Surgical management of the thyroid nodule: Patient selection based on the results of fine‐needle aspiration cytology

Abstract

To determine whether the routine use of fine-needle aspiration (FNA) cytology reduces the rate of unnecessary surgery, the surgical pathology of 54 thyroidectomy patients who had preoperative FNA was compared to the results obtained with 24 thyroidectomy patients who did not have preoperative FNA. Twenty-nine (85.3%) of the 34 patients who had a positive FNA were confirmed by histology to have a thyroid neoplasm; in 24 patients, the neoplasm was malignant. Two of the 17 patients who had a negative FNA but underwent thyroidectomy based on other factors were found to have thyroid cancer. Only 8 (33.3%) of the 24 surgical specimens of patients who did not have an FNA were found to be malignant. FNA had a sensitivity of 93.5% and a specificity of 75.0%. The results indicate that the routine use of FNA for patients with thyroid nodules reduces the incidence of unnecessary surgery. Furthermore, FNA alone is sufficient to identify most patients at risk and is, therefore, cost-effective. However, the presence of other findings suspicious of malignancy should preclude clinical decision making based on FNA alone.

A Comparative Study of Fine Needle Aspiration Cytology, Ultrasonography and Radionuclide Scan in Management of Solitary Thyroid Nodule: A Prospective Analysis of Fifty Cases

“…The sensitivity and specificity of FNAC were 71.43% and 100% respectively according to Altavilla et al (1990), 98% and 99% according to Goellner et al (1987), 93.5% and 75% according to Bouvet et al (1992).…”

Diagnostic accuracy of fine-needle aspiration cytology in diagnosis of thyroid nodules

“…The methods used for the calculation of sensitivity, specificity, accuracy, positive predictive value and negative predictive value were similar to previous studies. 11,14,[16][17][18] Sensitivity and accuracy of FNAC for detection of neoplasm were 80% and 84%, respectively, whereas they were 76% and 69%, respectively, in a study by Cusick et al 14 The sensitivity, specificity, and accuracy of FNAC for solitary thyroid nodules were 80%, 86.6% and 84%, respectively, in study done by Gupta et al Whereas sensitivity, specificity, and accuracy of FNAC were 93.5%, 75% and 79.6%, respectively, in a study by Bouvet et al and 79%,98.5% and 87%, respectively, in a study by Kessler et al 15,17,18 …”

Comparative Study of Solidary Nodules of Thryoid in Adults in Tertiary Care Teaching Hospital

“…All patients with a palpable thyroid nodule, however, should undergo US examination.US-guided FNA (US-FNA) is recommended for nodules≥10 mm; US-FNA is suggested for nodules <10 mm only if clinical information or US features are suspicious. Preferably, the aspirates should be obtained from the peripheral areas and different parts of the nodule in a sequential manner to ensure representative sampling (11,13) . For larger nodules, the deep center of the mass should be avoided because it is more likely to contain degeneration and fluid [14,19] …”