Abstract
Purpose: The current gold standard for determining malignancy in thyroid nodules >4 cm is diagnostic lobectomy, regardless of the fine needle aspirate cytology (FNAC) result. This is based on the reportedly high false‐negative rates of FNAC (>10%) in large thyroid nodules. The purpose of this study was to determine if routine removal of thyroid nodules >4 cm is best clinical practice. We hypothesize that ultrasound guided FNAC is as effective as diagnostic lobectomy in detecting malignancy in these patients.Method: We conducted a cross sectional study of 225 consecutive patients with thyroid nodules >4 cm between 1994 and 2008 who all underwent surgical excision. We assessed the efficacy of preoperative FNAC alone in detecting malignancy in this group compared to surgical excision.Results: 225 patients in the study underwent surgery. 162 patients had preoperative FNAC performed. Male to female ratio was 1:3. Overall incidence of thyroid cancer was 9.6% (16/165). The sensitivity of preoperative FNAC alone in identifying thyroid cancer was 81% and specificity was 62%. False negative rate for FNAC was 1/16 (6%). Positive predictive value of FNAC was 22% (13/60), with negative predictive value of 99% (90/91). Likelihood ratio for positive FNAC result was 2.13.Conclusion: The incidence of carcinoma in thyroid nodules less than 4 cm is low. Preoperative FNAC is highly sensitive and specific in detecting thyroid cancer even in nodules less than 4 cm in size. Effective management of these patients can be confidently carried out based on the preoperative FNAC result alone, without the need for diagnostic lobectomy.
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