Effects of preoperative fine needle aspiration biopsy on surgical strategy in patients with papillary thyroid carcinomas

Abstract

Aim: Papillary thyroid carcinomas (PTCs) usually have good prognosis. In the presence of lymph node metastasis, capsular invasion and extra-thyroidal extension, some PTCs may display aggressive behavior. Early diagnosis of these cases is extremely important. Ultrasound-guided fine needle aspiration biopsy (FNAB) is an important diagnostic procedure and may identify the PTC likely to behave aggressively. Our study aimed to examine the effects of FNAB on surgical strategy in patients with PTC. Methods: The data of 269 patients who underwent total thyroidectomy were evaluated in our retrospective cohort study. FNAB had been performed in 188 (70%) patients. Patients with non-incidental diagnoses were compared with patients who had incidental diagnoses in terms of parameters likely to be related to aggressive PTC. Results: Patients ≤ 45 years old were more common in the non-incidental group (P=0.041). Incidental diagnoses were common in females (P=0.014), those with nodules larger than 2 cm in diameter and in patients with ≥2 nodules (P=0.001). Postoperative remnant thyroid tissue was observed more commonly in incidental cases (P=0.008). Lymph node metastasis (P=0.044), capsular invasion (P=0.009), and extra-thyroidal extension (P=0.022) were more common in the non-incidental group. Conclusion: It is difficult estimate the behavior of PTCs preoperatively. Only a small number of PTCs can be preoperatively diagnosed with ultrasound-guided FNAB. The extent of surgery generally is defined by FNAB results. Detailed examination of all suspicious nodules is of great importance for earlier detection of aggressive PTCs and avoiding surgical over-treatment.