{
  "abstract": "In order to effectively understand and communicate the potential benefits and harms of medicine, it is essential to evidence-based patient care and make a shared decision. Nowadays, modern medicine has complex medical data with an increased need to be clear and transparent with the patients while providing medical information. Patients must be correctly informed not only about the benefits of any proposed procedure, but also of the possible risks it might drive. This promotes informed consent, as well as we, as healthcare providers, can promote and respect the patient’s autonomy, values and preferences.An important element that a healthcare provider should have is the ability to recognize and mitigate cognitive biases in patients and themselves, such as conversations about benefits and risks, avoiding overestimation of treatment efficacy or underestimation of harm, affecting perceptions and choices. A very good strategy to improve understanding is by simplifying complex clinical data and present probabilistic outcomes through the use of decision aids, which provide concise and evidence-based information increasing the patients’ knowledge about the risks and benefits of any treatment, helping them to make the best decision and improving the satisfaction with the chosen treatment. One clear example are accessible formats, such as visual aids and visual risk charts, always avoiding complex statistics that might be confusing for the patient; for example, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) that standardizes thyroid fine-needle aspiration biopsy (TFNAB) reporting, with a high sensitivity and specificity rate. This helps to differentiate benign from malignant thyroid nodules, categorizing risks of malignancy, providing the clinician and the patient literacy risk charts evidence that improves clinician-patient communication. TBSRTC guides an appropriate surgical or conservative management, with the benefits and risks of each one of those that can be better explained by the health care provider.In addition, shared discussion is the best bias wherein healthcare providers and patients collaborate on making the best treatment choices. Shared decision-making not only emphasizes on the transmission of the information, it also develops mutual understanding and confidence extending the clinician’s role by facilitating patients to understand the options with the clinicians’ own experience and the patients’ context and goals; it is even more helpful in cases when multiple options or the best decision is not yet clear.Moreover, a significant proportion of patients have limited capacity to understand health information, which can affect decision making. Enhancing communication strategies can significantly reduce this gap, for example plain language, visual formants and teach-back methods. Furthermore, it should always be kept in mind to respect diverse backgrounds, such as cultural diversity, context and sensitivity.In conclusion, improving communication of the potential benefits placed next to the uncertainties and risks of medical interventions is pivotal for informed patient decision-making. Moreover, it requires multifaceted approaches such as consciousness of cognitive biases, decision aids and medical literacy support, as well as clear, honest and individualized information.Objectives The aim of the present study is to evaluate false-positive thyroid fine-needle aspiration biopsy (TFNAB) cases, which are discordant cases with a malignant report per the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) followed by a benign post-thyroidectomy histopathological report, in a Mexico City tertiary hospital, in order to recognize and enhance diagnostic accuracy and multidisciplinary care, minimizing unnecessary procedures.Method An observational, retrospective study was conducted in the Pathology Department of the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City from January 1 st, 2012 to December 31st, 2021. Thyroidectomized patients previously submitted to TFNAB with complete clinical follow-up were included. False-positive cases, which had a ‘Suspicious for malignancy’ (category V) or ‘Malignant’ (category VI) TFNAB report followed by a benign final histopathological report in the thyroidectomy were analyzed.Results During the 10-year study period, 1151 thyroid resections were performed, of which 1144 thyroidectomies were included in our study. Sixteen cases were considered as discordant, resulting in a 1.4% false positive rate. Of these discordant cases, 10 (62.5%) of them were reported as ‘Suspicious for malignancy’ category V and 6 (37.5%) as ‘Malignant’ category VI in the TFNAB. Most of these events occurred in 2013 (4.2%). Moreover, 12 (75%) of them were females and 4 (25%) of them males, all patients with an average age of 55 years.Conclusions This study highlights the clinico-pathological importance and refinement of TBSRTC, reflected on the higher false-positive rates around 2010, when the classification was firstly implemented. Moreover, it can be inferred that the current discordance rate has declined due to an increased pathologist understanding and experience with TBSRTC, but also to the improvement of multidisciplinary collaboration between clinicians, surgeons and pathologists established over the past decade in our Institute.",
  "authors": [
    {
      "affiliations": [
        "National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico, Mexico",
        "Anahuac Puebla University, Puebla, Mexico"
      ],
      "name": "Liliana Perez-Limon"
    },
    {
      "affiliations": [
        "Anahuac Puebla University, Puebla, Mexico"
      ],
      "name": "Antonio Rafael Flores-Bello"
    },
    {
      "affiliations": [
        "National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico, Mexico"
      ],
      "name": "Brenda Bautista-Martinez"
    },
    {
      "affiliations": [
        "National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico, Mexico"
      ],
      "name": "Anielka Jareany Gomez-Bolaños"
    },
    {
      "affiliations": [
        "National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico, Mexico"
      ],
      "name": "Armando Gamboa-Dominguez"
    }
  ],
  "title": "103 The impact of the thyroid fine needle aspiration biopsy guiding thyroidectomies: a false positive 10-year report in a tertiary care center",
  "uid": "1e59dcd2-e88d-56d7-968d-3be17de0b619"
}