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Repeat thyroid nodule fine-needle aspiration in patients with initial benign cytologic results
Melina B Flanagan1, N Paul Ohori, Sally E Carty
1Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA.
American Journal of Clinical Pathology
|May 19, 2006
Summary
A repeat fine-needle aspiration (FNA) after an initial benign thyroid nodule result improves cancer detection. One repeat FNA enhances diagnostic accuracy, while further repeats offer no additional benefit.
Area of Science:
- Endocrinology
- Surgical Pathology
- Diagnostic Cytopathology
Background:
- Fine-needle aspiration (FNA) is the primary method for evaluating thyroid nodules.
- Management of patients with benign FNA results lacks standardized guidelines.
- Thyroid surgery is often performed for nodules with benign FNA findings.
Purpose of the Study:
- To evaluate the diagnostic performance of initial and repeat satisfactory FNAs in patients undergoing thyroid surgery.
- To determine the optimal number of repeat FNAs for improving malignancy detection after a benign initial result.
Main Methods:
- Retrospective analysis of 402 patients who underwent thyroid surgery over 22 months.
- Inclusion of patients with at least one satisfactory FNA (n=267) and those with two or more (n=70).
- Comparison of FNA results with final pathologic diagnoses.
Main Results:
- One repeat FNA following an initial benign diagnosis identified 2 unsuspected malignancies and 7 additional malignancies from indeterminate results.
- The use of one repeat FNA increased sensitivity for malignancy from 81.7% to 90.4%.
- One repeat FNA decreased the false-negative rate from 17.1% to 11.4%, with no further improvement from additional repeats.
Conclusions:
- A single repeat FNA is recommended after an initial benign FNA diagnosis for thyroid nodules.
- Repeat FNA improves the detection rate of thyroid cancer in initially benign nodules.
- Current data support the utility of one repeat FNA in refining thyroid nodule management.