Most authorities recommend repeating fine-needle aspiration (FNA) of thyroid nodules when an initial FNA yields nondiagnostic results. In a single-center study, Rhode Island researchers sought to determine outcomes of this practice. Among 5349 patients who underwent initial FNA of thyroid nodules, results were nondiagnostic in 15%. Of these, 393 patients had sufficient follow-up to warrant inclusion in this study; 336 underwent repeat FNA, with the following results: 18 were suspicious for malignancy, but surgical resection confirmed malignancy in only 2 of those 18 cases.

245 were benign. 73 were persistently nondiagnostic: 24 of these patients had stable nodules identified by serial ultrasound; and 49 patients underwent surgery, with 5 malignancies diagnosed.Of the 57 patients who did not undergo repeat FNA, 27 underwent surgery (with 2 malignancies diagnosed), and 30 had ultrasound follow-up that showed stable nodules. In sum, 9 of 393 patients (2.3%) were diagnosed with thyroid cancer (6 papillary, 3 follicular). Average follow-up for patients with stable nodules identified by serial ultrasound was 3 years.

Because most patients with suspicious repeat FNA did not have cancer, whereas a few patients with nondiagnostic repeat FNA did have cancer, the authors question the utility of repeating FNA when an initial FNA is nondiagnostic. Instead, they suggest conservative follow-up with serial ultrasound for most patients and surgical resection for selected patients with high-risk clinical or ultrasound features.

Comments: We at Gems Editorial Team will suggest physicians make intelligent decisions on an individual basis.

Read More