The value of repeating fine-needle aspiration for thyroid nodules.

BACKGROUND

Fine-needle aspiration (FNA) is an invaluable technique used in the evaluation of thyroid nodules.

OBJECTIVES

Evaluate the concordance of results for consecutive FNA readings.

DESIGN

Retrospective, descriptive.

SETTINGS

Two tertiary care centers.

METHODS

Demographics were collected along with every FNA result and final pathology results for all patients (aged 9-90 years old) who underwent thyroid surgery from 2010 to 2017. The Bethesda system was used for cytology. Agreement levels were calculated and compared with final pathology.

SAMPLE SIZE

Of 1237 initially included, 1134 had at least one FNA performed with results available for review.

RESULTS

For the 1134 patients, demographic and clinical data were collection and a comparison was made between the three FNA results; the highest agreement was between FNA 2 and 3 (53.6%); however, the kappa value was consistently low for all comparisons, indicating a poor level of agreement overall. Also, the risk of malignancy was higher in this study than in the 2017 Bethesda system for reporting thyroid cytopathology in FNA cytology categories I and II.

CONCLUSION

Repeating FNA biopsies yield different results every time; hence, there is a low level of agreement. The clinical decision should therefore include other important risk factors. Prospective studies could help shed more light on this topic.

LIMITATIONS

Retrospective design.

CONFLICT OF INTEREST

None.