Fine Needle Aspiration Biopsy FNA

Patients with either an isolated thyroid nodule or a multinodular goiter should be considered for FNA because the incidence of thyroid cancer

Fine Needle Aspiration Thyroid

Figure 1.8 Algorithm for the cost-effective evaluation and treatment of a patient with a thyroid nodule. (From Hegedus L. Clinical practice.The thyroid nodule. N Engl J Med 2004;351(17):1764-1771. Copyright © 2004 Massachusetts Medical Society. All rights reserved.) * In the original algorithm, FNA is not suggested for patients with strong suspicion of cancer; however, in our clinic we perform this procedure even in patients we are certain have thyroid cancer.

Figure 1.8 Algorithm for the cost-effective evaluation and treatment of a patient with a thyroid nodule. (From Hegedus L. Clinical practice.The thyroid nodule. N Engl J Med 2004;351(17):1764-1771. Copyright © 2004 Massachusetts Medical Society. All rights reserved.) * In the original algorithm, FNA is not suggested for patients with strong suspicion of cancer; however, in our clinic we perform this procedure even in patients we are certain have thyroid cancer.

in thyroid nodules is the same, usually between 5% and 10% in both solitary nodules and in multinodular goiters [101,102]. However, the exact rate varies, and averaged about 9% among 7724 patients in one review, which varied according to FNA technique and the selection of patients for FNA, ranging from 5% to 17% in patients with solitary thyroid nodules and from 5% to 14% in those with multiple nodules [102]. Although nodule size of 1 cm or more has been the cutoff used to identify those that require FNA, studies show that smaller nodules with suspicious features should undergo biopsy [99]. Many now perform FNA on nodules as small as 8 mm if they appear highly suspicious on ultrasonography [99].

The cytology from FNA shows one of four general characteristics: (1) insufficient material for diagnosis, (2) PTC, or (3) indeterminate cytology (follicular tumor) representing either follicular adenoma or low grade FTC, or (4) benign cytology from either a colloid nodule or thyroiditis [103]. When the cytology is insufficient for diagnosis, repeat aspiration will yield adequate material for diagnosis in about half the cases; those that do not should be surgically removed because about 5% are malignant [104,105]. In Europe, serum calci-tonin measurements are often done in the course of evaluating patients with multinodular goiter [106], a practice that has not yet been fully embraced by American endocrinologists [107]. The current algorithm used for the diagnosis of thyroid nodules is shown in Figure 1.8.

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