Value of re-aspirations in benign nodular thyroid disease

Fine-needle aspiration cytology (FNAC) is the most useful procedure for the evaluation of thyroid nodules. The requirement for repeated aspirations in the follow-up of benign nodular thyroid disease, however, is controversial . To determine the value of re-aspirations in benign nodular thyroid diseas e, we studied 457 fine-needle reaspirations performed on 216 patients (197 female, 19 male) aged 42.9 +/- 12 years with uninodular (n = 65) and multin odular (n = 151) thyroid disease. Two hundred fifty-seven of these were sec ond, 137 were third, 46 were fourth, and 17 were fifth re-aspirations of th e same nodule, performed in a mean follow-up time of 43.9 +/- 31 (3-156) mo nths. FNAC results were benign in 407 (89%), insufficient for diagnosis in 31 (6.8%), suspicious in 16 (3.5%), and papillary carcinoma (PC) in 3 (0.7% ). An initial benign diagnosis did not change after multiple aspirations in 213 (98.61%) of the cases. Three patients with initial aspirations read as benign had a diagnosis of PC from their second biopsies, (diagnosis confir med at surgery). Re-examination of the initial FNAC revealed atypical featu res in 1 of the 3 patients. These 3 patients likely represent a false-negat ive result of the initial FNAC rather than benign nodular disease transform ed to a malignant one during the follow-up period. In conclusion, a second aspiration of clinically suspicious nodules may correct a few initial false -negative results, but routine additional re-aspirations are not useful for clinically stable disease.