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Objective: Evaluate strategies for managing patients following non-diagnostic thyroid FNA.
Design: Retrospective review
Setting: Endocrine Surgery division at a tertiary referral hospital
Patients: All patients with non-diagnostic thyroid FNA in 2006
Main Outcome Measures: Ultrasound characteristics of thyroid nodules, FNA cytology results, and final pathologic diagnoses
Results: 328 patients had an initial non-diagnostic FNA. There were 267 women and 61 men. A second FNA was performed in 217 patients and yielded a diagnosis in 142 (65.5 %). Median number of days between first and second FNA was 34 (6_635). There were 123 (56.7%) benign, 15 (6.9%) follicular or Hurthle cell neoplasm, and 4 (1.8%) papillary thyroid cancer (PTC). In 75 patients with a second non-diagnostic FNA, 22 went on to a third biopsy, and diagnosis was achieved in 15 (68.2%). This left 171 patients (52.1%) with a non-diagnostic FNA. 131 were followed clinically, and 40 underwent thyroidectomy. At surgery, papillary thyroid cancer ≥ 1 cm was present in none of the 21 patients who had undergone a second or third non-diagnostic FNA. For 277 patients ultrasound findings were available. Mean nodule size was 2.39 ± 1.2 cm. 54 (19.5%) were cystic, 111 (40.1%) were heterogeneous, and 112 (40.4%) were solid. The likelihood of a second non-diagnostic biopsy was 55.2 % for cystic, 33.7% for heterogeneous, and 35.1% for solid (p = 0.039). Third FNA was diagnostic 76.5% of the time when employed for solid and heterogeneous nodules, and 33.3% for cystic (p = 0.2).
Conclusions: After a second non-diagnostic thyroid FNA of a non-suspicious nodule, it is safe to follow patients with exam and ultrasound, rather than repeat FNA or perform thyroidectomy