Inadequate Cytology of Thyroid Nodules. Repeat It or Live With It

Excerpt

“The specimen is inadequate for diagnosis” after ultrasound (US) guided fine needle aspiration (FNA) of a thyroid nodule is a phrase all thyroid surgeons and physicians are uncomfortable with. In most cases, repeating the biopsy within the next 6 months seems to be the obvious next step. However, what if your hospital is performing 6000 biopsies a year, and 1500 (25%!) were reported as inadequate? Assuming a constant referral rate, the following year the number of biopsies would have increased to 7500. One can see why the article of Yoon et al. in this issue of Annals of Surgical Oncology becomes so relevant in their setting.1 In their article, the authors report that “in thyroid nodules with inadequate cytology, malignancy rates of mainly cystic nodules showing no suspicious US features were significantly lower than those with suspicious features present.” They conclude that “follow-up ultrasound (US) can be considered over repeat aspiration if there were no suspicious US features present,” especially in mainly cystic thyroid nodules. …