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%.