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Adequate sampling of multiple thyroid nodules by fine-needle aspiration
Andrew A Renshaw1, Ewing W Gould1
1Department of Pathology, Baptist Hospital and Miami Cancer Institute, Miami, Florida.
Cancer Cytopathology
|August 1, 2017
Summary
Biopsying three thyroid nodules in patients with multiple nodules can reduce the risk of malignancy. This approach helps achieve diagnostic accuracy comparable to benign fine-needle aspiration specimens.
Area of Science:
- Cytopathology
- Endocrinology
- Oncology
Background:
- Current recommendations for the number of thyroid nodules to biopsy during fine-needle aspiration (FNA) are inconsistent.
- Thyroid nodules are common, and determining the optimal number for biopsy is crucial for accurate diagnosis and patient management.
Purpose of the Study:
- To evaluate the impact of the number of biopsied nodules on the risk of malignancy in patients with multiple thyroid nodules.
- To determine the optimal number of biopsies for maximizing diagnostic yield and minimizing the risk of malignancy.
Main Methods:
- A retrospective review of 12,763 thyroid fine-needle aspiration specimens from 10,506 patients.
- Correlation of the number of biopsied nodules with patient demographics, tumor characteristics, and cytopathologic diagnoses.
Main Results:
- Patients undergoing multiple nodule biopsies were younger, more often female, and had larger, more frequently papillary tumors (P<.001).
- While multiple biopsies were associated with more benign diagnoses (P<.001), the risk of malignancy per cytologic diagnosis remained similar.
- Biopsying three nodules identified all carcinomas in the study series, and literature review indicated a 1.2% malignancy risk when three biopsies were performed on patients with at least four suspicious nodules.
Conclusions:
- Biopsy of three distinct nodules in patients with multiple nodules appears to reduce the risk of malignancy to that of a benign FNA specimen.
- Cytopathologists can enhance diagnostic accuracy by focusing on papillary carcinoma identification after the initial two biopsies, though exceptions exist.
