Reliability of benign fine needle aspiration cytology of large thyroid nodules. Surgery 144, 963-968
Division of Gastroenterologic and General Surgery, Mayo Clinic, Mayo Graduate School of Medicine, Rochester, Minn, USA. Surgery
(Impact Factor: 3.38).
01/2009; 144(6):963-8; discussion 968-9. DOI: 10.1016/j.surg.2008.09.006
With increasing use of thyroid ultrasonography, thyroid nodules have been found to be extremely common. For over 25 years, fine needle aspiration (FNA) has been the pivotal diagnostic test to discriminate benign from potentially malignant thyroid nodules. Recently, false negative rates exceeding 10% have led to recommendations that thyroid nodules >/=4 cm should be resected regardless of cytology results. Our aim was to determine the false negative rate of FNA cytology on thyroid nodules >/=3 cm interpreted as benign at our institution.
A retrospective review was performed at Mayo Clinic from January 2002 through December 2006.
From 6,921 ultrasonographic-guided thyroid FNAs, 742 were interpreted as benign and >/=3 cm. A definitive histologic diagnosis was available for 145 (20%) patients who underwent thyroidectomy: 1 (0.7%) was false negative. No additional thyroid malignancies were identified in 550 index nodules with average follow-up of 3 years.
With precise ultrasonographic-guided aspiration, strict adherence to guidelines for adequacy of the sample, proper cytologic preparation, and most importantly, expert cytologic analysis, a diagnosis of benign is extremely reliable for thyroid nodules, regardless of size. Resection for diagnosis is not necessary, and a size >/=3 cm should not be an independent indication for resection.
Available from: Nihat Aksakal
- "Some of these reports conclude that large nodules lead to increased risk for malignancy   , whereas others note the contrary  . As previously outlined by other authors, FNABs sometimes do not reflect the histology of the entire nodule  . This could be due to inaccurate sampling, dependency on a skilled USG operator and interpreting cytopathologist as Gharib and Goellner  mentioned previously in one of their studies. "
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ABSTRACT: Background. The purpose of this study was to assess the factors that affect the false-negative outcomes of fine-needle aspiration biopsies (FNABs) in thyroid nodules. Methods. Thyroid nodules that underwent FNAB and surgery between August 2005 and January 2012 were analyzed. FNABs were taken from the suspicious nodules regardless of nodule size. Results. Nodules were analyzed in 2 different groups: Group 1 was the false-negatives (n = 81) and Group 2 was the remaining true-positives, true-negatives, and false-positives (n = 649). A cytopathologist attended in 559 (77%) of FNAB procedures. There was a positive correlation between the nodule size and false-negative rates, and the absence of an interpreting cytopathologist for the examination of the FNAB procedure was the most significant parameter with a 76-fold increased risk of false-negative results. Conclusion. The contribution of cytopathologists extends the time of the procedure, and this could be a difficult practice in centres with high patient turnovers. We currently request the contribution of a cytopathologist for selected patients whom should be followed up without surgery.
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ABSTRACT: The aim of this study was to analyze the results of histopathological studies in neck masses observed in young patients. The neck masses were detected using ultrasonography and fine-needle aspiration cytology (FNAC).
In this retrospective study, we analyzed 234 young patients who were surgically treated for neck masses at Chang Gung Medical Center in Linkou. The mean age of the 234 young patients was 16.3 +/- 4.0 years (range 1-20 years). Neck ultrasonography studies were conducted using a real-time ultrasonographic machine and a 10 MHz transducer. FNAC was performed for the suspected neck nodules.
Of the 234 cases, 187 (79.9%) were surgically confirmed to be benign lesions, including four cases that were diagnosed as atypical adenoma. Malignant thyroid masses were identified in 47 patients. Surgery confirmed 22 cases to be lesions that were non-thyroid in origin, including those developing from a cyst, soft tissue, and with a lymphatic origin. Diagnostic accuracies of the FNAC and frozen section examination were found to be 91.1 and 97.7%, respectively.
In the study population, 20.1% of the neck masses were malignant. Except in cases of follicular thyroid neoplasm, neck ultrasonography with FNAC could effectively identify the thyroid or non-thyroid origin of these masses with high-diagnostic accuracy.
Available from: Rebecca S Sippel
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ABSTRACT: All thyroid nodules 4 cm or larger should be surgically removed regardless of fine-needle aspiration biopsy (FNAB) results because of an unacceptably high rate of false-negative preoperative biopsy results in these large nodules.
Retrospective cohort study.
Single-institution, tertiary academic referral center.
A retrospective analysis was performed on all patients who underwent surgery for a thyroid nodule 4 cm or larger from May 1, 1994, through January 31, 2007.
Preoperative FNAB results were correlated with final surgical pathologic results. The FNAB results were reported as nondiagnostic, benign, inconclusive (follicular neoplasm), or malignant, whereas the final surgical pathologic data were reported as benign or malignant.
Of 155 patients who underwent a thyroidectomy for a nodule 4 cm or larger, 21 patients (13.5%) had a clinically significant thyroid carcinoma within the nodule on final pathologic analysis. Preoperative cytologic testing of the mass was performed on 97 patients, and the results read as benign for 52, inconclusive for 23, nondiagnostic for 11, and malignant for 11. In lesions 4 cm or larger, 26 of 52 FNAB results reported as benign (50.0%) turned out to be either neoplastic (22) or malignant (4) on final pathologic analysis. Among patients with nondiagnostic FNAB results, the risk of malignant neoplasms was 27.3%.
In patients with thyroid nodules 4 cm or larger, the FNAB results are highly inaccurate, misclassifying half of all patients with reportedly benign lesions. Furthermore, those patients with a nondiagnostic FNAB result display a high risk of differentiated thyroid carcinoma. Therefore, we recommend that diagnostic lobectomy be strongly considered in patients with thyroid nodules 4 cm or larger regardless of FNAB cytologic test results.
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