Repeat FNA Significantly Lowers Number of False Negative Results in Patients with Benign Nodular Thyroid Disease and Features of Chronic Thyroiditis.

Dorota Słowińska-Klencka,Mariusz Klencki,Bożena Popowicz,Ewa Woźniak-Oseła,Stanisław Sporny

doi:10.1155/2014/967381

Dorota Słowińska-Klencka, Mariusz Klencki + Show 3 more

Open Access

https://doi.org/10.1155/2014/967381

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Abstract

Purpose. The aim of the study was to compare the risk of thyroid malignancy and efficacy of repeat FNA in patients with thyroid nodules diagnosed cytologically as benign lesion (BL) with features of chronic thyroiditis (BL-CT) and BL without CT features (BL-nCT). Methods. The analysis included 917 patients with BL-CT and 7046 with BL-nCT in the first FNA. Repeat biopsy was carried out in 787 patients of BL-CT and 5147 of BL-nCT; 218 patients of BL-CT and 2462 of BL-nCT were operated; in 88 cases of BL-CT and 563 of BL-nCT both ways of follow-up were available. Results. Outcome of repeat cytology implied surgery more frequently in patients with BL-CT than with BL-nCT—3.2% versus 1.9%, P < 0.05. Incidence of cancer (including incidentalomas) was higher in patients with BL-CT operated after one benign cytology than in patients with two benign FNA outcomes: 10.8% versus 1.6%, P < 0.05. In patients with BL-nCT that difference was not significant: 3.2% versus 2.6%. Conclusions. Patients with thyroid nodules diagnosed as BL with CT features have higher risk of malignancy than patients with BL without CT features. Repeat biopsy significantly lowers percentage of FN results in patients with BL-CT in the first FNA.

Highlights

Fine needle aspiration biopsy (FNA) is the main examination in diagnostics of thyroid nodules
In the studies performed above ten years ago some authors indicated the necessity to perform repeat FNA of all patients with benign lesion (BL) in order to lower the number of false negative results (FN) results [3, 4]
Those studies were performed when mainly large, dominant nodules were subjected to FNA and many biopsies were performed without Ultrasound examination (US) guidance

Summary

Introduction

Fine needle aspiration biopsy (FNA) is the main examination in diagnostics of thyroid nodules. The most frequent FNA result is diagnosis of benign lesion which validates conservative treatment. Some investigators suggest that repeat FNA should be performed in each case of benign lesion in order to increase validity of the diagnosis [3,4,5]. Others prove that such procedure is not reasonable as repeat FNA rarely changes the category of the cytological diagnosis while exposing patients to stress and it is not reasonable economically [6,7,8]. In this study we decided to consider another such possible factor, that is, coexistence of the thyroid nodule with chronic lymphocytic thyroiditis (CT)

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