Low false-negative rate of cytology in thyroid nodules > 4 cm

Abstract

Objective: To report the results of cytology and histology obtained for a series of systematically resected thyroid nodules ≥ 4 cm. Methods: A group of 151 patients with thyroid nodules ≥ 4 cm was submitted to surgery despite the cytology result. Results: Malignancy was confirmed histologically in 22.5% of the patients. Excluding cases of insufficient material, cytology was benign in only 3/31 carcinomas (90.3% sensitivity). The frequency of malignancy was 35% among nodules with indeterminate cytology (follicular neoplasm), and there was a predominance (77%) of papillary carcinoma. The negative predictive value of benign cytology was 96.4%. Conclusions: The false-negative rate of cytology in thyroid nodules ≥ 4 cm does not justify systematic resection of these nodules in asymptomatic patients with benign cytology. Arq Bras Endocrinol Metab. 2009;53(9):1143-5Keywords Thyroid nodule; cytology; benign resumo Objetivo: Reportar os resultados da citologia e da histologia em uma série de nódulos tireoidianos ≥ 4 cm sistematicamente ressecados. Métodos: Foram submetidos à cirurgia 151 pacientes com nódulo tireoidiano ≥ 4 cm, a despeito do resultado da citologia. Apenas a histologia referente a este nódulo foi considerada nos resultados. Resultados: Malignidade foi confirmada histologicamente em 22,5% dos pacientes. Excluindo os casos com material insuficiente, a citologia foi benigna somente em 3/31 carcinomas (sensibilidade 90,3%). A frequência de malignidade foi de 35% nos nódulos com citologia indeterminada (neoplasia folicular), predominando o carcinoma papilífero (77%). O valor preditivo negativo da citologia benigna foi 96,4%. Conclusões: A taxa de falso-negativo da citologia em nódulos tireoidianos ≥ 4 cm não justifica a ressecção sistemática destes em pacientes assintomáticos com citologia benigna. Arq Bras Endocrinol Metab. 2009;53(9):1143-5 Descritores Nódulo da glândula tireoide; citologia; benigna

Thyroid nodule size calculated using ultrasound and gross pathology as predictors of cancer: A 23‐year retrospective study

“…Several studies have assessed the relationship between thyroid nodule size and FNA accuracy as well as the false‐negative rates. Carrillo et al and McCoy et al reported false‐negative rates for thyroid nodules ≥4 cm that were higher than our findings (20.0% and 12.7%, respectively), whereas Kuru et al, Rosario et al, and Kamran et al reported FNR (false‐negative rates) lower than found in our data (4.3%, 3.6%, and 1.3%, respectively). Other studies have shown similar findings which were either higher or lower than the findings on the false negative rates in our study Porterfield et al, Shrestha et al, Carrillo et al, and Meko and Norton .…”

Large (≥3cm) thyroid nodules with benign cytology: Can Thyroid Imaging Reporting and Data System (TIRADS) help predict false-negative cytology?

“…Six studies recommended surgery [9–11,13,19,25] or repeat FNA [10] for large thyroid nodules even after benign FNA results because of a high false-negative rate (FNR) of 7.7–25.0%. In contrast to those studies, the remainder studies mentioned that large size itself should not be an indication for surgery because the FNR was within an acceptable range of 0.7–3.6% [20, 22, 24, 26] or not different from that of smaller nodules despite having a high FNR of 4.3–15.0% [8, 12, 21, 23]. In the present study, the FNR of large thyroid nodules with benign cytology was 3.6% (23 of all 632 nodules including follow-up nodules) to 13.4% (22 of 164 resected nodules) which was higher than the Bethesda recommendation of 0–3%.…”

Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus

“…FNA is the best available method to distinguish between benign and malignant lesions (5), even in the case of nodules smaller than 1 cm (3) or larger than 4 cm (38). In addition, FNA is an easy and low-cost outpatient procedure that is virtually devoid of serious complications.…”