Reducing indeterminate thyroid FNAs

Abstract

BACKGROUND The Bethesda System recommends limiting the percentage of cases diagnosed as indeterminate in thyroid fine-needle aspirations (TFNAs). However, studies are lacking that document how to decrease the rate of indeterminate TFNAs and its effects. METHODS The authors modified the Bethesda criteria to reduce the rate of indeterminate TFNAs ("atypical cells of undetermined significance" and "suspicious for a follicular/Hurthle cell neoplasm") by reassigning cases that may have been categorized as indeterminate to "suspicious for papillary carcinoma" or "favor benign" for an 18-month period and correlated this with histologic follow-up. RESULTS The indeterminate rate decreased from 14.4% (Bethesda) to 8.2% (modified Bethesda; P