Is repeated fine-needle aspiration cytology useful in the management of patients with benign nodular thyroid disease?

Management of nonneoplastic thyroid nodules (TN) diagnosed by fine-needle aspiration (FNA) is controversial. While clinical follow-up with repeat FNA for enlarging TN is recommended in some studies, others recommend repeat FNA in follow-up of all benign TN after several months or years, in order to identify possible misdiagnosed malignant lesions. This study was done to determine the usefulness of repeat FNA in patients with benign nodular thyroid disease. We studied 94 fine-needle reaspirations performed on 43 females and 2 males 48.2 +/- 17 years of age with benign nodular thyroid nodular disease. Four patients had 3 consecutive FNAs and 41 patients had 2 consecutive FNAs. All FNAs were carried out by the same endocrinologist in the same thyroid area or by cytopathologists. The average time elapsed between the two consecutive FNAs was 18.3 +/- 11.2 (range, 4-48) months. Of the 45 patients, 23 presented with increase in size of the nodule and the remaining 22 patients did not have any change in size at the time of repeat FNA. Identical cytologic diagnoses were rendered in 39 of the 45 patients who underwent 2 or 3 consecutive FNA. Repeat FNA did not result in detection of any malignant neoplasms. Thyroid resection in 7 patients with increased nodule size and pressure symptoms confirmed the cytologic impressions of benign thyroid nodular disease. Our results show that the routine performance of repeated FNA cytology in the follow-up of patients with benign nodular thyroid disease with or without any clinical changes is of limited usefulness. Clinical factors rather than repeat FNA may hold precedence in surgical management of patients with benign nodular thyroid disease.