Thyroid Nodules
4
9. Thyroid nodule FNA cytology should be reported using diagnostic
groups outlined in the Bethesda System for Reporting Thyroid
Cytopathology (http://ajcp.ascpjournals.org/cgi/pmidlookup?view=lo
ng&pmid=20660341). (SR-M)
10. A) For a nodule with an initial nondiagnostic cytology result, FNA
should be repeated with US guidance and, if available, on-site
cytologic evaluation. (SR-M)
B) Repeatedly nondiagnostic nodules without a high suspicion
sonographic pattern require close observation or surgical excision for
histopathologic diagnosis. (WR-L)
C) Surgery should be considered for histopathologic diagnosis if the
cytologically nondiagnostic nodule has a high suspicion sonographic
pattern, growth of the nodule (greater than 20% in two dimensions)
is detected during ultrasound surveillance, or clinical risk factors for
malignancy are present. (WR-L)
11. If the nodule is benign on cytology, further immediate diagnostic
studies or treatment are not required. (SR-H)
12. If a cytology result is diagnostic for primary thyroid malignancy,
surgery is generally recommended. (SR-M)
13. If molecular testing is being considered, patients should be
counseled regarding the potential benefits and limitations of testing,
and about the possible uncertainties in the therapeutic and long-term
clinical implications of results. (SR-L)
14. If intended for clinical use, molecular testing should be performed in
CLIA/CAP (Clinical Laboratory Improvement Amendments/College
of American Pathologists) certified molecular laboratories, or
international equivalent, as reported quality assurance practices may
be superior compared to other settings. (SR-L)
15. A) For nodules with AUS/FLUS cytology, after consideration of
worrisome clinical and sonographic features, investigations such
as repeat FNA or molecular testing may be used to supplement
malignancy risk assessment in lieu of proceeding directly with
a strategy of either surveillance or diagnostic surgery. Informed
patient preference and feasibility should be considered in clinical
decision-making. (WR-M)
B) If repeat FNA cytology and/or molecular testing are not performed
or inconclusive, either surveillance or diagnostic surgical excision
may be performed for an AUS/FLUS thyroid nodule, depending on
clinical risk factors, sonographic pattern, and patient preference.
(SR-L)
