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| |  Surgery Avoidable With Repeat Fine-Needle Aspiration in Most Cases of Benign Thyroid Nodules: Presented at ECE By Chris Berrie ISTANBUL, Turkey -- April 27, 2009 -- Surgery can be avoided in most cases of benign nodules with no clinical or sonographic suspicions with repeat fine-needle aspiration biopsy (FNAB) while only delaying surgery for few cases with malignancy in patients initially diagnosed with thyroid nodules showing indeterminate or follicular lesions, according to a study presented here at the 11th European Congress of Endocrinology (ECE). However, repeat FNAB for patients with growing thyroid nodules with an initial diagnosis as benign is not useful, the researchers stated on April 26 in a poster presentation. Principal investigator Ignasi Castells, MD, Endocrinology Unit, Hospital General de Granollers, Granollers, Spain, explained that their centre recently approved adoption of the British Thyroid Association (BTA) cytological classification for reporting of FNAB results in treatment of patients with thyroid nodules. BTA classification was as follows: (1) inadequate sample (Thy1) requiring repeat FNAB; (2) benign nodules (Thy2) requiring follow-up and repeat FNAB if nodules grow; (3) indeterminate or follicular lesions (Thy3) managed with surgery or repeat FNAB at 6 months if clinical, sonographic, or cytological suspicions are low; (4) suspicious (Thy4) or malignant (Thy5) nodules requiring surgery. However, because of doubts remaining for this management, the aim of the study presented here at ECE was to assess the role of repeat FNAB in evaluation of thyroid nodules initially classified as benign (Thy2) or indeterminate (Thy3). Researchers reviewed a cohort of 149 patients over 5 years of which 108 (72%) were classified as Thy2 and 41 (28%) as Thy3. Repeat FNAB was carried out in all cases. Of the patients initially classified as Thy2, upon repeat FNAB, 93 (86%) were assessed as Thy2 and 15 (14%) were reclassified Thy3. Of the 23 Thy2 patients who underwent surgery, 21 (91%) showed benign adenomatous nodules, and 2 (9%) follicular adenomas. Similarly, of the 8 patients classified as Thy3 who underwent surgery, 6 (75%) showed benign adenomatous nodules, 1 (13%) follicular adenoma, and 1 (13%) papillary carcinoma focus. Of the patients initially classified as Thy3, repeat FNAB saw 30 (73%) reclassified as Thy2, of which 3 underwent surgery and all showed benign adenomatous nodules. Of 11 patients (27%) who maintained Thy3 assessment at repeat FNAB, 10 (91%) had surgery and 1 (9%) refused surgery. For this group, surgery showed 6 (60%) benign adenomatous nodules, 2 (20%) follicular adenomas, and 2 (20%) papillary carcinomas. "Repeat fine-needle aspiration biopsy in thyroid nodules may be useful when the result of the biopsy is indeterminate follicular lesion, because 70% of these patients could have a benign new biopsy, and could avoid the surgery," said Dr. Castells. At the same time, this approach would delay surgery in less than 5% of patients with malignancy. Thus FNAB should be repeated in patients with an initial diagnosis of indeterminate or follicular lesions (Thy3). Conversely, he added, "When the first biopsy is benign [Thy2] and we repeat because this nodule is growing, that does not serve to change the biopsy result." [Presentation title: The Role of Repeat Fine-Needle Aspiration Biopsy (FNAB) in the Management of Thyroid Nodule. Abstract P83]
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