Journal
ASIAN JOURNAL OF SURGERY
Volume 45, Issue 5, Pages 1113-1116Publisher
ELSEVIER SINGAPORE PTE LTD
DOI: 10.1016/j.asjsur.2021.08.005
Keywords
Benign cytology; Biopsy; Cancer incidence; Large thyroid nodule; Malignancy
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Funding
- [6-2018-0170]
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Fine needle aspiration biopsy (FNAB) has limited diagnostic accuracy in large thyroid nodules with Bethesda Cat. 2 result. In nodules >= 4 cm, there is a high false-negative rate with benign cytology, and these nodules often have suspicious ultrasound findings with a high malignancy rate.
Background/objective: The diagnostic accuracy of fine needle aspiration biopsy (FNAB) seems limited in large thyroid nodules with Bethesda Cat. 2 result. We aimed to determine the incidence of carcinoma with benign cytology and the reason for the high false-positive rate in thyroid nodules >= 4 cm. Methods: The records of 103 patients with thyroid nodules >= 4 cm with preoperative cytological diagnosis of Bethesda Cat. 2 who underwent thyroidectomy were consecutively reviewed. Characteristics between patients with malignant vs. benign pathology were compared. Results: Forty patients (38.8%) had malignancy. Malignancy was subclassified into follicular variant of papillary thyroid carcinoma (43%), minimally invasive follicular thyroid carcinoma (20.0%), and minimally invasive Hurthle cell thyroid carcinoma (10.9%). Patients with malignant cytology had significantly more suspicious ultrasound findings than those with benign cytology (p = 0.001). Conclusions: Preoperative FNAB showed high false-negative rates in patients with thyroid nodules >= 4 cm with benign cytology. These nodules have a high malignancy rate with suspicious ultrasound findings. (C) 2021 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.
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