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

Abstract

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 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  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

Personalised recommendations