The value of coarse needle biopsy in evaluating thyroid nodules

At Columbia Presbyterian Medical Center, CPMC, the incidence of thyroid cancer found at surgery (CI) has recently changed. CI prior to 1950 was 3-4%. The CI gradually increased to 29% in 1975 without the use of needle biopsy. Fine needle biopsy (FNB) was introduced in 1976. The CI did not change during the next 7 years but remained stable at 27% in patients who did not undergo coarse needle biopsy (CNB). The overall CI using both FNB and CNB in 1982 was 42% and with CNB alone, 47%. Since that time, extensive experience using both CNB and FNB has led to a CI of 51%. The CI in patients who only received FNB remains at 28%. The increase in CI seen in patients undergoing CNB are a result of better distinction between hyperplastic lesions and microfollicular neoplasms. 78 patients, referred for surgery because of suspicion of a follicular neoplasm determined on FNB alone, underwent CNB. 35 of these patients were shown to have benign macro-micro follicular lesions (hyperplastic). In a review of 1,625 patients who have undergone CNB there were 3 complications which required surgical intervention (.018%). All of these were for bleeding 6-72 hours after CNB. These 3 patients underwent total thyroidectomy for follicular cancer without complications. There were no other significant complications. These experiences demonstrate that CNB is extremely useful in evaluating thyroid nodules. The complication rate is low and is offset by a large decrease (40%) in the number of patients referred for operation. The primary value of CNB is in differentiating between true microfollicular neoplasms and hyperplastic ones.