Significance of Repeatedly Nondiagnostic Thyroid FNA
Significance of Repeatedly Nondiagnostic Thyroid FNA
Nondiagnostic thyroid fine-needle aspirations are associated with a risk of malignancy that can be reduced with repeated aspiration. However, the significance of repeated nondiagnostic aspirates is less well studied. This study assessed the risk of malignancy for repeated nondiagnostic aspirates from a large series of cases using the results of histologic follow-up.
From a series of 7,089 aspirates, there were 1,671 nondiagnostic aspirates (23.6%), and 235 of these (14.1%) had histologic follow-up. The risk of malignancy for a single nondiagnostic aspirate was 20.0% (47/235). A total of 51 cases had repeated aspiration. The risk of malignancy for cases with a second nondiagnostic aspirate was 0% (0/23), which was significantly less than for patients with a single nondiagnostic aspirate (20.0%; P = .03).
Patients with 2 sequential nondiagnostic thyroid aspirates have a very low risk of malignancy. Cytologists should strive to better convey this risk in their reports.
Nondiagnostic thyroid fine-needle aspirations remain a source of frustration for patients, clinicians, and cytologists. Beyond the wide range of definitions (6 groups each with 10 or more benign epithelial cells, 10 groups each with 20 or more epithelial cells, 6 groups on at least 2 of 6 aspirates, and 8 groups on at least 2 slides) and poor reproducibility, patients should return and have the aspirate repeated. In some cases, the repeated aspiration is also nondiagnostic, and in some cases clinicians will elect to resect a lesion in which a diagnostic aspirate cannot be obtained.
Although it is well documented that the results of repeated aspiration can significantly change the risk of malignancy in patients who have an initial nondiagnostic aspirate and subsequently have a diagnostic aspirate, the risk of malignancy in patients with repeatedly nondiagnostic aspirates is less well defined. In 1 study, repeated nondiagnostic aspirates had a risk of malignancy of 4%, which was less than the risk of a single aspirate (8.5%). To further examine this issue, a large series of thyroid fine-needle aspirates was reviewed and results were correlated with histologic follow-up.
Abstract and Introduction
Abstract
Nondiagnostic thyroid fine-needle aspirations are associated with a risk of malignancy that can be reduced with repeated aspiration. However, the significance of repeated nondiagnostic aspirates is less well studied. This study assessed the risk of malignancy for repeated nondiagnostic aspirates from a large series of cases using the results of histologic follow-up.
From a series of 7,089 aspirates, there were 1,671 nondiagnostic aspirates (23.6%), and 235 of these (14.1%) had histologic follow-up. The risk of malignancy for a single nondiagnostic aspirate was 20.0% (47/235). A total of 51 cases had repeated aspiration. The risk of malignancy for cases with a second nondiagnostic aspirate was 0% (0/23), which was significantly less than for patients with a single nondiagnostic aspirate (20.0%; P = .03).
Patients with 2 sequential nondiagnostic thyroid aspirates have a very low risk of malignancy. Cytologists should strive to better convey this risk in their reports.
Introduction
Nondiagnostic thyroid fine-needle aspirations remain a source of frustration for patients, clinicians, and cytologists. Beyond the wide range of definitions (6 groups each with 10 or more benign epithelial cells, 10 groups each with 20 or more epithelial cells, 6 groups on at least 2 of 6 aspirates, and 8 groups on at least 2 slides) and poor reproducibility, patients should return and have the aspirate repeated. In some cases, the repeated aspiration is also nondiagnostic, and in some cases clinicians will elect to resect a lesion in which a diagnostic aspirate cannot be obtained.
Although it is well documented that the results of repeated aspiration can significantly change the risk of malignancy in patients who have an initial nondiagnostic aspirate and subsequently have a diagnostic aspirate, the risk of malignancy in patients with repeatedly nondiagnostic aspirates is less well defined. In 1 study, repeated nondiagnostic aspirates had a risk of malignancy of 4%, which was less than the risk of a single aspirate (8.5%). To further examine this issue, a large series of thyroid fine-needle aspirates was reviewed and results were correlated with histologic follow-up.
