Cavalheiro et al. There were no cases of NIFTP among our thyroidectomy patients. As a result, all patients with category IV and some with category III TNs have histopathological verification. There was no statistical difference between AUS, FLUS and FN/SFN groups in terms of malignancy rates (P=0.67). 2010;54:12331. 2014;38(3):62833. Registration is free. A total of 814 (59.63%) of these patients underwent thyroidectomy. TBSRTC recommends lobectomy for this category. Manganese superoxide dismutase serves as an antioxidant by converting that dangerous species into hydrogen peroxide, which another enzyme can break down into water, thereby relieving the cell of the danger. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Internet Explorer). JAMA 319, 914924 (2018). Ho, A. S. et al. It should be mentioned that the number of patients diagnosed with AUS/FLUS and FN/SFN in the current study was limited. These rates may be considered to guide clinicians when deciding whether to perform a thyroidectomy, as well as to encourage pathologists to reconsider the current recommendations given by the Bethesda System for Reporting Thyroid Cytopathology. It is therefore clear that these authors recommend repeat UG-FNAB for TBSRTC category III nodules on initial biopsy23. WebThe Bethesda system suggests a six category classification system to report thyroid FNAB results: 1. CAS WebIntroduction: The Bethesda System classifies suspicious thyroid nodules or those with a large size after fine-needle aspiration (FNA) depending on the risk of malignancy through Evaluation of the thyroid nodule. WebBethesda Classification of Thyroid Nodule Fine Needle Aspirations I. Nondiagnostic or Unsatisfactory. Kaliszewski, K., Diakowska, D., Wojtczak, B. et al. FNAC outcomes are routinely classified using the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), facilitating appropriate clinical management. The other aspect of these hypotheses is the correlation between molecular prognostic markers and thyroid hormone therapy and its influence on the neoplastic progression. The steps for patient selection are presented in Fig. Cytopathology. The current study included a large single-center cohort of patients with TNs classified as AUS/FLUS and FN/SFN with all individuals undergoing surgery (n=532). Bethesda category III nodules are further categorized as atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS). Resources: K.K., B.W., B.K., K.S. Thyroid follicular lesion of undetermined significance: evaluation of the risk of malignancy using the two-tier sub-classification. The authors declare that they have no competing interest. The first question is, Which nodules assigned to the AUS/FLUS and FN/SFN categories should be considered for surgical treatment and which can be safely observed? The second question is, Is thyroid hormone therapy for patients with category III and IV nodules safe? Eszlinger M, Lau L, Ghaznavi S, et al. Cancer Cytopathol. Int. Among the six categories in this classification, the third category is known as atypia of undetermined significance and follicular lesion of undetermined significance (AUS/FLUS), and the fourth category is known as follicular neoplasm and suspicious for follicular neoplasm (FN/SFN)1,3. Thyroid 26, 1133 (2016). All tests were two-sided and 0.05 was considered statistically significant. If material is not included in the articles Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. In Turkey, an aggressive surgical approach for nodules classified as Bethesda class III is not recommended because the primary role of resection assessment is to identify patients who do not require an operation for thyroid nodules. WebNodules classified as Bethesda III and IV are considered intermediate risk, and although Bethesda III nodules are more likely to be benign than Bethesda IV, our hypothesis is and D.D. All participants underwent surgery, and histopathological verification was obtained in all cases. Ann Surg Oncol. Web*Bethesda Category IV. These two categories of TBSRTC are the most controversial cytological groups and are managed completely differently by many departments. This paper provides a more precise correlation of malignancy rates with thyroid nodules classified as Bethesda categories III and IV, as our findings are comparable to the literature, giving malignancy rates ranging from 10 to 30% for category III and 2540% for category IV. Gene expression assays using FNAC material may demonstrate a high predictive value in cytological undetermined thyroid nodules diagnosed as Bethesda classes III and IV. 2018;40(9):18818. Provided by the Springer Nature SharedIt content-sharing initiative. In our department, all patients with FN/SFN category TNs and some selected patients with AUS/FLUS category TNs qualify for surgery. Tucker Carlson ousted at Fox News following network's $787 million settlement. - Case Studies Broome JT, Cate F, Solorzano CC. Google Scholar. Gene expression assays using FNAC material may demonstrate a high predictive value for cytologically indeterminate thyroid nodules diagnosed as Bethesda classes III and IV. The two groups of treated and untreated patients were comparable in age, clinical features, initial nodule volume and duration of L-T4 therapy. Choi, Y. J. et al. 2019 Mar;30(1):815. In the present study, the rate of malignancy among patients who underwent immediate surgery was 16% for class III and 28.6% for class IV. emphasized that L-T4 is one of the most widely and commonly prescribed medications in the United States7. Of the 108 patients diagnosed with Bethesda III nodules, 69.4% underwent immediate surgery and 16% of these patients had nodules that were malignant. For the 75 (14.7%) patients with nodules classified as AUS/FLUS who underwent immediate surgery, the rate of malignancy was 16% (12/75). The study was approved by Kocaeli Derince Training and Research Hospital Clinical Research Ethics Committee of Health Sciences University, Turkey (Protocol number: 202031). (Image credit: Bethesda) After years of waiting, Bethesda has finally shown off Starfield -- and it looks both expansive and generic. In such cases, the matter of unnecessary surgeries should be taken into consideration20. Cookies policy. Bongiovanni M, Crippa S, Baloch Z, Piana S, Spitale A, Pagni F, Mazzucchelli L, Di Bella C, Faquin W. Comparison of 5-tiered and 6-tiered diagnostic systems for the reporting of thyroid cytopathology: a multi-institutional study. All analyzed patients assigned to this category had the same clinical and ultrasound features of the biopsied lesions. reported that AUS subclassifications such as the presence of focal nuclear atypia, focal microfollicular proliferation, focal Hurthle cell proliferation and others were associated with malignancy rates of 54, 39, 19, and 26%, respectively. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. Fine-needle aspiration cytology (FNAC) has become a well-established modality in the diagnosis, staging and follow-up of thyroid nodules. 2010;118(1):1723. France: IARC, Lyon; 2017. p. 65145. 1). JAMA 174, 459464 (1960). The gender distribution showed a female preponderance, with 664 females and 150 males. Some series report an AUS/FLUS diagnosis rate of 18% among cytopathological specimens [15]; however, Ho et al. Over a 6-year period, 11,627 FNAC procedures were performed on thyroid nodules. Though the risk of malignancy for category III and IV TNs has been estimated, some authors suggest, that the risk of malignancy for patients with AUS/FLUS and FN/SFN category nodules depends upon the specific clinical situation3,6. Many people take it in combination with other drugs. Patients with III and IV category of the Bethesda System under levothyroxine non-suppressive therapy have a lower rate of thyroid malignancy, https://doi.org/10.1038/s41598-019-44931-8. and D.D. In conclusion, our study demonstrates that the prevalence of patients with Bethesda System category III and IV TNs who take thyroid hormone therapy is high. Thus, follow-up of suspicious nodules and repeated FNAC is usually recommended for the clinical management of thyroid nodules [24]. significant alteration in the follicular cell architecture, characterized by cell crowding, micro follicles, dispersed isolated cells and scant or absent colloid. Invest. A tertiary centers experience with second review of 3885 thyroid cytopathology specimens. Currently, we know that the oncological potential of these tumors is not clearly established, and the risk of further progression towards aggressive behavior is still uncertain. Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. AHNS series: do you know your guidelines? To determine accurate malignancy rates for nodules classified as Bethesda III or IV, data from 155 patients who underwent thyroidectomies were analyzed. Data obtaining: K.K., B.W., B.K., K.S. Webcategories. We previously described some ultrasound features that are associated with an increase or decrease in the risk of malignancy for AUS/FLUS-classified TNs. 2014;24(5):8329. Our study demonstrates that patients with thyroid nodules assigned to category IV taking thyroid hormone therapy in non-suppressive doses might be monitored for longer periods of time without surgical treatment than those who are not receiving this therapy. Correspondence to Nodules suspected for malignity were totally embedded in paraffin, and stained with haematoxylin and eosin (H&E). Histological analysis was performed on all surgically excised lesions that were the target of cytological evaluation. It was estimated that this benefit did not outweigh the potential harm of iatrogenic hyperthyroidism. Nevertheless, when examined by type of thyroid malignancy, the rate of follicular carcinoma and other rare malignancy increased with increasing nodule size. Three patients in the AUS/FLUS group had encapsulated tumours, while none of the FN/SFN patients had encapsulation. Approximately 515% and 1040% of TNs assigned to AUS/FLUS and FN/SFN categories, Efficacy and safety of core-needle biopsy in initially detected thyroid nodules via propensity score analysis. In patients with category III nodules, application of NSTHT was associated with a lower rate of thyroid cancer (TC), though this observation was not significant (OR=0.55, p=0.381). J. Clin. Currently, it cannot be predicted if TNs assigned to Bethesda System categories III or IV will remain clinically silent or manifest as malignant lesions. Cancer Cytopathol. Project administration: K.K. 2013;49:64553. There were 9(25%) in Bethesda category 4, and 7(77.7%) of them were TP and 2(22.2%) were FP on histopathology. 4th ed. AUS nodules consist of follicular cells that are mostly benign in appearance. TSH non-suppressive LT-4 therapy in the first group of patients was administered and conducted at a minimum for the last two years before surgery. In another study that investigated 3080 thyroid FNACs, the malignancy rates in Bethesda categories III and IV were 17 and 25.4%, respectively [23], which are comparable to our findings. From the initial group of patients (n=4,716), 532(11.28%) individuals were selected for further evaluation. 2016;26(1):1133. Endocrinol. The malignancy rates of Bethesda categories III and IV for patients triaged for immediate surgery were 54.6 and 72.4%, respectively, which are much higher than the rates reported by the ATA and by our study [21]. These two groups included to the study differed just only LT-4 supplementation (yes/no). BMC Endocr Disord 20, 48 (2020). PubMedGoogle Scholar. The images or other third party material in this article are included in the articles Creative Commons license, unless indicated otherwise in a credit line to the material. Baloch ZW, Cibas ES, Clark DP, Layfield LJ, Ljung BM, Pitman MB, Abati A. Barely breaking orbit. Manganese superoxide dismutase serves as an antioxidant by converting that dangerous species into hydrogen peroxide, which another enzyme can break down into water, thereby relieving the cell of the danger. The rate of malignancy for all patients with nodules categorized as Bethesda III who were triaged to surgery was 25%. Of the 47 patients diagnosed with Bethesda IV nodules, 74.5% underwent immediate surgery and 28.6% of these patients had nodules that were malignant. Bongiovanni, M., Spitale, A., Faquin, W. C., Mazzucchelli, L. & Baloch, Z. W. The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis. Among them, 108 were diagnosed with AUS/FLUS (59 patients were AUS and 49 were FLUS) and 47 were diagnosed with FN/SFN (Fig. But within the settlements themselves, you'd think they would make an effort to clean the place up. However, the controversy still remains. Cavalheiro, G. B. et al. 2009;19(11):115965. - Conference Coverage Therefore, controversies over the management of these lesions persist. However, there are controversial data about the risk of malignancies, recurrence and clinical management of nodules in Bethesda categories III and IV, as the reported risks of malignancy vary significantly, from 10 to 30% to 2540% (including noninvasive follicular thyroid neoplasm with papillary-like nuclear features [NIFTP]), respectively [4]. McIver B. Of the 2630 patients diagnosed with AUS/FLUS on initial FNAC, 510 (19.4%) were documented during follow-up. volume20, Articlenumber:48 (2020) Thyroid 24, 832839 (2014). 2012;367:70515. Aspirations were performed according to the literature [8]. Surgery 156, 14711476 (2014). WebBethesda classification system for thyroid fine needle aspirates comprises six categories of pathological reporting of thyroid FNA, with each category linked to a malignancy risk. ADS Others point out that, when using predictive factors for malignancy for the categories of AUS/FLUS and FN/SFN as a risk index, 17% of individuals without the risk factors do not need surgery3. Surprisingly, the rate of malignancy for nodules categorized as Bethesda III increased from 16% for patients who underwent immediate surgery to 45.5% for those who underwent 2 sequential FNAC tests, supporting repeated FNAC for this category of lesions. The histopathological specimens were analyzed by two pathologists experienced in thyroid diseases. Van der Laan, P. A., Marqusee, E. & Krane, J. F. Usefulness of diagnostic qualifiers for thyroid fine-needle aspirations: with atypia of undetermined significance. Pathol. The average size of malignant tumours was 1.910.15cm, with no difference between groups (P=0.78). The present study analysed the cytopathological findings of thyroid nodules of 950 patients at a single institution, classified into two categories: AUS/FLUS or FN/SFN. Yaprak Bayrak, B., Eruyar, A.T. Malignancy rates for Bethesda III and IV thyroid nodules: a retrospective study of the correlation between fine-needle aspiration cytology and histopathology. Mathur, A., Najafian, A., Schneider, E. B., Zeiger, M. A. Google Scholar. Effects on bone mass of long term treatment with thyroid hormones: a meta-analysis. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Future studies investigating the use of gene expression assays and molecular assays on FNAC material in predicting the malignancy of undetermined thyroid nodules diagnosed as Bethesda classes III and IV could help to eliminate subjectivity. The rate of malignancy for all patients with nodules categorized as Bethesda IV who were triaged to surgery was 27.6%. Deniwar, A., Hambleton, C., Thethi, T., Moroz, K. & Kandil, E. Examining the Bethesda criteria risk stratification of thyroid nodules. PubMed Somma J, Schlecht NF, Fink D, Khader SN, Smith RV, Cajigas A. Thyroid fine needle aspiration cytology: follicular lesions and the gray zone. TI-RADS 4a category Mildly suspect nodules are both mildly hypoechoic, and no sign of high suspicion TI-RADS 4b and 4c categories Highly suspicious features include taller than wide shape irregular borders microcalcifications markedly hypoechoic high stiffness with sonoelastography (if available) 3,4-methylenedioxy-methamphetamine (MDMA) is a synthetic drug that alters mood and perception. Malignancy rates for Bethesda III and IV thyroid nodules: a retrospective study of the correlation between fine-needle aspiration cytology and histopathology, https://doi.org/10.1186/s12902-020-0530-9, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. The Microsoft-owned company has delayed both the sci-fi RPG Starfield and Arkane's vampire shooter Redfall to the first half of 2023. BYB and ATE ensured that questions related to the accuracy or integrity of any part of the work, are appropriately investigated, resolved, and the resolution documented in the literature. As a result, there is a debate about the best management of category III and IV TNs based on certain clinical characteristics. Metab. Each of the categories has an implied cancer risk (ranging from 0% to 3% for the benign category to virtually 100% for the malignant category) that links it to a rational clinical management guideline Table 2 . 2014;42:1822. The Bethesda categories III and IV describe varying risks of malignancy. Provided by the Springer Nature SharedIt content-sharing initiative. Follicular carcinomas have cytomorphologic features that distinguish them from benign follicular nodules but do not permit distinction from a follicular adenoma (FA). Diagn. Kantor, E. D., Rehm, C. D., Haas, J. S., Chan, A. T. & Giovannucci, E. L. Trends in prescription drug use among adults in the United States from 19992012. There are six cytological diagnostic categories, each with different suggested treatment approaches. Int. Privacy Mission to Mars For example, histopathological follow-up in cases of AUS/FLUS range from 3090% (18%). Thyroid 24, 494501 (2014). Also, epidemiological and geographical differences between populations should not be ignored. The rates of malignancy among patients who underwent surgery were 25% for category III and 27.6% for category IV, with no significant differences between categories (p=0.67). Websong that goes bum bum bum 2020. bethesda category 5 is dangerousconservation international ceo. Cibas, E. S. & Ali, S. Z. Article Reporting of FNAC results has been successfully standardised by the Bethesda System for Reporting Thyroid Cytopathology, which also facilitates more accurate diagnostic decisions in clinical management. 211, 345348 (2015). The FN/SFN category presents the greatest uncertainty, as follicular carcinomas resemble benign follicular neoplasms at the individual cellular level, hence limiting the ability of pathologist to accurately diagnose these nodules unless the tissue demonstrates any vascular or capsular invasion [7]. Considering these limitations and debates on the management of Bethesda III and IV thyroid nodules, together with the diverse malignancy rates reported in the literature, the present retrospective study aimed to attribute an accurate malignancy rate for patients with nodules classified as Bethesda III or IV. Endocr. The cytopathological reports were issued by a pathologist, following the Bethesda classification according to the literature [1, 4]. WebThe Bethesda System for Reporting Thyroid Cytopathology (BSRTC) uses six categories for thyroid cytology reporting (I-nondiagnostic, IIbenign, III-atypia of undetermined The entire cohort was classified around the time of the surgical treatment under TBSRTC rather than retrospectively reviewed and assigned a category. Webas Bethesda category 3 on cytology turned out to be FP on histopathology. The process used to obtain oral consent was deemed to be acceptable and was approved by the Bioethics Committee of Wroclaw Medical University. WebBethesda categories III and IV encompass varying risks of malignancy. Enjoying our content? 2014;156(6):14716. Acta Cytol. Cite this article. Of 14 patients with FN/SFN and AUS/FLUS and family history of thyroid cancer (14/73 additionally excluded; Fig. The nonparametric Mann-Whitney test was used to compare quantitative variables, while the chi-square test or chi-square test for independence were used to compare dependent or independent qualitative data. The other known cytological category of AUS/FLUS covers a subset of lesions that are not easily classified as benign, suspicious or malignant [4]. Thyroid 24, 11151120 (2014). This makes reaching a definitive histologic diagnosis difficult in a large number (1030%) of patients undergoing thyroidectomy [3]. UG-FNAB: ultrasound guided fine needle aspiration biopsy, AUS/FLUS: atypia of undetermined significance or follicular lesion of undetermined significance, FN/SFN: follicular neoplasm or suspicious for follicular neoplasm, TNs: thyroid nodules, MEN: multiple endocrine neoplasm, TSH: thyroid stimulating hormone. People who use MDMA typically take it as a capsule or tablet. After clinical and radiological diagnosis, the FNA procedure was performed under ultrasound guidance. CAS Including all resected nodules, the rates of malignancy for all patients triaged to surgery were 25 and 27.6%, respectively. Article This is the category with the greatest uncertainty, as follicular carcinomas resemble benign follicular neoplasms at the cellular level, making it difficult to distinguish between benign and carcinogenic nodules without additional indication. WebBethesda Category V is considered 60% - 75% likely to be malignant. Thyroid. There was no significant difference between groups in terms of tumour type (P=0.65). Clinical outcome for atypia of undetermined significance in thyroid fine-needle aspirations: should repeated FNA be the preferred initial approach? Logistic regression analysis for predicting the occurrence of thyroid cancer in association with NSTHT was performed for both subgroups. Therefore, it is important to estimate the rates of malignancy at each institution. Indian J Otolaryngol Head Neck Surg. Indetermi-nate, 4. Patients with nodules that were diagnosed as AUS/FLUS after 2 successive FNAC tests had a malignancy rate of 45.5%. Horne et al. Suh, C. H. et al. 2017;16(1):e12871. Malignancy risk and reproducibility associated with atypia of undetermined significance on thyroid cytology. Among the malignant lesions, the most frequently diagnosed entity was papillary thyroid carcinoma, diagnosed in 81.5% of AUS/FLUS and 69.2% of FN/SFN patients (Table3). Sapio et al. Another limitation of this study was the loss of patients to follow-up over the 6-year period, as many patients were transferred to another university hospital or another surgeon [16]. In the meantime, to ensure continued support, we are displaying the site without styles The study authors noted that because there is heterogeneity in categorization at different institutions, it is important to determine the rates of malignancy at each institution. Horne MJ, Chhieng DC, Theoharis C, Schofield K, Kowalski D, Prasad ML, Hammers L, Udelsman R, Adeniran AJ. Correspondence to Prolonged treatment with TSH non-suppressive therapy with L-T4 significantly decreases the rate of malignancy in FN/SFN but not in AUS/FLUS category lesions. Nat Rev Endocrinol. All patients with nodules with two consecutive AUS/FLUS diagnoses (n=33) underwent surgery, of which 45.5% (15/33) were found to be malignant while 54.5% (18/33) were benign (Fig. The inclusion criteria were as follows: the presence of a thyroid nodule or nodules observed for a minimum of 3 years, clearly defined TN features on ultrasonography, euthyreosis, UG-FNAB performed with cytology results confirming AUS/FLUS and FN/SFN categories, and TSH non-suppressive L-T4 therapy conducted at a minimum for the last two years before surgery. WHO classification of Tumours of endocrine organs. Cytojournal. BYB and ATE made substantial contributions to the conception, design of the work, the acquisition, analysis, and interpretation of data; drafted the work and substantively revised it. High growth rate of benign thyroid nodules bearing RET/PTC rearrangements. Bethesda categories III and IV encompass varying risks of malignancy. However, a Bethesda IV diagnosis may require a different type of management. Category 4 Suspicious or Indeterminate abnormality A BI-RADS category 4 mammogram is where concern for breast cancer risk begins to increase. - And More, Close more info about Study Examines Malignancy Rates for Thyroid Nodule Bethesda Categories III and IV, Outdoor Air Pollutants May Be Linked to Development of Thyroid Nodules, American Association of Endocrine Surgeons Publishes Guidelines for Thyroid Disease Surgery, Active Surveillance Feasible for Papillary Thyroid Microcarcinomas, Malignancy rates for Bethesda III and IV thyroid nodules: a retrospective study of the correlation between fine-needle aspiration cytology and histopathology. Busra Yaprak Bayrak. Only the specimens obtained from UG-FNAB of the thyroid nodules from patients operated in 2008 were retrospectively reanalyzed and assigned to adequate categories according to TBSRTC because this classification was formed and finally recommended in 20091. However, this management approach remains controversial. The proportion of malignancy in Bethesda III nodules confirmed by surgery were significantly increased in proportion Based on their own observation of the totally independent evolution of two separate nodules in one patient, some authors suggest that individual intra-nodular factors are more important for determining progression than the presence or absence of thyroid hormone therapy and clinical and ultrasound characteristics21. WebThe estimated risk of malignancy in Bethesda category III (AUS/FLUS) and Bethesda category IV, Follicular Neoplasm/Suspicious for Follicular Neoplasm (FN/SFN) nodules was described to be 5--15% and 15--30%, respectively, as per TBSRTC 2007. WebBethesda Category III, IV, and V Thyroid Nodules: Can Nodule Size Help Predict Malignancy? Thyroid nodules (TNs) assigned to the Bethesda System categories III and IV include numerous clinical characteristics, which increase or decrease the risk of malignancy. WebThe Bethesda categories III and IV describe varying risks of malignancy. However, to date, the guidelines from 1996 have not been updated and have not recommended the use of thyroid hormone therapy in either suppressive or non-suppressive doses for the treatment of thyroid nodules8. Bethesda Category IV. and D.D. Due to the high sensitivity and accuracy, genetic analysis may be helpful in ruling out malignancy in cases of indeterminate nodules. Writing original draft: K.K. We hope youre enjoying the latest clinical news, full-length features, case studies, and more. Molecular assays are of increasing importance in determining the need for surgical intervention for thyroid lesions. J. Clin. WebConversely, Bethesda Category IV (follicular neoplasm or suspicious for follicular neoplasm) is thought to warrant surgery due to an estimated 1530% risk of malignancy. Home > E. Pathology by systems > Endocrine system > Thyroid gland > thyroid Bethesda category 4. Similar to our findings for Bethesda categories III and IV, Cavalheiro et al. Jo VY, Stelow EB, Dustin SM, Hanley KZ. Malignancy was diagnosed in 25% of 108 patients in Bethesda group III and 27.6% of 47 patients in Bethesda group IV (Table2). New Engl J Med. Diagnostics of thyroid malignancy and indications for surgery in the elderly and younger counterparts: comparison of 3,749 patients. & Olson, M. T. Malignancy risk and reproducibility associated with atypia of undetermined significance on thyroid cytology. Pract. This is the category with the greatest uncertainty, as Please login or register first to view this content. J. Endocrinol. Thus, if a surgery is inevitable in cases diagnosed with Bethesda category IV nodules, we suggest a diagnostic lobectomy as the most aggressive approach rather than total thyroidectomy. They are reportable as FN or SFN. Of 1716 patients with FN/SFN on initial FNA, 440 (2.6%) were documented during follow-up.

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