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  • Author: Gaetano Paone x
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Andrea Leoncini A Leoncini, EOC, Bellinzona, Switzerland

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Chiara Camponovo C Camponovo, EOC, Bellinzona, Switzerland

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Gaetano Paone G Paone, EOC, Bellinzona, Switzerland

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Elena Gamarra E Gamarra, Endocrinologia-Diabetologia, Repubblica e Cantone Ticino Ente Ospedaliero Cantonale, Lugano, Switzerland

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Giorgio Treglia G Treglia, EOC, Bellinzona, Switzerland

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Pierpaolo Trimboli P Trimboli, EOC, Bellinzona, Switzerland

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Objective.

Thyroid nodule (TN) is usually managed according to Thyroid Imaging And Reporting Data Systems (TIRADS) with the major aim to reduce as much as possible unnecessary fine-needle aspiration cytologies (UN-FNACs). Since the assessment of autonomously functioning thyroid nodule (AFTN) according to TIRADS is heterogeneous, that virtually benign entity may increase the rate of UN-FNAC. This study retrospectively analyzed the appropriateness of TIRADS-based FNAC indication in AFTNs, also looking at the impact of TSH and nodule size.

Methods.

Cases diagnosed with AFTN on scintigraphy were searched. Patients who had undergone AFTN treatment, were on medications or supplementation that could affect thyroid function, or had multiple AFTNs were excluded. The AFTNs were assessed according to ACR-TIRADS.

Results.

Forty-eight AFTNs were included and a 37.5% of cases had FNAC indication according to TIRADS. The FNAC indication rate of patients with TSH lower than 0.4 mIU/L was significantly higher than the remaining ones (p = 0.0078). The most accurate cut-off of TSH and AFTN size associated with UN-FNAC was ≤0.41 mIU/L and >22 mm, respectively. The multivariate analysis showed that both TSH and nodule size were independent predictors of UN-FNAC with OR 6.65 and 6.46, respectively. According to these data, the rate of FNAC indication dropped up to 4.16%.

Conclusion.

Inappropriate FNACs in AFTNs are primarily observed in patients with low TSH and large AFTN. Since these cases typically undergo scintigraphy, the risk of TIRADS-based UN-FNAC is clinically negligible. There is no need for integrating other imaging procedures into the TIRADS model.

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