Preoperative Fine-Needle Aspiration in Goiter With Compressive Symptoms: A Systematic Review and Meta-analysis

There are currently no firm recommendations regarding the necessity of preoperative fine-needle aspiration (FNA) in patients with symptomatic goiter. FNA is an efficient and reliable method for determining the risk of malignancy of thyroid nodules; thus, it became the primary procedure for diagnosing neoplasms and guiding surgical treatment. We performed this systematic review of articles to establish the necessity of FNA in patients with compressive goiter.

Following PRISMA guidelines, a systematic literature search was conducted using electronic databases. Included were studies dealing with euthyroid goiter and compressive symptoms in adult patients designated to undergo therapeutic surgery. Two reviewers independently extracted the data and assessed the risk of bias using the risk of bias visualization (ROBVIS; visualization tool). Our main outcome measure was final histology compared with preoperative FNA.

The initial search identified 3304 relevant studies. After screening and quality assessment, 14 studies were included in the systematic review. The FNA accuracy of malignant and nonmalignant nodules diagnosed correctly preoperatively was 88.4%. In a meta-analysis that included both benign and malignant preoperative FNA results with subsequent postoperative histology, we observed a relative risk of 0.79.

Our data underscore the significant value of preoperative FNA when planning a thyroidectomy for patients with a goiter. The FNA results enable both the physician and the patient to make informed decisions, consider a staged surgical approach if necessary, determine an appropriate follow-up strategy, and discuss potential complications based on the preoperative findings.