Current practice of endocrinologists for non-diagnostic solid thyroid nodules: A survey report

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 437-470-Non-neoplastic Thyroid Disorders
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-463
Marius Stan*, Juan Pablo Brito, M. Regina Castro, Diana Suter Dean and Vahab Fatourechi
Mayo Clinic, Rochester, MN
Current practice of endocrinologists for non-diagnostic solid thyroid nodules: A survey report

 Juan P. Brito,  M. Regina Castro, Diana Dean, Vahab Fatourechi and Marius Stan.

 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.


 It has been estimated that approximately 7% of ultrasound guided fine-needle aspiration biopsies (USFNA) are non-diagnostic; and the prevalence of thyroid cancer in patients with this cytology is not trivial, 5 to 10%. Due to this, current clinical guidelines suggest to repeat USFNA of these nodules. However, besides the recommended use of ultrasound, there is no specific recommendation or evidence on how and when this re-aspiration should be done.


 We aim to describe the approach currently employed by endocrinologists and the one considered to yield the highest likelihood of satisfactory sample in solid thyroid nodules


 A cross sectional survey of  The Endocrine Society (TES) and the American Thyroid Association (ATA) members was conducted between October and December 2012. The survey consisted of 17 questions that addressed demographic information, clinician’s decision analysis and approach to non-diagnostic USFNA for solid nodules,  and clinicians’ opinion in future research topic in this area. A copy of the questionnaire is attached.


 A total of 695 surveys were returned, 649 (93.4%) from TES. The responders were equally divided between private and academic settings and had a high degree of expertise: 223(32%) performed more than 100 USFNA per year and 568(81%) had more than 5 years of experience. The frequency of non-diagnostic USFNA was described above 10% for 271(39%) and for its management the majority, 311(45%) recommended repeating USFNA in 1 to 3 months. For a second non-diagnostic USFNA the majority (216 or 31%) recommend surgery. The most common approaches to increase the diagnostic yield were 1) use of suction with FNA, 17%;  2) changing the targeted area of biopsy within the nodule, 16%; 3) increasing the number of passes, 15%. Finally, a molecular test for bypassing non diagnostic USFNA was regarded as the most needed strategy for future research.


 Non-diagnostic USFNA is still a significant problem across practices and expertise levels. Even though its described management is consistent with ATA guidelines, significant variability of the strategies to increase the diagnostic yield suggests great uncertainty about any benefit. Use of suction, changing the targeted area of biopsy, and increasing the number of passes are considered the most rewarding approaches. Testing these strategies in clinical trials, in parallel with evaluating molecular markers that might bypass the non-diagnostic cytopathology, should be supported by guideline panels and funding agencies.

Nothing to Disclose: MS, JPB, MRC, DSD, VF

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