Adequate sampling of multiple thyroid nodules by fine‐needle aspiration

Abstract

BACKGROUND Recommendations regarding how many nodules to biopsy with thyroid fine‐needle aspiration vary. METHODS The authors reviewed fine‐needle aspiration specimens of 12,763 nodules from 10,506 patients and correlated them with the number of nodules biopsied. RESULTS Compared with patients in whom only a single nodule was biopsied, patients in whom multiple nodules were biopsied were found to be significantly younger, more likely female, and to have larger tumors, and those tumors were more often papillary (all P<.001). On fine‐needle aspiration, patients who had multiple nodules biopsied were more often diagnosed with benign findings (P<.001), but usually had no significant difference in the risk of malignancy associated with any cytologic diagnosis. Performing biopsy in 3 nodules detected all carcinomas in the current series. Combining all cases in the literature demonstrated that performing only 3 biopsies in a patient with at least 4 suspicious nodules had a risk of malignancy of 1.2%. CONCLUSIONS Biopsy of 3 different nodules in patients with multiple nodules appears to lower the risk of malignancy to that of a benign fine‐needle aspiration specimen. Although exceptions can occur, cytologists may be able to improve the accuracy of their diagnoses by focusing predominantly on identifying papillary carcinoma after the first 2 nodules have been biopsied. Cancer Cytopathol 2017;125:848–53. © 2017 American Cancer Society.

Characteristics of False-Negative Thyroid Fine-Needle Aspirates

“…Different types of errors would require different interventions to improve the performance of the test. Previous studies have already shown that inadequate sampling may result in a significant error rate in patients with multiple suspicious nodules [38][39][40] . Similarly, error rates related to sampling have been well described in core needle biopsy compared to FNA [41] .…”

In Response to “Overdiagnosis of Thyroid Cancer: Is This Not an Ethical Issue for Pathologists As Well As Radiologists and Clinicians?”

“…The second edition of the Bethesda System 7 does, however, also include a table in which NIFTP is taken into account. Our experience with more than 15 000 aspirates and 2000 resections 8 is that the ROM for indeterminate aspirates in our laboratory is at the very lowest end of the range reported in the Bethesda System. We believe that as pathologists continue to become more comfortable diagnosing NIFTP, the reported ROMs for indeterminate thyroid aspirates will continue to decrease, and the difference in risk between an indeterminate and a benign aspirate will continue to shrink.…”

Ultrasound-Guided Fine-Needle Aspiration Versus Fine-Needle Capillary Sampling in Evaluation of Lymph Node Metastasis of Thyroid Cancer

“…(11)(12)(13). The values of FNA and FNC with different needle gauges have been extensively investigated in the previous studies (14)(15)(16)(17). However, there are relatively less studies reporting the application of FNA in suspected cervical lymph nodes even this method has been recommended in ATA guideline (2).…”