IMPORTANCE OF REPEAT FINE-NEEDLE BIOPSY IN THE MANAGEMENT OF THYROID-NODULES

Fine-needle aspiration (FNA) biopsy of a thyroid nodule was performed in 797 patients. Ninety-six patients had resection of the thyroid nodu le performed subsequent to a one-time FNA biopsy. The surgical patholo gy of these 96 cases demonstrated a 5.8% false-negative rate and a 9.9 % false-positive rate. As a consequence, we prospectively evaluated th e routine practice of repeat FNA of cytologically benign thyroid nodul es. Repeat FNA confirmed the original benign cytology in 183 (93%) of 196 patients. Seventeen of these 183 patients with benign FNA on both biopsies had resection of the nodule performed because of the developm ent of suspicious clinical signs or in response to the patient's choic e; 1 recurrent cyst was found to be carcinomatous. Of the 13 patients demonstrating a change in cytology on repeat FNA biopsy, 9 had a nodul e that was classified as possibly malignant (suspicious); 6 of these p atients underwent resection, and 1 patient was found to have a carcino matous nodule. Four patients had nodules that were classified as proba bly malignant on repeat FNA biopsy; all of their nodules were resected , and three of them were found to be carcinomatous. This study demonst rates that, although one-time FNA biopsy of thyroid nodules is highly accurate, with a relatively low false-negative rate, repeat fine-needl e biopsy improves on this diagnostic accuracy, thereby decreasing the risk of misdiagnosing a thyroid nodule that is malignant.