The role of needle aspiration biopsy in the selection of patients for thyroidectomy

Fine needle aspiration (FNA) biopsy is gaining in popularity among all diagnostic tests used in the evaluation of patients for thyroidectomy. Its safety and accuracy have been well documented, but criteria regarding when FNA is appropriate are lacking. We retrospectively reviewed our experience with 408 consecutive patients evaluated for thyroid surgery. Two hundred seventy-three ultimately underwent thyroidectomy; 100 of these had preoperative FNA. An additional 135 patients underwent FNA without surgery. Patients who benefited from FNA were those in whom cytologic findings led to surgery for otherwise unsuspected malignancy (15), and those with asymptomatic benign nodules who avoided unnecessary thyroidectomy on the basis of FNA findings (96). FNA is superfluous when clinical conditions mandate surgery. These include nodules that arouse clinical suspicion of malignancy, massive nodules that cause aerodigestive tract compression or cosmetic disfigurement, and nodules extending into the mediastinum. All patients with asymptomatic, clinically benign thyroid nodules should undergo FNA biopsy, as approximately 50% can anticipate significant benefit from the procedure.