Negative Fine-Needle Aspiration in Patients with Goiter: Should We Doubt It?

Area of Science:

• Endocrinology
• Surgical Oncology
• Pathology

Background:

• Epidemiologic studies indicate an increased incidence of thyroid cancer in individuals with multinodular goiters.
• Thyroid cancer risk in patients undergoing thyroidectomy for presumed benign thyroid conditions requires evaluation.

Purpose of the Study:

• To assess the likelihood of detecting significant thyroid cancer in patients undergoing thyroidectomy for non-cancerous indications.
• To determine the incidence of unexpected thyroid malignancies in multinodular goiters.

Main Methods:

• Retrospective analysis of 273 patient records undergoing thyroidectomy for non-cancerous reasons or indeterminate cytology.
• Review of preoperative fine-needle aspiration (FNA) results and final histopathological findings.

Main Results:

• Malignancy was unexpectedly identified in 19% of patients (50 out of 273).
• Papillary carcinoma was the predominant type (94%), with 86% being incidental microcarcinomas.
• Only 2.6% of patients had tumors larger than 1 cm, and a negative FNA had a 1.5% false-negative rate for significant cancer.

Conclusions:

• The incidence of clinically significant thyroid cancer unexpectedly found in surgically resected goiters is notably low.
• A negative fine-needle aspiration (FNA) result effectively rules out the presence of significant thyroid cancer.