Guiding thyroid nodule management by fine-needle aspiration

To determine the clinical value and cost effectiveness of fine-needle aspiration (FNA) in thyroid nodule management, a retrospective analysis of 945 consecutive patients subjected to FNA of cold nodules detected by clinical exam and Tc-99m pertechnetate thyroid scan between January 1, 1980, and December 31, 1987, was performed. After FNA, thyroid surgery was required in only 287 of 945 patients (30.4%). Of 87 cancers with satisfactory aspirates, 84 exhibited positive or suspicious cytology (sensitivity 96.6%). The predictive values for positive and negative cytology were 96.9% and 95.7%, respectively. Of 745 patients with known or presumed benign disease up to seven years of follow up, 642 showed benign cytologies (specificity 86.2%). The cancer removal rate (1980-1987) was higher with FNA and surgery than with surgery alone (P less than 0.001). The estimated cost saving of FNA in 1980-1987 approximates $564,000. FNA is of great value since it enables greater cancer detection in a cost-effective manner.