Using the bethesda system, list the possible results of fine-needle aspiration (FNA) of thyroid nodules and describe the appropriate surgical intervention.
• Nondiagnostic: Repeat FNA with ultrasound guidance. Thyroid lobectomy if still non-diagnostic.
• Benign: Risk of cancer is < 5%. Clinical follow-up is appropriate.
• Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS): Risk of cancer 10% to 40%. Options include observation (if determined to be low risk on the basis of ultrasound appearance and other clinical factors), repeat FNA with or without molecular testing, or surgery.
• Follicular neoplasm (FN): Risk of cancer 15% to 35%. Options include repeat FNA for molecular testing or surgery.
• Suspicious: Risk of cancer 60% to 75%. Surgery for either thyroid lobectomy or thyroidectomy.
• Malignant: Risk of cancer > 97%. Surgery for thyroid lobectomy or thyroidectomy is generally recommended; however, active surveillance can be considered in patients with very low risk cancers (<1 cm, no evidence of invasion, metastasis, or aggressive features) or in patients with high surgical risk or short expected remaining life spans because of comorbidities.