What Are the Keys to Successful Thyroid FNA Interpretation?

What Are the Keys to Successful Thyroid FNA Interpretation?

Where Do We Go From Here? Some Suggestions

The TFNAB approach to nodules is not broken – we just need to remember our historical roots and celebrate our successes. Here are some suggestions:

1. 
   Reinforce strong communication amongst physicians managing a patient with a thyroid nodule – still the essential hallmark.
   
2. 
   Reduce the "equivocal" categorization in TFNAB interpretation to a manageable level – in my experience, no more than 10%. If "equivocal" rates significantly exceed this level, consider obtaining another opinion on the interpretation of the TFNAB.
   
3. 
   If the above is not an option or does not clarify the clinical situation, then consider the use of a biomarker – tailored specifically to the diagnosis of greatest clinicopathological concern. In my practice, this means invoking the "10% rule" (Fig. 1) with a keen understanding of what to do with the result of a biomarker test in the specific clinicopathological setting in which it was requested.
   
4. 
   If you remember only one thing from this review, remember this: The purpose of the TFNAB is to reduce the "risk" of surgery.
   

(Enlarge Image)


Figure 1.

Flow chart highlighting the "10% Rule." Under stringent and experienced TFNA interpretation, no more than 10% of patients (and likely less) should need novel biomarker evaluation to help better define their aspirated nodules.