Abstract
BackgroundThyroid fine needle aspiration cytology (FNAC) is the standard diagnostic modality for thyroid nodules. However, it has limitations among which is the incidence of non-diagnostic results (Thy1). Management of cases with repeatedly non-diagnostic FNAC ranges from simple observation to surgical intervention. We aim to evaluate the incidence of malignancy in non-diagnostic FNAC, and the success rate of repeated FNAC. We also aim to evaluate risk factors for malignancy in patients with non-diagnostic FNAC.Materials and MethodsRetrospective analyses of consecutive cases with thyroid non diagnostic FNAC results were included.ResultsOut of total 1657 thyroid FNAC done during the study period, there were 264 (15.9%) non-diagnostic FNAC on the first attempt. On repeating those, the rate of a non-diagnostic result on second FNAC was 61.8% and on third FNAC was 47.2%. The overall malignancy rate in Thy1 FNAC was 4.5% (42% papillary, 42% follicular and 8% anaplastic), and the yield of malignancy decreased considerably with successive non-diagnostic FNAC. Ultrasound guidance by an experienced head neck radiologist produced the lowest non-diagnostic rate (38%) on repetition compared to US guidance by a generalist radiologist (65%) and by non US guidance (90%).ConclusionsThere is a low risk of malignancy in patients with a non-diagnostic FNAC result, commensurate to the risk of any nodule. The yield of malignancy decreased considerably with successive non-diagnostic FNAC.
Highlights
Thyroid nodules are common in clinical practice
Out of total 1657 thyroid fine needle aspiration cytology (FNAC) done during the study period, there were 264 (15.9%) non-diagnostic FNAC on the first attempt
There is a low risk of malignancy in patients with a non-diagnostic FNAC result, commensurate to the risk of any nodule
Summary
Thyroid nodules are common in clinical practice. Using ultrasound scanning, the prevalence of thyroid nodules can reach up to 50% of the population [1]. Fine needle aspiration cytology (FNAC) is the accepted standard tool for the evaluation of thyroid nodules [3,4,5,6,7,8,9,10,11,12]. It is safe and accurate with reported high sensitivity and specificity for malignancy [13,14]. Thyroid fine needle aspiration cytology (FNAC) is the standard diagnostic modality for thyroid nodules It has limitations among which is the incidence of non-diagnostic results (Thy). We aim to evaluate risk factors for malignancy in patients with non-diagnostic FNAC
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