Timing of Repeat Thyroid Fine-Needle Aspiration in the Management of Thyroid Nodules

Abstract

Objective: The Bethesda System for reporting thyroid fine-needle aspirations (FNAs) recommends repeat aspirations be done at least 3 months following the initial aspiration to prevent false-positive misinterpretations due to reactive/reparative changes. Because limited data exists, we reviewed our own data to ascertain the recommendation. Study Design: We retrospectively reviewed thyroid FNAs accessioned in the Cytology Laboratory at Beth Israel Deaconess Medical Center in Boston, Mass., USA, from January 2006 to December 2008. We identified patients with repeat aspirates of a single lesion and those with thyroidectomy specimens. Cytologic and surgical diagnoses along with time between FNAs were recorded. Results: No statistically significant difference was detected in the distribution among nondiagnostic, suboptimal, and adequate categories with respect to the timing of repeat FNA (p = 0.25). Forty-six percent of the lesions that were nondiagnostic/suboptimal initially yielded the same results on repeat. Twenty-eight percent of initially adequate specimens were nondiagnostic/suboptimal on repeat (p = 0.04). Nine percent of those with an initial atypical diagnosis had the same diagnosis on repeat, while 2.6% of those who did not have an initial atypical diagnosis had an atypical diagnosis on repeat (p = 0.29). False positives between early (16%) and late (12%) repeats were not statistically significant (p = 0.74). Conclusion: The diagnostic yield and accuracy of repeat FNA is independent of the time interval between procedures but may be related to the original FNA diagnosis.

Application of the Bethesda System for Reporting Thyroid Cytopathology in the Eastern Province of Saudi Arabia: A Follow-Up Study

“…It is well known and demonstrated by others that a repeat FNA for nondiagnostic aspirates is of benefit where some cases may show malignancy. Similar to our previous study and other investigators, a repeat FNA with a more appropriate triage is of significant benefit in many of these cases [13,16,17,18,19,20]. …”

“…This rate is relatively comparable to other studies [16,17,18,19,20,21,22]. Out of those 25, 4 had a subsequent surgical follow-up where 1 (25%) revealed papillary thyroid carcinoma and the other 3 (75%) resulted in a benign surgical diagnosis.…”

Repeat Fine-Needle Aspiration Biopsy within a Short Interval Does Not Increase the Atypical Cytologic Results for Thyroid Nodules with Previously Nondiagnostic Results

“…This is what has led to a wait of at least 3 months before the next biopsy is performed. Several recent studies have reported that the timing of repeat FNAB does not influence the atypical cytology results [7,8,9]. A case series of 298 patients with ND results reported no significant difference between the AUS/FLUS results of repeat FNAB of an earlier (<3 months) and a later (≥ 3 months) biopsy group [8].…”

“…Recently, several studies have reported that repeat FNAB performed within 3 months did not increase the atypical cytologic results [7,8,9]. According to the Bethesda System for Reporting Thyroid Cytopathology, the category follicular lesion of undetermined significance (FLUS)/atypia with undetermined significance (AUS) includes cases which do not have convincing evidence of benignity or sufficient features in order to conclude that they are follicular neoplasms or suspicious for malignancy [1].…”

The Bethesda System for Reporting Thyroid Cytopathology: Proposed Modifications and Updates for the Second Edition from an International Panel

“…The ROM was 2-4% among all initially ND samples and 9-32% among those ND samples that were resected [4]. While it was originally recommended to wait >3 months to perform a repeat FNA, evidence exists to support shorter intervals for repeating an FNA after a ND result [4,19,20]. However, it should be noted that reactive atypia and other cellular changes may be present if the time interval is shortened.…”