FINE-NEEDLE ASPIRATION CYTOLOGY AND THYROID-SURGERY IN THE COMMUNITY-HOSPITAL

BACKGROUND: TO assess the use and usefulness of fine-needle aspiration cytologic biopsy (FNAB) of the thyroid in our hospital. METHODS: All cytology slides and charts of patients who had FNAB of the thyroid don e in our hospital in 1993 were reviewed. Charts of all patients having thyroid surgery in our hospital in 1993 were reviewed to determine th e pathological diagnosis and whether FNAB had been performed preoperat ively. Finally, we reviewed all consecutive thyroid surgery cases for an 8-year period, and we calculated the yearly percentage of malignanc y. RESULTS: Fifty-five FNAB were done in 53 patients. In 21 patients t he FNAB gave indication for thyroid surgery, yet surgery was done in o nly 12 (57.1%). Forty-two patients had surgery for a thyroid nodule, b ut only 20 patients (41.6%) had a preoperative FNAB. There were 3 mali gnancies among the 20; 2 were correctly predicted by FNAB. The FNAB wa s correct in 18 of 20. In all, 378 thyroid operations were done from 1 987 to 1994. The yearly proportion of thyroid malignancy ranged from 1 1% to 29%, but showed no change corresponding with increasing diagnost ic sophistication. CONCLUSIONS: Fine-needle aspiration cytologic biops y in the workup of patients with thyroid masses is strikingly underuti lized in our institution. While accurate in 90% of cases where used, F NAB appears to play a minor role in the surgeon's decision regarding s urgery, As a result of these findings, we developed a grading system f or better communication of the FNAB report and a clinical guideline to improve the evaluation of patients with thyroid masses. (C) 1996 by E xcerpta Medica, Inc.