Fine-needle aspiration of thyroid nodules: past, present, and future

To present a review of the traditional and more recent techniques and applications of thyroid fine-needle aspiration biopsy.

We describe the cytologic features and differential diagnoses of various thyroid lesions, outline recommendations for diagnostic categories, and discuss new techniques that have shown some promise in the diagnosis of thyroid nodule fine-needle aspiration specimens.

Fine-needle aspiration biopsy of the thyroid has proved to be an excellent diagnostic tool in the initial management of thyroid nodules. Numerous studies have shown its high sensitivity and specificity in diagnosing malignant tumors of the thyroid, especially papillary thyroid carcinoma. As with other diagnostic tests, however, its effectiveness is highly dependent on the expertise of the operator performing the procedure and the adequacy of the specimen for interpretation of the cytomorphologic features. On-site evaluation of thyroid specimens promotes adequate specimen sampling and reduces the incidence of nondiagnostic specimens. Diagnostic reports on thyroid fine-needle aspiration should include patient demographics and pertinent clinical history, site and size of the thyroid nodule, mode of aspiration, number of needle passes, assessment of specimen adequacy, diagnosis, and recommendations. Although immunohistochemical and molecular markers have received considerable attention recently, additional studies are needed before they can be used to separate benign from malignant follicular thyroid lesions.

Overall, fine-needle aspiration biopsy of thyroid nodules has proved to be sensitive, specific, and well accepted by patients because of minimal discomfort and complications.