Critical Assessment Is Missing
We wish to add the following to the review article on fine needle aspiration (FNA) biopsy (1):
- In the second line of the Figure the large group of thyroid nodules >1 cm with normal findings is missing. A reference to published comprehensive studies and guidelines would have been useful.
- No literature is cited that critically considers FNA biopsy. Tee et al. published an analysis of 12 studies including more than 54 000 patients and concluded that FNA biopsy potentially misses one-third of malignancies (2). McCartney et al. conducted a model analysis to compare four strategies for investigating thyroid nodules. Routine FNA biopsy came out worst (3). The effect of the low prevalence of malignant thyroid tumors in Germany on the results of FNA biopsy was not shown adequately. We fail to understand why the perspective of the American Thyroid Association (ATA) is being uncritically applied to the German thyroid scenario. The ATA guideline has thus far not been accepted by European thyroid specialists.
- It is true that guidelines so far have not included tumor scintigraphy using Tc-99m-MIBI (methoxyisobutylisonitrile) for the purpose of further investigation of hypofunctioning thyroid nodules, so called “cold” thyroid nodules. However, it would have been appropriate to point out the high negative predictive value of >97% of a normal MIBI finding to rule out malignancy, and the positive predictive value of about 15–20% for a malignant thyroid tumor (18 publications, >1000 patients with a histopathological gold standard ).
Prof. Dr. med. Matthias Schmidt
Prof. Dr. med. Dr. Dipl.-Phys. Wolfgang Schäfer
Kliniken Maria Hilf GmbH, Mönchengladbach
|1.||Feldkamp J, Führer D, Luster M, Musholt TJ, Spitzweg C, Schott M: Fine needle aspiration in the investigation of thyroid nodules—indications, procedures and interpretation. Dtsch Arztebl Int 2016; 113: 353–9 VOLLTEXT|
|2.||Tee YY, Lowe AJ, Brand CA, Judson RT: Fine-needle aspiration may miss a third of all malignancy in palpable thyroid nodules: a comprehensive literature review. Ann Surg 2007; 246: 714–20 CrossRef MEDLINE|
|3.||McCartney CR, Stukenborg GJ: Decision analysis of discordant thyroid nodule biopsy guideline criteria. J Clin Encocrinol Metab 2008; 93: 3037–44 CrossRef MEDLINE PubMed Central|
|4.||Schmidt M: Tc-99m-MIBI for thyroid imaging. In: Bucerius J, Ahmadzadehfar H, Biersack HJ: 99mTc-sestamibi—clinical applications, Springer-Verlag 2012: 133–58 CrossRef|