Is One Benign Fine Needle Aspiration Enough?

Abstract

The overall false-negative rate of thyroid FNAs is 10.2%, which is reduced to 4.5% with a second benign FNA. Ninety percent of patients with a false-negative FNA had suspicious sonographic features. Reaspiration should be considered in patients with sonographically suspicious nodules.

A Risk Model to Determine Surgical Treatment in Patients with Thyroid Nodules with Indeterminate Cytology

“…Calcifications and atypia have been found to be strongly associated with malignant thyroid nodules in most series. 4,7,10,13,22 Data regarding nodule size is conflicting. Some authors have shown that larger nodule size is suggestive of malignancy, whereas others have shown that benign nodules tend to grow larger than malignant ones.…”

“…Some investigators have shown that routine second opinion review of cytopathology results in a different diagnosis in over one-third of FNAs. 3,4 Several molecular markers have been investigated for distinguishing benign from malignant thyroid nodules with indeterminate cytology. 5 Recently, a commercially available DNA microarray-based genomic classifier assay was shown to diagnose malignancy of indeterminate thyroid nodules with a positive predictive value of 47 % and a negative predictive value of 93 %.…”

“…7,8 Male patients or those at the extremes of age, with larger or calcified nodules, patients with a personal history of radiation exposure or a family history of benign thyroid disease, and those with nuclear features suggestive of thyroid carcinoma upon examination of FNAs are considered to be at higher risk. 4,[7][8][9][10][11][12] Some authors have tried unsuccessfully to use logistic regression models to predict cancer in patients with indeterminate FNA cytology. 11 Others have developed such models using some clinical and cytological parameters.…”

“…In the multivariable model, the factors that were statistically significant predictors of malignancy were tobacco use [odds ratio (OR)4.59, 95 % confidence interval (CI) 1.30-16.27, p \ 0.01], larger nodule size (OR 1.75, 95 % CI 1.19-2.57, p \ 0.01), calcifications on ultrasound (OR 6.37, 95 % CI 1.62-25.1, p \ 0.01), and atypia on FNA (OR 4.91, 95 % CI 1.90-12.66, p \ 0.01). Age was included in the model, because it had marginal significance in our analyses and is a known predictor of thyroid cancer in the literature (OR 0.97, 95 % CI 0.94-1.00).…”

Cytologic Comparison Between Growing and Non-growing Benign Thyroid Nodules Evaluated Using Two Different Growth Criteria

“…Similarly, in another study including the rebiopsies of benign nodules with suspicious ultrasonographic features, in 17.4% of them, suspicious cytology was found (14). Therefore, in some studies, TFNAB is recommended for benign thyroid nodules in follow-up (15). We faced various limitations during our study.…”