False Negative Cytology in Large Thyroid Nodules

Giles, W. Heath; Maclellan, Reid A.; Gawande, Atul A.; Ruan, Daniel T.; Alexander, Erik K.; Moore, Francis D.; Cho, Nancy L.

doi:10.1245/s10434-014-3952-7

Cited by 65 publications

(71 citation statements)

References 18 publications

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“…However, no difference in risk of malignancy was noted when a cut-off of 3 cm was used. Giles et al [16] evaluated the accuracy of benign FNAC in patients who underwent surgery for nodules 3 cm or larger. The patient cohort included patients with thyroid nodules measuring 3 cm or larger, with benign FNAC.…”

Section: Discussionmentioning

confidence: 99%

“…Some surgeons recommend thyroidectomy for nodules ≥4 cm even in the setting of benign FNAC, due to increased risk of malignancy and increased false negative rates in large thyroid nodules [12131415]. Even more aggressive surgeons use a threshold of 3 cm [16]. This increase in false negative rates with large thyroid nodules is thought to be due to sampling error.…”

Section: Introductionmentioning

confidence: 99%

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Risk of Malignancy in Thyroid Nodules 4 cm or Larger

Megwalu

2017

Endocrinol Metab

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BackgroundSeveral authors have questioned the accuracy of fine-needle aspiration cytology (FNAC) in large nodules. Some surgeons recommend thyroidectomy for nodules ≥4 cm even in the setting of benign FNAC, due to increased risk of malignancy and increased false negative rates in large thyroid nodules. The goal of our study was to evaluate if thyroid nodule size is associated with risk of malignancy, and to evaluate the false negative rate of FNAC for thyroid nodules ≥4 cm in our patient population.MethodsThis is a retrospective study of 85 patients with 101 thyroid nodules, who underwent thyroidectomy for thyroid nodules measuring ≥4 cm.ResultsThe overall risk of malignancy in nodules ≥4 cm was 9.9%. Nodule size was not associated with risk of malignancy (odds ratio, 1.02) after adjusting for nodule consistency, age, and sex (P=0.6). The false negative rate for FNAC was 0%.ConclusionNodule size was not associated with risk of malignancy in nodules ≥4 cm in our patient population. FNAC had a false negative rate of 0. Patients with thyroid nodules ≥4 cm and benign cytology should not automatically undergo thyroidectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk of Malignancy in Thyroid Nodules 4 cm or Larger

Megwalu

2017

Endocrinol Metab

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“…After excluding patients with a primary TN smaller than 0.5 cm 27 (3), and those who did not have a preoperative FNAB performed and/or reviewed within our institution (15), 297 patients with 326 distinct primary TNs who met the inclusion criteria for this study remained for analysis. Our sample comprised 233 women and 64 men, a ratio of 3.6:1.0.…”

Section: Patient Demographicsmentioning

confidence: 99%

Association of Thyroid Nodule Size and Bethesda Class With Rate of Malignant Disease

Magister

Chaikhoutdinov

Schaefer

et al. 2015

JAMA Otolaryngol Head Neck Surg

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“…However, for nodules with suspicious US features or increase in size during follow-up, even after benign cytology, repeat FNA is recommended to prevent delayed diagnosis of malignancy from possible false-negative FNA results [6,7]. Meanwhile, for large lesions, until now, the relationship between size and false-negative cytology remains controversial [8–13] and US features have yet to have an established role in predicting false-negative cytology for these large lesions.…”

Section: Introductionmentioning

confidence: 99%

Large (≥3cm) thyroid nodules with benign cytology: Can Thyroid Imaging Reporting and Data System (TIRADS) help predict false-negative cytology?

et al. 2017

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BackgroundThere is controversy about the accuracy of the fine-needle aspiration (FNA) cytology results in large sized thyroid nodules. Our aim was to evaluate the false-negative rate of FNA for large thyroid nodules and the usefulness of the Thyroid Imaging Reporting and Data System (TIRADS) in predicting false-negative cytology for large thyroid nodules with benign cytology.Methods632 thyroid nodules larger than or equal to 3cm in size with subsequent benign cytology on US-guided FNA were included. US features of internal composition, echogenicity, margin, calcifications, and shape were evaluated, and nodules were classified according to TIRADS. TIRADS category 3 included nodules without any of the following suspicious features:solidity, hypoechogenicity or marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape. Category 4a, 4b, 4c, and 5 were assigned to nodules showing one, two, three or four, or five suspicious US features, respectively. US features associated with malignancy for these lesions were analyzed and malignancy risk according to TIRADS was calculated.ResultsOf the 632 lesions, 23 lesions(3.6%) were malignant and 609(96.4%) were benign, suggesting a 3.6% false-negative rate for FNA cytology. Of the 23 malignant lesions, final pathology was mainly follicular carcinoma minimally invasive(65.2%, 15/23) and the follicular variant of papillary carcinoma(26.1%, 6/23). The malignancy risks of categories 3, 4a, 4b, and 4c nodules were 0.9%, 4.6%, 10.0%, and 11.8%, respectively.ConclusionLarge thyroid nodules with benign cytology had a relatively high false-negative risk of 3.6% and TIRADS was helpful in predicting false-negative cytology for these lesions.

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False Negative Cytology in Large Thyroid Nodules

Abstract: When referred for thyroidectomy, patients with large thyroid nodules demonstrate a modest, yet significant, false-negative rate despite initial benign aspiration cytology. Therefore, thyroid nodules ≥3 cm may be considered for removal even when referred with benign preoperative cytology.

Cited by 65 publications

References 18 publications

Risk of Malignancy in Thyroid Nodules 4 cm or Larger

Risk of Malignancy in Thyroid Nodules 4 cm or Larger

Association of Thyroid Nodule Size and Bethesda Class With Rate of Malignant Disease

Large (≥3cm) thyroid nodules with benign cytology: Can Thyroid Imaging Reporting and Data System (TIRADS) help predict false-negative cytology?

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