Role of repeat fine‐needle aspiration biopsy (FNAB) in the management of thyroid nodules

Abstract

The purpose of the present study was to determine the role of repeat fine-needle aspiration biopsy (FNAB) in the evaluation of thyroid nodules initially classified as "nondiagnostic" due to limited cellularity or as "indeterminate for neoplasm." We reviewed a cohort of 431 patients (352 females, 79 males; average age 50 yr); 237 patients were classified as "nondiagnostic" due to limited cellularity and 194 as "indeterminate for neoplasm" over a 3-yr period (1999-2002). Repeat FNAB under ultrasound guidance was performed in 226 patients (226/431, 52%); surgical pathology results were available in 101 patients. Repeat FNAB diagnoses were: benign 70 (31%), follicular/Hürthle cell neoplasm 62 (27%), suspicious for papillary carcinoma 25 (12%), malignant 17 (7%), and nondiagnostic 52 (23%) cases. Surgical follow-up was available in 101 (45%) patients; malignancy was identified in 50 (49%) patients. The malignancy rate was 51% and 48% in cases in which initial FNAB was nondiagnostic and indeterminate for neoplasm, respectively. There were no false-positives and all malignant cases undergoing surgery were found to be malignant. This study demonstrates that repeat FNAB is warranted in patients with thyroid nodules diagnosed on initial FNAB as nondiagnostic and indeterminate for neoplasm since it can yield a definitive diagnosis in the majority of cases with an overall malignancy rate of 49%.

Fine-needle aspiration of thyroid nodules: A study of 4703 patients with histologic and clinical correlations

“…8,16,[35][36][37][38] Patients with unsatisfactory specimens should undergo a repeat FNA, preferably under sonographic guidance. 38,39 The current study demonstrated that, among patients with initial unsatisfactory specimens who underwent repeat thyroid FNA, 83% had a diagnostic repeat FNA that permitted appropriate followup. The malignancy rate (8.5%) in repeat FNA done because of prior unsatisfactory aspirate was comparable to the malignancy rate for patients who had a diagnostic initial FNA (7.6%).…”

“…In the current study, 19 of 26 patients who had repeat cytology were downgraded to a negative category, and 6 were upgraded to FN, indicating that repeat cytology was able to provide a more definitive diagnosis for management purposes. 39 Of 52 patients who underwent thyroidectomy, 7 patients (13.5%) had malignant tumors identified. The malignant rate was higher than that observed in patients who had thyroid nodules in the benign category (7.3%).…”

“…47 Some studies have suggested that repeat cytology may help in further triaging patients in this category. 39 However, this may not be practical, because, once the cytologic diagnosis of FN is made, both patients and clinicians ultimately will choose surgery. Furthermore, the second diagnosis does not necessarily negate the validity of the first.…”

The atypical thyroid fine‐needle aspiration: Past, present, and future

“…This approach to managing patients with an AUS/ FLUS diagnosis is considered safe and cost-effective. 40,41 Correlation with clinical and radiologic features is also important, because patient management, although heavily influenced by the FNA interpretation, can and should be impacted by clinical and sonographic findings, and even the patient's own desires for treatment. In approximately 20% to 28% of AUS/FLUS cases, a repeat thyroid FNA will again be interpreted as AUS/FLUS (Table 2).…”

Combined analysis of galectin-3 and BRAFV600E improves the accuracy of fine-needle aspiration biopsy with cytological findings suspicious for papillary thyroid carcinoma

“…A specimen was qualified as satisfactory if there were six groups of epithelial cells with at least ten cells per group. Patients, whose FNAB results did not yield a clear cytological diagnosis, were subjected to a second FNA procedure, performed twice consecutively in the same session after 3 weeks according to Baloch et al (2003). One sample was used for cytological examination and the other was dispersed into Tri-reagent buffer (Sigma) and stored at K20 8C until DNA extraction.…”