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  • Author: María Victoria Ortega-Jiménez x
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Ana Isabel Alvarez-Mancha A Alvarez-Mancha, Department of Medicine, University of Malaga, 29010 Malaga, Spain. b, University of Malaga, Malaga, Spain

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Isabel Mancha-Doblas I Mancha-Doblas, Department of Medicine, University of Malaga, 29010 Malaga, Spain. , University of Malaga, Malaga, Spain

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María Molina-Vega M Molina-Vega, Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain, University Hospital Virgen de la Victoria, Malaga, Spain

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Diego Fernández-García D Fernández-García, Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain, University Hospital Virgen de la Victoria, Malaga, Spain

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Ana María Gómez-Pérez A Gómez-Pérez, Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain, University Hospital Virgen de la Victoria, Malaga, Spain

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Elena Gallego E Gallego, Department of Medicine, University of Malaga, 29010 Malaga, Spain, University of Malaga, Malaga, Spain

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María Victoria Ortega-Jiménez M Ortega-Jiménez , Department of Medicine, University of Malaga, 29010 Malaga, Spain, University of Malaga, Malaga, Spain

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Isabel Hierro-Martín I Hierro-Martín, Department of Pathology, Virgen de la Victoria University Hospital, University Hospital Virgen de la Victoria, Malaga, Spain

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Francisco J Tinahones F Tinahones, Department of Medicine, University of Malaga, 29010 Malaga, Spain, University of Malaga, Malaga, Spain

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Objective: The objective of this study was to analyze the evolution in the diagnosis and management of indeterminate thyroid nodules over three time periods.

Methods: 3020 patients with thyroid nodules underwent cytological evaluation during three periods (2006-2008, 2012-2014, 2017-2019). Distribution of diagnostic cytologies, risk of malignancy, diagnostic performance indices of FNA, and cytologic-histologic correlation in indeterminate cytologies were analyzed.

Results: only 2.2% of cytology tests were insufficient for a diagnosis. 86.9% cytologies were benign, 1.7% malignant, and 11.4% indeterminate. Indeterminate cytology rates were 15.9% (2006-2008), 10.1% (2012-2014), and 10% (2017-2019). Surgery was performed in 13% of benign cytology, result-ing in malignant histology in 2.7%. All malignant and suspicious cytologies underwent surgery: malig-nancy confirmed in 98% and 77% of cases, respectively.

All 'indeterminate with atypia' cytologies (2006-2008) and Bethesda IV (2012-2014; 2017-2019) un-derwent surgery, with malignancy confirmed in 19.6%, 43.8%, and 25.7%, respectively. In the 'inde-terminate without atypia' category (2006-2008) and Bethesda III (2012-2014; 2017-2019), diagnostic surgery was performed in 57.7%, 78.6%, and 59.4%, respectively, with malignancy confirmed in 3.3%, 20.5%, and 31.6%. The FNA sensitivity was 91.6% with a negative predictive value greater than 96% in all periods. The specificity exceeded 75% in the last two periods.

Conclusion: Bethesda system reduces indeterminate cytologies and improves the accuracy of FNA diagnosis. We reported a higher proportion of malignancy than expected in Bethesda III, underscoring the importance of having institution-specific data to guide decision-making. However, there is a need for risk stratification tools that allow for conservative management in low-risk cases.

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