Introduction: British Thyroid Association Guidelines state that the diagnosis of thyroid malignancy cannot be based on the results of an aspirations cytology alone and will usually require surgical removal for confirmation. There has been much debate about the management of indeterminate fine needle aspirations (Thy 3). Recent publications have reported that the prevalence of thyroid carcinoma following a Thy 3 result to be as high has 28%, emphasising the importance of surgical management in such individuals. To assess the outcomes within our own practice, we performed a retrospective review of all patients undergoing thyroid surgery between January 2006 and April 2010 identifying those with initial histology of Thy3.
Results: A total of 235 thyroid surgeries were performed, of which 44 (19%), were identified as Thy 3 on cytology. Patients average age was 49 years with the majority being female 37 (84%). 15 (35%) patients underwent more than one aspiration. The average size of the nodules was 34 mm. Management decisions were made by a dedicated multidisciplinary team for those with cytological features of a follicular neoplasm (Thy 3).
A total of 30 (68%) individuals had benign lesions of which 9 were colloid, 15 follicular lesions and 6 dominant nodules on a background of multi-nodular goitre.
The remaining 14 (32%) were confirmed to have malignant histology. Unlike a recent series only 2 were follicular (14%), while the other 12 were papillary (86%). 3 (25%) were micro-papillary, which if excluded as being incidental, reduces the prevalence of carcinoma to 11 (25%).
Conclusions: The incidence of malignancy among our patients with Thy 3 cytology on fine needle aspiration is similar to reports by other institutions. Differences resided in the unexpected prevalence of papillary carcinoma within our series. The results add further weight to the recommendation that following a confirmed Thy3 cytology result surgical intervention should be advocated.