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Repeat thyroid fine needle aspiration: a key step from nondiagnostic cytology to histologic diagnosis
1Department of Pathology and Laboratory Medicine, Albany Medical Center and Albany Medical College, Albany, New York.
Introduction:
Nondiagnostic thyroid fine-needle aspiration (FNA) results pose a diagnostic challenge due to their variable malignancy risk. Repeat FNA is often recommended to obtain a definitive diagnosis. This study evaluates the outcomes of nondiagnostic FNAs through repeat sampling and/or histologic follow-up, with emphasis on identifying malignant cases.
Materials And Methods:
A retrospective review was performed on all nondiagnostic thyroid FNAs diagnosed at Albany Medical Center from 2021 to 2022. Data collected included repeat FNA results and histologic outcomes when available. Each case included at least one ThinPrep or direct smear, with most having both preparations.
Results:
Among 404 nondiagnostic thyroid FNAs, 171 (42%) underwent first-repeat FNA, yielding 59 (35%) nondiagnostic, 99 (58%) benign, 11 (6%) indeterminate, and 2 (1%) malignant results. Of the 59 repeat-nondiagnostic cases, 17 had a second-repeat FNA, producing 9 (53%) nondiagnostic, 7 (41%) benign and 1 (6%) indeterminate diagnosis. Twenty-one nondiagnostic cases had surgical follow-up and 5 (24%) were papillary thyroid carcinoma (PTC). Among malignant resections, repeat FNA resolved the diagnosis in all cases.
Conclusions:
Repeat FNA achieved diagnostic resolution in 65% of first-repeat and 47% of second-repeat evaluations. Twenty-four percent of resected nondiagnostic nodules were malignant (PTC), underscoring the critical role of repeat FNA in detecting malignancy after an initial nondiagnostic result. Larger studies are needed to validate the observed association between positive concurrent/repeat FNAs and clinicopathologic features of PTC in nondiagnostic FNA cases.
