FINE-NEEDLE ASPIRATION BIOPSY OF THYROID-NODULES - IMPACT ON CLINICAL-PRACTICE

The aim of the present study was to analyze the changes in our clinica l practice due to the use of FNAB in the management of nodular thyroid disease. Patients attended the thyroid unit for thyroid nodules. The study comprises three periods: First, from January 1980 to May 1984, 2 26 patients. Second, from June 1985 to December 1990, 166 patients. Th ird, from January 1991 to December 1993, 403 patients. Design: retrosp ective the 1(st) period and prospective the 2(nd) and 3(rd) periods. D uring the 1(st) and 2(nd)periods, decision for surgery was based on cl inical parameters together with results of Tc-99 radionucleotide scan and B mode ultrasound studies. In the 3(rd) period surgical decision w as based principally on cytologic results. We comparatively studied th e frequency of surgical operation and frequency of malignancy in surgi cal thyroid specimens between the study periods. Determination of sens itivity, specificity and accuracy of the diagnostic methods was done. We observed a decrease in the frequency of patients requiring surgery, 89.9%, 67.8% and 46.6% for the 1(st), 2(nd) and 3(rd) study periods, x(2)=114.7, p<0.0001; and an increase in the frequency of malignancy i n the surgical specimens, 14.7%, 24.4% and 32.9% for 1(st), 2(nd) and 3(rd) periods respectively, X-2=4.5, p<0.05. The sensitivity 92.5% and 93.5%, the specificity 50.6% and 61.1%, and the accuracy 60.9% and 71 .8% of the FNAB for the second and third periods respectively. The rat es of false negative cytological specimens were 1.8% and 2.1% for 2(nd ) and 3(rd) respectively, p>0.05. Since the introduction of FNAB in th e evaluation of our patients around 70% of these had a definitive preo perative diagnosis of either benign or malignant disease. Simplificati on in management of patients with nodular thyroid disease is the most important impact for the use of FNAB. Furthermore, a decrease in the n umber of patients requiring surgical treatment and an increase of mali gnant nodules in the specimens obtained by surgery were also observed. We think that FNAB is the most direct and accurate method in the mana gement of patients with thyroid nodules. (C) 1997, Editrice Kurtis.