Aspiration needle biopsy in preoperative selection of thyroid nodules defined at fine-needle aspiration as microfollicular lesions

The palpable thyroid nodules that are diagnosed as microfollicular by fine- needle aspiration cytologic analysis are usually excised for the low probab ility that the nodule is a well-differentiated follicular cancer. The autho rs retrospectively assess the use of aspiration needle biopsy (either 16- o r 18-gauge needles) in the preoperative selection of the nodules diagnosed as microfollicular at fine-needle aspiration (either 20- Or 22-gauge needle s). Aspiration needle biopsy is a type of large needle biopsy that is a rel atively easy and innocuous method of obtaining tissue fragments for preoper ative histologic examination of palpable thyroid nodules. From 1980 through 1996, 6,314 patients with palpable thyroid nodules were examined by fine-n eedle aspiration; 29.5% of these nodules were also examined preoperatively by aspiration needle biopsy. Of all the patients with nodules, 6% received a fine-needle aspiration diagnosis of microfollicular nodule. Two hundred s ixty of the 380 nodules (68%) that were diagnosed as microfollicular at fin e-needle aspiration were also examined by aspiration needle biopsy; inadequ ate specimens were obtained in 17% of cases; pure microfollicular structure was confirmed by aspiration needle biopsy in 35% of the nodules; and aspir ation needle biopsy showed the remaining 48% to contain a macrofollicular c omponent suggesting a benign hyperplastic lesion. Seventeen nodules that we re found to be microfollicular at fine-needle aspiration cytologic analysis and micromacrofollicular at aspiration needle biopsy were excised and the postoperative result was benign in all cases. Twenty-five nodules diagnosed as microfollicular either on both fine-needle aspiration and aspiration ne edle biopsy were excised and the postoperative diagnoses were benign (20 no dules) or malignant (5 nodules). These data indicate that aspiration needle biopsy can be used for preoperative selection of the nodules that are micr ofollicular at fine-needle aspiration by identifying the nodules with high probability of being malignant and thus contributing to the reduction in th e number of surgical operations for benign nodules.