[Thyroid nodules. Diagnostic value of fine-needle biopsy. 159 surgical patients]

Between October 1980 and March 1983 we explored 269 patients who had one or several thyroid nodules with low or normal technetium 99 uptake. Each palpable nodule was aspirated 1 to 3 times, using a fine 21 G2 needle, and the aspirates were immediately spread on glass-plates and kept in alcohol-ether. After staining by the Harris- Shor method, all plates were examined by the same cytologist. Biopsies were unassessable in 50 patients (18%), mainly because they were entirely made up of red cells. Sixty patients did not undergo surgery. In the 159 patients operated upon, cytology was compared with histology which showed 139 benign and 20 malignant nodules. In 5 histologically benign nodules, cytology had shown nuclear abnormalities or enlarged cells suggestive of malignancy (false-positive results: 3.5%). Among 5 nodules diagnosed as benign at cytology, there were 2 papillary microcarcinomas , 2 to 4 mm in diameter, the course of which is little known, 1 well differentiated vesicular cancer extremely difficult to distinguish from vesicular adenoma, and 2 papillary cancers. Fine needle biopsy cytology is a harmless procedure, but it requires considerable experience on the part of cytologists. We consider that it should be performed in all cases of thyroid nodule, either to help in deciding whether or not to operate, or to guide the surgeon in deceding whether or not to operate, or to guide the surgeon in his operative strategy.