Scientific paper
Fine-needle aspiration of the thyroid and correlation with histopathology in a contemporary series of 240 patients

Presented at the 55th Annual Meeting of the Southwestern Surgical Congress, Tucson, Arizona, April 27–30, 2003
https://doi.org/10.1016/j.amjsurg.2003.08.015Get rights and content

Abstract

Background

False-positive, false-negative, and indeterminate fine-needle aspiration (FNA) biopsy results complicate the management of patients with thyroid nodules.

Methods

Thyroid FNA results from 240 consecutive patients (seen 1991 to 2002) were categorized into four groups: positive for malignancy, negative for malignancy, indeterminate for malignancy, and nondiagnostic. Indeterminate results included follicular neoplasm, Hürthle cell neoplasm, and suspicious for papillary carcinoma. The FNA results were compared with histopathologic analysis after thyroidectomy.

Results

The FNA results were 76 (32%) positive for malignancy, 53 (22%) negative for malignancy, 100 (42%) indeterminate for malignancy, and 11 (5%) nondiagnostic. There were 3 (4%) false-positive and 2 (4%) false-negative FNA results. Among the 100 indeterminate FNA results, carcinoma was found in 11 (15%) of 73 follicular neoplasms, 2 (20%) of 10 Hürthle cell neoplasms, and 14 (82%) of 17 suspicious for papillary carcinoma. For the 73 patients with follicular neoplasms, nodule diameter >2 cm was associated with an increased risk of malignancy (P <0.03).

Conclusions

False-negative FNA results are uncommon, supporting the practice of observation in most of these patients. Among those with indeterminate biopsy results, high-risk subgroups include patients with FNA results suspicious for papillary carcinoma and follicular neoplasms >2 cm.

Section snippets

Material and methods

Between January 1991 and September 2002, 240 consecutive patients underwent thyroidectomy in the Department of Surgical Oncology at the University of Texas M. D. Anderson Cancer Center for thyroid nodules that had undergone FNA biopsy (at our institution or at an outside institution prior to referral). FNA biopsies performed at M. D. Anderson Cancer Center were done with or without ultrasound guidance: thyroid nodules that were easily palpable were aspirated by a cytopathologist, and

Results

We identified 240 consecutive patients who underwent FNA biopsy followed by thyroidectomy (lobectomy or total thyroidectomy) for a dominant thyroid nodule. The 180 (75%) female and 60 (25%) male patients had a median age of 46 years (range 5 to 96) at the time of thyroidectomy. One hundred and thirteen (47%) of the 240 FNA biopsies were performed at an outside institution prior to referral, and 127 (53%) were performed at M. D. Anderson Cancer Center. Ultrasound-guided FNA biopsy was performed

Comments

We categorized cytologic results into four groups: positive for malignancy, negative for malignancy, indeterminate for malignancy, and nondiagnostic specimen. Such categorization of FNA biopsy results is necessary to allow clinicians to use cytology results to guide patient management with specific reference to the need for thyroidectomy. False-positive FNA biopsy results are uncommon and were found in only 3 (4%) patients in this series. This finding is consistent with other recent reports

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