Survey of current approaches to non-diagnostic fine-needle aspiration from solid thyroid nodules

The exact frequency of non-diagnostic ultrasound-guided fine-needle aspiration (USFNA) is unknown. Clinical guidelines suggest repeating USFNA of these nodules. However, there is no specific recommendation or evidence on how and when this re-aspiration should be done. We aim to describe the approaches considered by endocrinologists to yield the highest likelihood of a satisfactory sample in solid thyroid nodules. A cross-sectional survey of The Endocrine Society (TES) and the American Thyroid Association members was conducted between October and December 2012. A total of 694 surveys were returned, 648 (93.4 %) from TES. The responders were equally divided between private and academic settings and had a high degree of expertise. Thirty-nine percent of respondents estimated the frequency of non-diagnostic USFNA to be above 10 %. For its management, 311 (46 %) recommended repeating USFNA in 1-3 months. For a second non-diagnostic USFNA, 216 (31 %) recommend surgery. The most common approaches to increase the diagnostic yield were (1) use of suction with USFNA, 18 % and (2) changing the targeted area of biopsy within the nodule, 18 %. Few considered the patients' preferences as an important driver for the management of non-diagnostic USFNA. Finally, a molecular test for bypassing non-diagnostic USFNA was regarded as the most needed strategy for future research. Variability exists in the management of non-diagnostic USFNA and strategies to increase the diagnostic yield. Testing the suggested strategies in clinical trials and understanding patient's preferences should be supported by guideline panels and funding agencies.