Invited commentary

Walfish, Paul G.; Rosen, Irving B.

doi:10.1007/bf02393536

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…Short of resecting all dominant thyroid nodules, there is no method to select patients for surgery without incurring a small risk of overlooked malignancy among non-surgically treated patients. As pointed out by Rosen and colleagues [12,16], such false-negative errors need to be defined clearly in order to standardize reporting. The false-negative error as defined in this study should be distinguished from that used by L6whagen et al [5], who refer to the proportion of malignancies that FNA fails to detect.…”

Section: Discussionmentioning

confidence: 99%

“…The second shortcoming is that falsenegative errors among the patients who do not undergo surgery may go undetected. Confirmatory evidence of the benign nature of unresected nodules and details of their outcome are notably lacking [15,16]. Only a minority of workers practice concomitant large-needle biopsy to provide added assurance that the unresected nodules are truly benign.…”

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confidence: 99%

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False‐negative errors in fine‐needle aspiration biopsy of dominant thyroid nodules: A prospective follow‐up study

1986

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Reluctance to adopt fine-needle aspiration (FNA) of dominant thyroid nodules stems largely from fear of overlooking a malignancy in a nodule diagnosed as benign on FNA (false-negative error). Published error rates have been derived from surgical series without regard to the outcome of those who were followed without operation. In order to ascertain the overall false-negative error rate, we conducted a prospective study in 600 patients who underwent FNA. Among the 482 study patients who had a benign FNA diagnosis or inadequate specimens, 117 underwent surgery because of the concurrent large-needle biopsy result or a clinical suspicion of malignancy. Eight false-negative errors were identified in this group, 5 of which were detected by large-needle biopsy. Among the remaining 365 patients who were followed for an average of 2V2 years, 2 patients were found to have well-differentiated carcinomas in recurrent cysts. The overall false-negative error rate of FNA alone in all 482 patients was 2.1%. This was reduced to 1.0% by the use of concurrent large-needle biopsy. Properly applied, FNA can reduce unnecessary surgery among patients with clinically benign nodules without incurring an unacceptably high false-negative error rate. Furthermore, this error rate may be reduced substantially by combining large-needle biopsy with FNA and by close follow-up with surgery performed later in patients who manifest clinical features suggestive of malignancy.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

False‐negative errors in fine‐needle aspiration biopsy of dominant thyroid nodules: A prospective follow‐up study

1986

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Needle aspiration biopsy of thyroid nodules

Brauer

Silver

1984

The Laryngoscope

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Needle aspiration biopsies for cytology were performed on 224 patients with thyroid nodules. Diagnosis was confirmed by surgical exploration in 134 patients. Twenty-four biopsies were reported positive for malignancy; 23 were confirmed at operation and there was 1 false positive. Forty-one biopsies were reported benign. Three of these lesions were found to be malignant, representing false negatives. Sixty-nine biopsies were in the questionable category; 16 (23%) of these were malignant. None of the patients suffered complications from the biopsies. Routine employment of needle aspiration biopsy on our service has resulted in a marked increase in the incidence of carcinoma in thyroid nodules selected for surgery. This has resulted from detection of otherwise unsuspected malignancy, as well as avoidance of surgery in patients with benign lesions. Needle aspiration is not a substitute for surgery. It is a valuable diagnostic procedure, and should be performed in the evaluation of essentially all thyroid nodules. We continue to use radioiodine scanning to evaluate our patients, but have found the routine use of ultrasonography unnecessary when needle aspiration is employed. The ultimate decision regarding surgical exploration is based on a combination of factors including history, physical findings, radioiodine scan and needle aspiration biopsy.

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