Thyroid nodules. The place of fine-needle aspiration biopsy in management

Although the advent of fine-needle aspiration biopsy (FNAB) has revolutionized evaluation of thyroid nodules, the procedure remains an imperfect instrument when used alone. Careful consideration of factors in the patient's history and physical examination can signal an indication for biopsy; an abundance of high-risk factors should override even negative biopsy results. Suspicious (cellular) biopsy results require singular attention. Subsequent radioisotopic imaging revealing an autonomous (hot) nodule essentially excludes the possibility of carcinoma, but warm or cold nodules require surgical excision for definitive diagnosis. Low false-negative rates accompanying benign or indeterminate results on FNAB permit management with suppressive therapy and periodic examination to detect growth or changes in characteristics of the nodule, development of adenopathy, or vocal cord paralysis. Persistent nodules justify rebiopsy in 1 year, or sooner if new risk factors emerge.