LARGE NEEDLE ASPIRATION BIOPSY FOR REDUCING THE RATE OF INADEQUATE CYTOLOGY ON FINE-NEEDLE ASPIRATION SPECIMENS FROM PALPABLE THYROID-NODULES

From 1980 to 1996, 1,907 consecutive euthyroid subjects with palpable thyroid nodules were examined by fine needle aspiration (FNA) cytology plus large needle aspiration biopsy (LNAB) histology. There were 1,63 0 (85%) women and 277 (14.5%) men aged from 17 to 80 years. A single n odule was palpated in 1,419 subjects (74.4%) while 488 (25.6%) showed multiple nodules. The nodule size ranged between 1 and 7.5 cm. The num ber of inadequate specimens at the first examination, FNA cytology or LNAB histology, were 261 (13%) or 398 (20.8%), respectively. LNAB perf ormed on the 261 nodules with nondiagnostic cytology showed findings w hich were adequate for diagnosis in 130 (49.8%) and inadequate in 131 (50.2%). Among the 261 patients with inadequate initial cytological fi ndings 61 were subjected to repeated FNA and 36 repeated LNAB. More th an 60% of the nodules on which FNA was repeated achieved a cytological diagnosis; more than 80% of the nodules reinvestigated by LNAB were f inally diagnosed by histology. The mean nodule size was larger in the group with inadequate result than in that with adequate FNA or LNAB re sult. Among the 261 patients with inadequate cytological finding at th e first FNA 28 were operated on; 20 were in the group with adequate LN AB histological findings and eight in the group with an inadequate LNA B. Two papillary cancers, one per group, were found at postoperative h istology. However, one was diagnosed by LNAB and one at the second FNA . The remaining 26 nodules were all found to be benign postoperatively . This study shows that the addition of LNAB to FNA leads to a histolo gical diagnosis in 50% of the palpable thyroid nodules with inadequate cytology at the first FNA and that LNAB can be used even for those no dules which remain uncharacterized after repeat FNA. (C) 1998 Elsevier , Paris.