NEEDLE ASPIRATION TECHNIQUES IN PREOPERATIVE SELECTION OF PATIENTS WITH THYROID-NODULES - A LONG-TERM STUDY

Purpose: Long-term evaluation of the combination of two needle aspirat ion techniques (NAT) (fine-needle aspiration [FNA] and aspiration need le biopsy [ANB]) in performing an efficient preoperative selection of palpable thyroid nodules. Patients and Methods: Eight years of extensi ve use of surgery for the;detection of thyroid cancer was compared wit h 12 years of preoperative selection by NAT. Results: A total of 1,140 operations were performed from; 1972 to 1979, and 35 malignant nodule s were discovered (3.1%). five thousand four hundred three patients we re examined by NAT from 1980 to 1992; 483 (9%) underwent surgery and 1 58 malignant nodules were excised. The number of malignant nodules ide ntified by NAT was 166 (eight were not excised) (3.1% of the total pop ulation examined), The principal clinical and pathologic: features wer e similar in both groups. ANB yielded a definite benign diagnosis in 8 8 patients with inadequate FNA findings, it correctly identified four malignant nodules diagnosed as benign by FNA, it showed a macrofollicu lar component in 115 nodules diagnosed by FNA as microfollicular nodul es, and if significantly changed the predictive value of 79 suspicious FNA diagnoses. Conclusion: introduction of NAT reduced the number of operations for palpable thyroid nodules from 143 to 40 per year and in creased from four to 13 the number of malignant nodules excised withou t any change in the overall incidence of malignant nodules. The combin ation of ANB to FNA significantly contributed to the high and efficien t preoperative patient selection, principally by reducing the number o f indeterminate or suspicious, as well as false-negative, preoperative FNA diagnoses. (C) 1996 by American Society of Clinical Oncology.