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False Negative Cytology in Large Thyroid Nodules

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Controversy exists regarding the accuracy of fine-needle aspiration (FNA) in large thyroid nodules. Recent surgical series have documented false-negative rates ranging from 0.7 to 13 %. We examined the accuracy of benign FNA cytology in patients with thyroid nodules ≥3 cm who underwent surgical resection and identified features characteristic of false-negative results.

Methods

We retrospectively studied all thyroidectomy specimens between January 2009 and October 2011 and identified nodules ≥3 cm with corresponding benign preoperative FNA cytology. We collected clinical information regarding patient demographics, nodule size, symptoms, sonographic features, FNA results, and final surgical pathology. For comparison, we analyzed nodules <3 cm from this cohort also with benign FNA cytology.

Results

A total of 323 nodules with benign preoperative cytology were identified. Eighty-three nodules were <3 cm, 94 nodules were 3–3.9 cm, and 146 nodules were ≥4 cm in size. The false-negative rate was 11.7 % for all nodules ≥3 cm and 4.8 % for nodules <3 cm (p = 0.03). Subgroup analysis of nodules ≥3 cm revealed a false-negative rate of 12.8 % for nodules 3–3.9 cm and 11 % for nodules ≥4 cm. Age ≥55 years and asymptomatic clinical status were the only patient characteristics that reached statistical significance as risk factors. Final pathology of the false-negative specimens consisted mainly of follicular variant of papillary thyroid cancer and follicular thyroid cancer.

Conclusions

When referred for thyroidectomy, patients with large thyroid nodules demonstrate a modest, yet significant, false-negative rate despite initial benign aspiration cytology. Therefore, thyroid nodules ≥3 cm may be considered for removal even when referred with benign preoperative cytology.

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Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Wesley H. Giles MD, Atul A. Gawande MD, MPH, Daniel T. Ruan MD, Francis D. Moore Jr. MD & Nancy L. Cho MD

  2. Department of Surgery, Children’s Hospital, Boston, MA, 02115, USA

    Reid A. Maclellan MD, MMSc

  3. Division of Endocrinology, Diabetes, and Hypertension, Thyroid Unit, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA

    Erik K. Alexander MD

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  1. Wesley H. Giles MD
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  2. Reid A. Maclellan MD, MMSc
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  3. Atul A. Gawande MD, MPH
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  4. Daniel T. Ruan MD
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  5. Erik K. Alexander MD
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  6. Francis D. Moore Jr. MD
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  7. Nancy L. Cho MD
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Correspondence to Nancy L. Cho MD.

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Giles, W.H., Maclellan, R.A., Gawande, A.A. et al. False Negative Cytology in Large Thyroid Nodules. Ann Surg Oncol 22, 152–157 (2015). https://doi.org/10.1245/s10434-014-3952-7

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  • DOI: https://doi.org/10.1245/s10434-014-3952-7

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