FP14-2 An Assessment Of The Outcome Of Repeat Thyroid FINE-Needle Aspiration In Nodules Previously Found To Have A Benign Cytology

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP14-Thyroid Cancer: Insights into Diagnosis & Treatment
Saturday, June 15, 2013: 11:00 AM-11:30 AM
Presentation Start Time: 11:05 AM
Room 103 (Moscone Center)

Poster Board SAT-417
Becky Thai Muldoon*1, Michele Gage2, Merica Shrestha3, Alexander Stojadinovic1 and Henry B Burch1
1Walter Reed National Military Medical Center, Bethesda, MD, 2Walter Reed National Military Medical Center, 3Eisenhower Army Medical Center, Evans, GA
Background:  After an initially benign FNA, thyroid nodules are still monitored for growth or development of suspicious clinical or ultrasound features, owing to a false-negative rate from 0.4-13%.  Such nodules frequently undergo a second FNA procedure in order to further reduce the FNA false-negative rate.  We sought to determine the outcome of repeat thyroid FNA following an initially benign result.

Methods:  All thyroid FNAs performed at the Walter Reed Army Medical Center during a 10-year period from September 2001-August 2011 were retrospectively reviewed.  All patients who had a repeat FNA after an initially benign result were considered for inclusion.  A strict correlation between the biopsy site, location and size of nodule on ultrasound and ultimate pathology report for those undergoing surgery was ensured. FNA results were classified as insufficient, benign, malignant, or indeterminate (includes atypical lesions, follicular neoplasm/suspicious for follicular neoplasm, suspicious for malignancy), and the pathology result was categorized as either benign or malignant.  The outcome of repeat FNA was then categorized for each nodule.

Results:  Of 3013 patients that had FNA, 439 patients had more than one FNA.  In those with more than one FNA, 104 patients had repeat biopsy of a nodule with a previously benign FNA and did not have surgery and 71 patients had a repeat of a benign FNA and ultimately did go to surgery.  In those patients that did not go to surgery, there were a total of 237 nodules with benign FNA that were repeated, in which the repeat FNA was benign in 228 nodules (96%), indeterminate in 4 nodules (1.7%, all were atypical), and inadequate in 5 nodules (2.1%).  Of the 71 patients that had surgery, 45 patients (63%) had repeatedly benign FNA result after the initial benign FNA and all but one patient had benign surgical pathology except for 1 who had malignant surgical pathology corresponding to the nodule. Three patients had concurrent incidental microcarcinomas.  Two patients went to surgery after repeat FNA was insufficient (both had benign surgical pathology),  and 22 patients had repeat FNA that was indeterminate, leading to surgery, with no malignancy found;  3 patients had incidental microcarcinoma in areas not previously sampled.  In 2 patients, repeat biopsy yielded a malignant FNA result, but only 1 of those had malignant surgical pathology; the second patient had an incidental microcarcinoma elsewhere in the gland.

Conclusion:   Our results show that repeat of a benign FNA generally leads to another benign result or one that is indeterminate, resulting ultimately in unnecessary surgery.  For those that did go to surgery, the majority of those nodules with initial benign FNA ultimately had benign surgical pathology of those nodules.  Stricter criteria need to be applied in the selection of thyroid nodules for a repeat FNA following a previously benign result.

Shrestha M, Crothers BA, Burch HB. The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-needle aspiration: A 10-Year Study from a Single Institution. Thyroid. 2012 2012; 22(12):1251-6.

Disclosure: HBB: Consultant, Up To Date. Nothing to Disclose: BTM, MG, MS, AS

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