From the Guidelines
Surgical treatment is indicated for thyroid fine-needle aspiration (FNA) results that show anaplastic thyroid cells, as these results strongly suggest thyroid cancer and typically warrant thyroidectomy. The presence of anaplastic thyroid cells is a clear indication of malignancy, and surgical intervention is necessary to prevent further progression of the disease. According to the evidence provided by 1, the diagnostic work-up of thyroid cancer comprises pre- and postoperative pathological and molecular assessments, and FNA cytology is a crucial tool in the diagnosis of thyroid nodules. The evidence also highlights the importance of molecular profiling in distinguishing between different types of thyroid cancer, including papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC).
Some key points to consider when evaluating FNA results include:
- The presence of anaplastic thyroid cells is a clear indication of malignancy and warrants surgical intervention
- Follicular neoplasms or suspicious for follicular neoplasms (Bethesda category IV) may also lead to surgical management, as approximately 15-30% of these nodules are malignant
- Atypia of undetermined significance or follicular lesion of undetermined significance (Bethesda category III) may require repeat FNA or molecular testing, particularly if there are concerning clinical or sonographic features
- The decision for surgery is based on the risk of malignancy associated with each Bethesda category, with higher categories carrying greater risk
It is essential to note that the evidence provided by 1 is the most recent and highest quality study, and its findings should be prioritized when making a definitive recommendation. The study highlights the importance of accurate diagnosis and molecular profiling in the management of thyroid cancer, and its recommendations should be followed to ensure optimal patient outcomes.
From the Research
Results of Thyroid Fine-Needle Aspiration Indicating Surgical Treatment
- The results of thyroid fine-needle aspiration (FNA) that indicate surgical treatment are:
- Anaplastic thyroid cells: This is a rare and aggressive form of thyroid cancer that requires a multidisciplinary approach to manage, including surgery, radiotherapy, and chemotherapy 2, 3, 4, 5, 6.
- Lymphoma: The successful treatment of thyroid lymphoma currently lies in accurately diagnosing the histological subtype, and surgery may be reserved for certain cases, such as MALT lymphomas diagnosed at an early stage 2.
- The following results do not typically indicate surgical treatment:
- A nodule that disappeared on aspiration: This result does not provide sufficient information to determine the need for surgical treatment.
- Clumps of follicular cells: This result is not specific to a particular diagnosis and would require further evaluation to determine the need for surgical treatment.
Specific Indications for Surgical Treatment
- Anaplastic thyroid cancer: Surgery may be considered in patients who have shown an initial response to multimodality therapy and in patients in whom a complete macroscopic resection can be achieved with minimal morbidity 2, 4.
- Thyroid lymphoma: Surgery may be considered for MALT lymphomas diagnosed at an early stage, but the role of surgery in the treatment of other types of thyroid lymphoma is limited 2, 3.