Objective: This study investigated a published series evaluating the role of second-opinion diagnosis (SOD) or repeat fine-needle aspiration cytology (RFNA) for indeterminate thyroid aspirates. Study Design: Twenty-three studies were selected and the following parameters were analyzed: disagreement between SOD or RFNA and the original diagnosis (OD), reclassification of OD according to the Bethesda system for reporting thyroid cytopathology, the rate of definitive diagnosis and the diagnostic performance of SOD and RFNA. Results: 7,154 thyroid FNAs were retrieved from 9 studies that investigated the role of SOD, including 1,048 (14.6%) cases originally reported as indeterminate. The 14 studies that analyzed the role of thyroid RFNA comprised 67,581 FNAs and included 7,246 (10.7%) indeterminate cases. A definitive diagnosis was achieved by SOD in 450 cases (42.9%) and RFNA in 1,645 cases (57.2%, p = 0.0001). Based on cases with histological follow-up, SOD demonstrated significantly higher rates of positive predictive value and accuracy than RFNA (55.8 vs. 37.7%, p = 0.0001; 67.4 vs. 56.0%, p = 0.0034, respectively). Conclusions: Both SOD and RFNA demonstrated an improvement in the diagnosis of initially indeterminate thyroid FNAs. RFNA achieved a definitive diagnosis for the majority of indeterminate cases. Regarding histological follow-up, SOD was shown to be more accurate than RFNA.

1.
Layfield LJ, Cibas ES, Gharib H, Mandel SJ: Thyroid aspiration cytology: current status. CA Cancer J Clin 2009;59:99-110.
2.
Cibas ES, Ali SZ: The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol 2009;132:658-665.
3.
Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW: The Bethesda system for reporting thyroid cytopathology: a meta-analysis. Acta Cytol 2012;56:333-339.
4.
Bongiovanni M, Krane JF, Cibas ES, Faquin WC: The atypical thyroid fine-needle aspiration: past, present, and future. Cancer Cytopathol 2012;120:73-86.
5.
Jing X, Knoepp SM, Roh MH, Hookim K, Placido J, Davenport R, Rasche R, Michael CW: Group consensus review minimizes the diagnosis of follicular lesion of undetermined significance and improves cytohistologic concordance. Diagn Cytopathol 2012;40:1037-1042.
6.
Abt AB, Abt LG, Olt GJ: The effect of interinstitutional anatomic pathology consultations on patient care. Arch Pathol Lab Med 1995;119:514-517.
7.
Kronz JD, Westra WH, Epstein JI: Mandatory second opinion surgical pathology at a large referral hospital. Cancer 1999;86:2426-2435.
8.
Weir MM, Jan E, Colgan TJ: Interinstitutional pathology consultations: a reassessment. Am J Clin Pathol 2003;120:405-412.
9.
Manion E, Cohen MB, Weydert J: Mandatory second opinion in surgical pathology referral material: clinical consequences of major disagreements. Am J Surg Pathol 2008;32:732-737.
10.
Lueck N, Jensen C, Cohen MB, Weydert JA: Mandatory second opinion in cytopathology. Cancer Cytopathol 2009;117:82-91.
11.
Bomeisl PE, Alam S, Wakely PE: Interinstitutional consultation in fine-needle aspiration cytopathology. Cancer Cytopathol 2009;117:237-246.
12.
Olson MT, Boonyaarunnate T, Han PA, Umbricht CB, Ali SZ, Zeiger MA: A tertiary center's experience with second opinion review of 3,885 thyroid cytopathology specimens. J Clin Endocrinol Metab 2013;98:1450-1457.
13.
Gerhard, R, Boerner SL: The value of second opinion in thyroid cytology: a review. Cancer Cytopathol 2014;122:611-619.
14.
Baloch ZW, Hendreen S, Gupta PK, LiVolsi VA, Mandel SJ, Weber R, Fraker D: Interinstitutional review of thyroid fine-needle aspirations: impact on clinical management of thyroid nodules. Diagn Cytopathol 2001;25:231-234.
15.
Layfield LJ, Jones C, Rowe L, Gopez EV: Institutional review of outside cytology materials: a retrospective analysis of two institutions' experiences. Diagn Cytopathol 2002;26:45-48.
16.
Tan YY, Kebebew E, Reiff E, Caron NR, Olgivie JB, Duh Q-Y, Clark OH, Ljung B-M, Miller T: Does routine consultation of thyroid fine-needle aspiration cytology change surgical management? J Am Coll Surg 2007;205:8-12.
17.
Davidov T, Trooskin SZ, Shanker B-A, Yip D, Eng O, Crystal J, Hu J, Chernyavsky VS, Deen MF, May M, Artymyshyn RL: Routine second-opinion cytopathology review of thyroid fine-needle aspiration biopsies reduces diagnostic thyroidectomy. Surgery 2010;148:1294-1301.
18.
Bajaj J, Morgenstein N, Sugrue C, Wasserman J, Wasserman P: Clinical impact of second opinion in thyroid fine-needle aspiration cytology (FNAC): a study of 922 interinstitutional consultations. Diagn Cytopathol 2012;40:422-429.
19.
Park JH, Kim HK, Kang S-W, Jeong JJ, Nam K-H, Chung W-Y, Park CS: Second opinion in thyroid fine-needle aspiration biopsy by the Bethesda system. Endocr J 2012;59:205-212.
20.
Baloch Z, LiVolsi VA, Jain P, Jain R, Aljada I, Mandel S, Langer JE, Gupta PK: Role of repeat fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules. Diagn Cytopathol 2003;29:203-206.
21.
Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, Moore FD, Kim BW, Nosé V, Marqusee E, Larsen PR, Alexander EK: Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer Cytopathol 2007;111:508-516.
22.
Oertel YC, Miyahara-Felipe L, Mendoza MG, Yu K: Value of repeated fine-needle aspirations of the thyroid: an analysis of over ten thousand FNAs. Thyroid 2007;17:1061-1066.
23.
Nayar R, Ivanovic M: The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer 2009;117:195-202.
24.
Faquin WC, Baloch ZW: Fine-needle aspiration of follicular patterned lesions of the thyroid: diagnosis, management, and follow-up according to the National Cancer Institute (NCI) recommendations. Diagn Cytopathol 2010;38:731-739.
25.
Nga ME, Kumarasinghe MP, Tie B, Sterrett GF, Wood B, Walsh J, Nguyen H, Whyte A, Frost FA: Experience with standardized thyroid fine-needle aspiration reporting categories: follow-up data from 529 cases with ‘indeterminate' or ‘atypical' reports. Cancer Cytopathol 2010;118:423-433.
26.
VanderLaan PA, Marqusee E, Krane JE: Clinical outcome for atypia of undetermined significance in thyroid fine-needle aspirations: should repeated FNA be the preferred initial approach? Am J Clin Pathol 2011;135:770-775.
27.
Üstün H, Astarci HM, Altunkaya C, Yilmaz S, Barin A, Ekici S, Çaydere M: Fine-needle aspiration of follicular pattern lesions of thyroid: diagnosis, management, and follow-up according to thyroid Bethesda system. Acta Cytol 2012;56:361-369.
28.
Chen JC, Pace SC, Chen BA, Khiyami A, McHenry CR: Yield of repeat fine-needle aspiration biopsy and rate of malignancy in patients with atypia or follicular lesion of undetermined significance: the impact of the Bethesda system for reporting thyroid cytopathology. Surgery 2012;152:1037-1044.
29.
Nagarkatti SS, Faquin WC, Lubitz CC, Garcia DM, Barbesino G, Ross DS, Hodin RA, Daniels GH, Parangi S: Management of thyroid nodules with atypical cytology on fine-needle aspiration biopsy. Ann Surg Oncol 2013;20:60-65.
30.
Ratour J, Polivka M, Dahan H, Hamzi L, Kania R, Dumuis ML, Cohen R, Laloi-Michelin M, Cochand-Priollet B: Diagnosis of follicular lesions of undetermined significance in fine-needle aspirations of thyroid nodules. J Thyroid Res 2013;2013:250347.
31.
Dincer N, Balci S, Yazgan A, Guney G, Ersoy R, Cakir B, Guler G: Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine-needle aspiration cytology. Cytopathology 2013;24:385-390.
32.
Broome JT, Cate F, Solorzano CC: Utilization and impact of repeat biopsy for follicular lesion/atypia of undetermined significance. World J Surg 2014;38:628-633.
33.
Önder S, Firat P, Ates D: The Bethesda system for reporting thyroid cytopathology: an institutional experience with the outcome of indeterminate categories. Cytopathology 2014;25:177-184.
34.
Ohori NP, Schoedel KE: Variability in the atypia of undetermined significance/follicular lesion of undetermined significance diagnosis in the Bethesda system for reporting thyroid cytopathology: sources and recommendations. Acta Cytol 2011;55:492-498.
35.
Krane FJ, VanderLaan PA, Faquin WC, Renshaw AA: The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio: a proposed performance measure for reporting the Bethesda system for reporting thyroid cytopathology. Cancer Cytopathol 2012;120:111-116.
36.
Song JY, Chu YC, Kim L, Park IS, Han JY, Kim JM: Reclassifying formerly indeterminate thyroid FNAs using the Bethesda system reduces the number of inconclusive cases. Acta Cytol 2012;56:122-129.
37.
Walts AE, Mirocha J, Bose S: Follicular lesion of undetermined significance in thyroid FNA revisited. Diagn Cytopathol 2014;42:18-22.
38.
Firat P, Cochand-Priollet B: The Bethesda system for reporting thyroid fine-needle aspiration cytology: a study comparing the results of two centers from two different countries. Ann Pathol 2012;32:e29-e34, 415-420.
39.
Nikiforova MN, Kimura ET, Gandhi M, Biddinger PW, Knauf JA, Basolo F, Zhu Z, Giannini R, Salvatore G, Fusco A, Santoro M, Fagin JA, Nikiforov YE: BRAF mutations in thyroid tumors are restricted to papillary carcinomas and anaplastic or poorly differentiated carcinomas arising from papillary carcinomas. J Clin Endocrinol Metab 2003;88:5399-5404.
40.
Finkelstein A, Levy GH, Hui P, Prasad A, Virk R, Chhieng DC, Carling T, Roman SA, Sosa JA, Udelsman R, Theoharis CG, Prasad ML: Papillary thyroid carcinomas with and without BRAF V600E mutations are morphologically distinct. Histopathology 2012;60:1052-1059.
41.
Poller DN, Glaysher S, Agrawal A, Caldera S, Kim D, Yiangou C: BRAF V600 co-testing in thyroid FNA cytology: short-term experience in a large centre in the UK. J Clin Pathol 2014;67:684-689.
42.
Johnson SJ, Hardy SA, Roberts C, Bourn D, Mallick U, Perros P: Pilot of BRAF mutation analysis in indeterminate, suspicious and malignant thyroid FNA cytology. Cytopathology 2014;25:146-154.
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