FINE NEEDLE ASPIRATION BIOPSY OF THE HYPOFUNCTIONING THYROID-NODULE

FNAB is the only method for the evaluation of malignancy and thyroidit is in goiters without surgery. FNAB should be performed in any patient with clinical signs of thyroid malignancy and thyroiditis, as well as in all hypofunctioning and hypoechoic nodules. In order to achieve hi gh accuracy the physician must be well trained in the technique of asp iration biopsy, in preparing the slides and in thyroid cytology. In ou r department clinical examination, scanning, ultrasound, puncturing an d cytological examination is done by the same physician who is respons ible for diagnosis and therapy of the thyroid patient. FNAB is an easy and safe procedure with rare complications. Clinical evident haemorrh ages were found in 0.10%, inflammations in 0.02% out of 25,420 patient s with FNAB. Within two periods sensitivity and specificity did not ch ange essentially: The sensitivity in 2,744 surgically treated patients 1967-1981 was 93.4%, specificity 73.9%. In 1,232 surgically treated p atients 1984-1989 sensitivity was 92.6%, specificity 82.7%. Inconclusi ve or suspicious cytology (III, IV) may be caused by various types of adenomas, regressive, inflammatory and functional changes and also by some drugs. The differentiation of follicular adenoma (follicular neop lasia) from follicular carcinoma or oxyphilic adenoma from oxyphilic c arcinoma may be impossible. In our opinion all patients should be oper ated upon, if cell atypia III cannot be understood clinically. 17.75% out of 231 biopsies stage III were caused by malignant tumors or atypi cal adenoma. In most thyroid malignancies it is possible to evaluate t he type of the malignant tumor cytologically as a very important means for the therapeutic approach. Repeated aspirations of thyroid cysts a re of therapeutic relevance in about 51% of all cystic nodules. As 6 c ysts were found in 181 malignancies, cystic regression does not exclud e malignancies. In conclusion FNAB is an easy, valuable and safe diagn ostic procedure, with high accuracy in the work up of thyroid disease, providing direct information on the underlying histologic condition. Sensitivity is about 90%, most types of the malignant tumors can be di agnosed cytologically.