Fine-needle aspiration biopsy of thyroid nodules: Is routine ultrasound-guidance necessary?

Current guidelines recommend either ultrasound-guided or palpation-guided fine-needle aspiration biopsy for evaluation of a thyroid nodule. However, it has been suggested that ultrasound-guided fine-needle aspiration biopsy should be used routinely in all patients to reduce the rate of nondiagnostic and false negative results. The purpose of this study was to determine whether any difference exists in nondiagnostic and false negative rates between the two methods of fine-needle aspiration biopsy at our institution.

A retrospective review of a prospectively maintained thyroid database was completed to determine the rates of nondiagnostic and false negative fine-needle aspiration biopsy in patients with nodular thyroid disease evaluated during the period 1990-2017.

From 1990 to 2017, a total of 2,322 patients underwent fine-needle aspiration biopsy for evaluation of nodular thyroid disease, 1,123 (48%) underwent ultrasound-guided fine-needle aspiration biopsy and 1,199 (52%) underwent palpation-guided fine-needle aspiration biopsy. Ultrasound-guided fine-needle aspiration biopsy was nondiagnostic in 4.5% and had a 5.2% false negative rate, compared with palpation-guided fine-needle aspiration biopsy, which was nondiagnostic in 5.0% and had a 2.6% false negative rate (P = .53 and .14, respectively).

The rate of nondiagnostic and false negative fine-needle aspiration biopsy results is similar whether US guidance is used or not. To minimize resource utilization, ultrasound-guided fine-needle aspiration biopsy can be used selectively for nonpalpable, predominantly cystic, or previously nondiagnostic nodules.