Endocrine Pathology

, Volume 15, Issue 1, pp 65–75 | Cite as

Non-diagnostic cytological outcome of thyroid biopsy and the risk of thyroid malignancy

  • Dorota Słowińska-Klencka
  • Stanisław Sporny
  • Mariusz Klencki
  • Andrzej Lewiński
Clinical Research


This study assessed the incidence of neoplasms, including malignant tumors, in lesions within the thyroid gland from which non-diagnostic biopsy aspirates were obtained. An auxiliary goal of the study was an evaluation of the diagnostic efficacy of repeated biopsy in cases when the first biopsy was non-diagnostic. Thus, results of 4603 fine-needle aspiration biopsies (FNABs) were submitted to histopathological verification. The verification revealed the rate of malignancy at 7.1% for non-diagnostic biopsies, i.e., significantly higher (p<0.001) than that in cases FNAB-diagnosed as benign lesions (2.1%). Repeated biopsy, performed when inadequate material has been collected, seems to be less effective than the first biopsy (non-diagnostic specimens; 14.4% vs 8.9%; p<0.01). The occurrence of neoplasms in the goiter was significantly higher (p < 0.0001) in patients with non-diagnostic first FNAB than in those with diagnostic one (50.7% vs 33.5%, p<0.001). And again, in patients with two non-diagnostic FNABs, the occurrence of neoplasms was higher than that in patients with the second diagnostic cytology (63% vs 41.2%, p<0.05). According to our data, patients with non-diagnostic FNAB results should be very carefully monitored, especially when the repeated biopsy is either non-diagnostic again or not performed at all.

Key Words

Thyroid biopsy FNAB thyroid carcinoma neoplasm 


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  1. 1.
    Ravetto C, Colombo L, Dottorini ME. Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: In retrospective study in 37,895 patients. Cancer 90:357–363, 2000.PubMedCrossRefGoogle Scholar
  2. 2.
    Altavilla G, Pascale M, Nenci I. Fine needle aspiration cytology of thyroid gland diseases. Acta Cytol 34:251–256, 1990.PubMedGoogle Scholar
  3. 3.
    Haas S, Trujillo A, Kunstle J. Fine needle aspiration of thyroid nodules in a rural setting. Am J Med 94:357–361, 1993.PubMedCrossRefGoogle Scholar
  4. 4.
    de Vos tot Nederveen Cappel RJ, Bouvy ND, Bonjer HJ, van Muiswinkel JM, Chadha S. Fine needle aspiration cytology of thyroid nodules: how accurate is it and what are the causes of discrepant cases? Cytopathology 12:399–405, 2001.PubMedCrossRefGoogle Scholar
  5. 5.
    Goellner JR, Gharib H, Grant CS, Johnson DA. Fine needle aspiration cytology of the thyroid, 1980 to 1986. Acta Cytol 31:587–590, 1987.PubMedGoogle Scholar
  6. 6.
    Kini SR. In: Kline S, ed. Guides to clinical aspiration biopsy series. Thyroid. 2nd ed. New York: Igaku-Shoin, 1996.Google Scholar
  7. 7.
    Guidelines of the Papanicolaou Society of Cytopathology for the Examination of Fine-Needle Aspiration Specimens from Thyroid Nodules. The Papanicolaou Society of Cytopathology Task Force on Standards of Practice. Mod Pathol 9:710–715, 1996.Google Scholar
  8. 8.
    Hamburger JI. Diagnosis of thyroid nodules by fine needle biopsy: use and abuse. J Clin Endocrinol Metab 79:335–339, 1994.PubMedCrossRefGoogle Scholar
  9. 9.
    Baloch Z, Carayon P, Conte-Devolx B, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 13:3–126, 2003.PubMedCrossRefGoogle Scholar
  10. 10.
    Li Volsi VA, Asa SL. The demise of follicular carcinoma of the thyroid gland. Thyroid 4:233–236, 1994.Google Scholar
  11. 11.
    Hedinger Ch, Williams D, Sobin L. The histological typing of thyroid tumors. In: World Health Organization, International histological classification of tumours, 2nd ed., No. 11, Berlin-Heidelberg-New York-London-Paris-Tokyo; Springer Verlag, 1988.Google Scholar
  12. 12.
    Słowińska-Klencka D, Klencki M, Sporny S, Lewiński A. Fine needle aspiration biopsy of the thyroid in an area of endemic goitre: influence of restored sufficient jodine supplementation on the clinical significance of cytological results. Eur J Endocrinol 146:19–26, 2002.PubMedCrossRefGoogle Scholar
  13. 13.
    Carson HJ, Saint Martin GA, Castelli MJ, Gattuso P. Unsatisfactory aspirates from fine-needle aspiration biopsies: a review. Diagn Cytopathol 12:280–284, 1995.PubMedCrossRefGoogle Scholar
  14. 14.
    Braga M, Cavalcanti TC, Collaco LM, Graf H. Efficacy of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of complex thyroid nodules. J Clin Endocrinol Metab 86:4089–4091, 2001.PubMedCrossRefGoogle Scholar
  15. 15.
    Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 8:15–21, 1998.PubMedCrossRefGoogle Scholar
  16. 16.
    Khurana KK, Richards VI, Chopra PS, Izquierdo R, Rubens D, Mesonero C. The role of ultrasonography-guided fine-needle aspiration biopsy in the management of nonpalpable and palpable thyroid nodules. Thyroid 8:511–515, 1998.PubMedCrossRefGoogle Scholar
  17. 17.
    Hamburger JI, Husain M, Nishiyama R, Nunez C, Solomon D. Increasing the accuracy of fine-needle biopsy for thyroid nodules. Arch Pathol Lab Med 113:1035–1041, 1989.PubMedGoogle Scholar
  18. 18.
    Musgrave YM, Davey DD, Weeks JA, Banks ER, Rayens MK, Ain KB. Assessment of fine-needle aspiration sampling technique in thyroid nodules. Diagn Cytopathol 18:76–80, 1998.PubMedCrossRefGoogle Scholar
  19. 19.
    La Rosa GL, Belfiore A, Giuffrida D, et al. Evaluation of the fine needle aspiration biopsy in the preoperative selection of cold thyroid nodules. Cancer 67:2137–2141, 1991.PubMedCrossRefGoogle Scholar
  20. 20.
    Gharib H, Goellner JR, Johnson DA. Fine-needle aspiration cytology of the thyroid. A 12-year experience with 11,000 biopsies. Clin Lab Med 13:699–709, 1993.PubMedGoogle Scholar
  21. 21.
    Belfiore A. The use of fine needle aspiration biopsy in thyroid disease. Thyroid International 2:3–17, 2002.Google Scholar
  22. 22.
    LiVolsi VA, Merino MJ. Worrisome histologic alterations following fine-needle aspiration of the thyroid (WHAFFT). Pathol Ann 29:99–120, 1994.Google Scholar
  23. 23.
    Kini SR. Post-fine-needle biopsy infarction of thyroid neoplasms: a review of 28 cases. Diagn Cytopathol 15:211–220, 1996.PubMedCrossRefGoogle Scholar
  24. 24.
    Ersöz C, Soylu L, Erkocak EU, Tetiker T, Gümürdülü D. Histologic alterations in the thyroid gland after fine-needle aspiration. Diagn Cytopathol 16:230–232, 1997.PubMedCrossRefGoogle Scholar
  25. 25.
    Vercelli-Retta J, Almeida E, Ardao G, et al. Capsular pseudoinvasion after fine-needle aspiration of follicular adenomas of the thyroid. Diagn Cytopathol 17:295–297, 1997.PubMedCrossRefGoogle Scholar
  26. 26.
    Gordon DL, Flisak M, Fisher SG. Changes in thyroid nodule volume caused by fine-needle aspiration: a factor complicating the interpretation of the effect of thyrotropin suppression on nodule size. J Clin Endocrinol Metab 84:4566–4569, 1999.PubMedCrossRefGoogle Scholar
  27. 27.
    MacDonald L, Yazdi HM. Nondiagnostic fine needle aspiration biopsy of the thyroid gland: a diagnostic dilemma. Acta Cytol 40:423–428, 1996.PubMedGoogle Scholar
  28. 28.
    Bakshi NA, Mansoor I, Jones BA. Analysis of inconclusive fine needle aspiration of thyroid follicular lesions. Endocr Pathol 14:167–176, 2003.PubMedCrossRefGoogle Scholar
  29. 29.
    McHenry CR, Walfish PG, Rosen IB. Nondiagnostic fine needle aspiration biopsy: a dilemma in management of nodular thyroid disease. Am Surg 59:415–419, 1993.PubMedGoogle Scholar
  30. 30.
    Chow LS, Gharib H, Goellner JR, van Heerden JA. Nondiagnostic thyroid fine-needle aspiration cytology: management dilemmas. Thyroid 11:1147–1151, 2001.PubMedCrossRefGoogle Scholar
  31. 31.
    Baloch Z, LiVolsi VA, Jain P, et al. Role of repeat fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules. Diagn Cytopathol 29:203–206, 2003.PubMedCrossRefGoogle Scholar
  32. 32.
    Schmidt T, Riggs MW, Speights VO Jr. Significance of nondiagnostic fine-needle aspiration of the thyroid. South Med J 90:1183–1186, 1997.PubMedGoogle Scholar
  33. 33.
    Schmid KW. Clinicopathologic management of tumors of the thyroid gland in an endemic goiter area; combined use of preoperative fine needle aspiration biopsy and intraoperative frozen section. Acta Cytol 33:27–30, 1989.PubMedGoogle Scholar
  34. 34.
    AACE Clinical practice guidelines for the diagnosis and management of thyroid nodules. Endocr Pract 2:78–84, 1996.Google Scholar
  35. 35.
    Alexander EK, Heering JP, Benson CB, et al. Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab 87:4924–4927, 2002.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc 2004

Authors and Affiliations

  • Dorota Słowińska-Klencka
    • 3
  • Stanisław Sporny
    • 1
  • Mariusz Klencki
    • 3
  • Andrzej Lewiński
    • 2
  1. 1.Department of PathomorphologyMedical University of ŁódźPoland
  2. 2.Department of Endocrinology and Isotope Therapy (AL), Institute of EndocrinologyMedical University of ŁódźPoland
  3. 3.Department of Thyroidology, Institute of EndocrinologyMedical University of ŁódźŁódźPoland

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