. Several multi-disciplinary societies have management recommendations. However, the majority of data to support these guidelines are derived from studies of predominantly younger and female populations. This study′s aim was to evaluate characteristics of thyroid nodules in a largely older and male Veteran population and apply these findings prospectively to reduce unnecessary thyroid fine needle aspiration (FNA).Materials and MethodsOver a 4-year period, all ultrasound-guided FNA of thyroid nodules performed in our department were reviewed. Sonographic features, patterns, and histopathology were evaluated. A prospective strategy of avoiding FNA in all lesions matching imaging patterns of benignity was implemented and positive predictive value of malignancy was calculated and compared to the retrospective data.ResultsRetrospectively, FNA was performed on 351 successive thyroid nodules, 9 of which were malignant. Statistically significant malignant features include presence of microcalcifications, irregular/amorphous morphology, taller-than-wide shape, spiculated margins, vascularity, and lymphadenopathy. Positive predictive value (PPV) of thyroid FNA was 2.6% in this period. Four sonographic patterns were 100% specific for benignity, including: "spongiform", "cyst with a colloid clot", "giraffe", and "white knight" patterns. Over 23 months, prospective avoidance of FNA of lesions characterized as a benign pattern (159 nodules) was implemented and PPV was calculated as 7.2% resulting in a cost savings of $477,000.ConclusionFour sonographic patterns were 100% specific for benignity in the older and predominantly male Veteran population. Strict prospective application of avoiding biopsy in these benign patterns resulted in a decrease of unnecessary biopsies, decrease in patient morbidity and improved allocation of healthcare resources.



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