Annals of Surgical Oncology

, Volume 13, Issue 6, pp 859–863 | Cite as

Fine-Needle Aspiration Optimizes Surgical Management in Patients With Thyroid Cancer

  • David Y. Greenblatt
  • Todd Woltman
  • Josephine Harter
  • James Starling
  • Eberhard Mack
  • Herbert Chen



Fine-needle aspiration (FNA) is accurate in diagnosing papillary, medullary, and anaplastic thyroid cancer, as well as lymphoma. Although many surgeons routinely perform FNA before surgery, some question whether FNA influences operative management. Therefore, to determine whether FNA affects surgical management in patients with thyroid cancer, we reviewed our experience.


A total of 442 consecutive patients underwent thyroid surgery at 1 academic center. Of these, 411 had surgery for an index nodule in the absence of previous radiation or familial thyroid cancer. FNA, operative, and permanent histology findings were reviewed.


The average patient age was 46 years, and 79% were female. A total of 211 patients (51%) had a preoperative FNA, and 71 (17%) had a final diagnosis of cancer. The sensitivity and specificity of FNA for thyroid cancer were 89% and 92%, respectively. In the FNA group, 1 (2.4%) of 41 patients with papillary thyroid cancer required completion thyroidectomy. In contrast, in the no-FNA group, 4 (40%) of 10 patients with papillary thyroid cancer required a second operation. No patient in the FNA group received thyroid resection for lymphoma, whereas three (100%) of three patients with lymphoma in the no-FNA group were treated surgically. A total of 98% of the FNA group, compared with 54% of the no-FNA group, received optimal surgical treatment for thyroid cancer.


FNA is a sensitive and specific test for the diagnosis of thyroid cancer, allowing definitive initial surgery and avoiding unnecessary procedures. Therefore, we recommend routine use of preoperative thyroid FNA, even in those patients in whom a resection is already planned.


Thyroid neoplasms Thyroid lymphoma Thyroid surgery Fine-needle aspiration 


  1. 1.
    Einhorn J, Franzen S. Thin-needle biopsy in the diagnosis of thyroid disease. Acta Radiol 1962; 58:321–36CrossRefGoogle Scholar
  2. 2.
    Hamburger JI, Hamburger SW. Declining role of frozen section in surgical planning for thyroid nodules. Surgery 1985; 98:307–12PubMedGoogle Scholar
  3. 3.
    Kopald KH, Layfield LJ, Mohrmann R, Foshag LJ, Giuliano AE. Clarifying the role of fine-needle aspiration cytologic evaluation and frozen section examination in the operative management of thyroid cancer. Arch Surg 1989; 124:1201–4; discussion 1204–5PubMedGoogle Scholar
  4. 4.
    Paphavasit A, Thompson GB, Hay ID, et al. Follicular and Hurthle cell thyroid neoplasms. Is frozen-section evaluation worthwhile? Arch Surg 1997; 132:674–8; discussion 678–80PubMedGoogle Scholar
  5. 5.
    Chen H, Nicol TL, Udelsman R. Follicular lesions of the thyroid. Does frozen section evaluation alter operative management? Ann Surg 1995; 222:101–6PubMedGoogle Scholar
  6. 6.
    Chen H, Zeiger MA, Clark DP, Westra WH, Udelsman R. Papillary carcinoma of the thyroid: can operative management be based solely on fine-needle aspiration? J Am Coll Surg 1997; 184:605–10PubMedGoogle Scholar
  7. 7.
    Shemen LJ, Chess Q. Fine-needle aspiration biopsy diagnosis of follicular variant of papillary thyroid cancer: therapeutic implications. Otolaryngol Head Neck Surg 1998; 119:600–2CrossRefPubMedGoogle Scholar
  8. 8.
    Boyd LA, Earnhardt RC, Dunn JT, Frierson HF, Hanks JB. Preoperative evaluation and predictive value of fine-needle aspiration and frozen section of thyroid nodules. J Am Coll Surg 1998; 187:494–502CrossRefPubMedGoogle Scholar
  9. 9.
    Sabel MS, Staren ED, Gianakakis LM, Dwarakanathan S, Prinz RA. Use of fine-needle aspiration biopsy and frozen section in the management of the solitary thyroid nodule. Surgery 1997; 122:1021–6; discussion 1026–7CrossRefPubMedGoogle Scholar
  10. 10.
    Irish JC, van Nostrand AW, Asa SL, Gullane P, Rotstein L. Accuracy of pathologic diagnosis in thyroid lesions. Arch Otolaryngol Head Neck Surg 1992; 118:918–22PubMedGoogle Scholar
  11. 11.
    Layfield LJ, Mohrmann RL, Kopald KH, Giuliano AE. Use of aspiration cytology and frozen section examination for management of benign and malignant thyroid nodules. Cancer 1991; 68:130–4PubMedGoogle Scholar
  12. 12.
    Rodriguez JM, Parrilla P, Sola J, et al. Comparison between preoperative cytology and intraoperative frozen-section biopsy in the diagnosis of thyroid nodules. Br J Surg 1994; 81:1151–4PubMedGoogle Scholar
  13. 13.
    Chang HY, Lin JD, Chen JF, et al. Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules. J Clin Pathol 1997; 50:1005–9PubMedGoogle Scholar
  14. 14.
    Brooks AD, Shaha AR, DuMornay W, et al. Role of fine-needle aspiration biopsy and frozen section analysis in the surgical management of thyroid tumors. Ann Surg Oncol 2001; 8:92–100PubMedGoogle Scholar
  15. 15.
    Emerick GT, Duh QY, Siperstein AE, Burrow GN, Clark OH. Diagnosis, treatment, and outcome of follicular thyroid carcinoma. Cancer 1993; 72:3287–95PubMedGoogle Scholar
  16. 16.
    Chen H, Udelsman R. Papillary thyroid carcinoma: justification for total thyroidectomy and management of lymph node metastases. Surg Oncol Clin North Am 1998; 7:645–63Google Scholar
  17. 17.
    Smith RR, Frazell EL, Caulk R, Holinger PH, Russell WO. The American Joint Committee’s proposed method of stage classification and end-result reporting applied to 1,320 pharynx cancers. Cancer 1963; 16:1505–20PubMedGoogle Scholar
  18. 18.
    Katoh R, Sasaki J, Kurihara H, Suzuki K, Iida Y, Kawaoi A. Multiple thyroid involvement (intraglandular metastasis) in papillary thyroid carcinoma. A clinicopathologic study of 105 consecutive patients. Cancer 1992; 70:1585–90PubMedGoogle Scholar
  19. 19.
    Pacini F, Elisei R, Capezzone M, et al. Contralateral papillary thyroid cancer is frequent at completion thyroidectomy with no difference in low- and high-risk patients. Thyroid 2001; 11:877–81CrossRefPubMedGoogle Scholar
  20. 20.
    Kim ES, Kim TY, Koh JM, et al. Completion thyroidectomy in patients with thyroid cancer who initially underwent unilateral operation. Clin Endocrinol (Oxf) 2004; 61:145–8CrossRefGoogle Scholar
  21. 21.
    Tollefsen HR, Decosse JJ. Papillary carcinoma of the thyroid. Recurrence in the thyroid gland after initial surgical treatment. Am J Surg 1963; 106:728–34PubMedCrossRefGoogle Scholar
  22. 22.
    Hay ID. Papillary thyroid carcinoma. Endocrinol Metab Clin North Am 1990; 19:545–76PubMedGoogle Scholar
  23. 23.
    DeGroot LJ, Kaplan EL, McCormick M, Straus FH. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab 1990; 71:414–24PubMedCrossRefGoogle Scholar
  24. 24.
    Samaan NA, Schultz PN, Hickey RC, et al. The results of various modalities of treatment of well differentiated thyroid carcinomas: a retrospective review of 1599 patients. J Clin Endocrinol Metab 1992; 75:714–20CrossRefPubMedGoogle Scholar
  25. 25.
    Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994; 97:418–28CrossRefPubMedGoogle Scholar
  26. 26.
    Menegaux F, Turpin G, Dahman M, et al. Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 cases. Surgery 1999; 126:479–83PubMedGoogle Scholar
  27. 27.
    Reeve TS, Delbridge L, Brady P, Crummer P, Smyth C. Secondary thyroidectomy: a twenty-year experience. World J Surg 1988; 12:449–53CrossRefPubMedGoogle Scholar
  28. 28.
    Wilson DB, Staren ED, Prinz RA. Thyroid reoperations: indications and risks. Am Surg 1998; 64:674–8; discussion 678–9PubMedGoogle Scholar
  29. 29.
    Chao TC, Jeng LB, Lin JD, Chen MF. Reoperative thyroid surgery. World J Surg 1997; 21:644–7CrossRefPubMedGoogle Scholar
  30. 30.
    Compagno J, Oertel JE. Malignant lymphoma and other lymphoproliferative disorders of the thyroid gland. A clinicopathologic study of 245 cases. Am J Clin Pathol 1980; 74:1–11PubMedGoogle Scholar
  31. 31.
    Doria R, Jekel JF, Cooper DL. Thyroid lymphoma. The case for combined modality therapy. Cancer 1994; 73:200–6PubMedGoogle Scholar
  32. 32.
    Tsang RW, Gospodarowicz MK, Sutcliffe SB, Sturgeon JF, Panzarella T, Patterson BJ. Non-Hodgkin’s lymphoma of the thyroid gland: prognostic factors and treatment outcome. The Princess Margaret Hospital Lymphoma Group. Int J Radiat Oncol Biol Phys 1993; 27:599–604PubMedGoogle Scholar
  33. 33.
    Staunton MD, Greening WP. Clinical diagnosis of thyroid cancer. Br Med J 1973; 4:532–5PubMedCrossRefGoogle Scholar
  34. 34.
    Glass AG, Karnell LH, Menck HR. The National Cancer Data Base report on non-Hodgkin’s lymphoma. Cancer 1997; 80:2311–20CrossRefPubMedGoogle Scholar
  35. 35.
    Holm LE, Blomgren H, Lowhagen T. Cancer risks in patients with chronic lymphocytic thyroiditis. N Engl J Med 1985; 312:601–4PubMedCrossRefGoogle Scholar
  36. 36.
    Kato I, Tajima K, Suchi T, et al. Chronic thyroiditis as a risk factor of B-cell lymphoma in the thyroid gland. Jpn J Cancer Res 1985; 76:1085–90PubMedGoogle Scholar
  37. 37.
    Pedersen RK, Pedersen NT. Primary non-Hodgkin’s lymphoma of the thyroid gland: a population based study. Histopathology 1996; 28:25–32CrossRefPubMedGoogle Scholar
  38. 38.
    Campbell DJ, Sage RH. Thyroid cancer: twenty years’ experience in a general hospital. Br J Surg 1975; 62:207–14PubMedGoogle Scholar
  39. 39.
    Hamburger JI, Miller JM, Kini SR. Lymphoma of the thyroid. Ann Intern Med 1983; 99:685–93PubMedGoogle Scholar
  40. 40.
    Pasieka JL. Hashimoto’s disease and thyroid lymphoma: role of the surgeon. World J Surg 2000; 24:966–70CrossRefPubMedGoogle Scholar
  41. 41.
    Laing RW, Hoskin P, Hudson BV, et al. The significance of MALT histology in thyroid lymphoma: a review of patients from the BNLI and Royal Marsden Hospital. Clin Oncol (R Coll Radiol) 1994; 6:300–4Google Scholar
  42. 42.
    Skarsgard ED, Connors JM, Robins RE. A current analysis of primary lymphoma of the thyroid. Arch Surg 1991; 126:1199–203; discussion 1203–4PubMedGoogle Scholar
  43. 43.
    Pyke CM, Grant CS, Habermann TM, et al. Non-Hodgkin’s lymphoma of the thyroid: is more than biopsy necessary? World J Surg 1992; 16:604–9; discussion 609–10CrossRefPubMedGoogle Scholar
  44. 44.
    Aozasa K, Ueda T, Katagiri S, Matsuzuka F, Kuma K, Yonezawa T. Immunologic and immunohistologic analysis of 27 cases with thyroid lymphomas. Cancer 1987; 60:969–73PubMedGoogle Scholar
  45. 45.
    Rasbach DA, Mondschein MS, Harris NL, Kaufman DS, Wang CA. Malignant lymphoma of the thyroid gland: a clinical and pathologic study of twenty cases. Surgery 1985; 98:1166–70PubMedGoogle Scholar
  46. 46.
    Junor EJ, Paul J, Reed NS. Primary non-Hodgkin’s lymphoma of the thyroid. Eur J Surg Oncol 1992; 18:313–21PubMedGoogle Scholar
  47. 47.
    Friedberg MH, Coburn MC, Monchik JM. Role of surgery in stage IE non-Hodgkin’s lymphoma of the thyroid. Surgery 1994; 116:1061–6; discussion 1066–7PubMedGoogle Scholar
  48. 48.
    Vigliotti A, Kong JS, Fuller LM, Velasquez WS. Thyroid lymphomas stages IE and IIE: comparative results for radiotherapy only, combination chemotherapy only, and multimodality treatment. Int J Radiat Oncol Biol Phys 1986; 12:1807–12PubMedGoogle Scholar
  49. 49.
    Connors JM, Klimo P, Fairey RN, Voss N. Brief chemotherapy and involved field radiation therapy for limited-stage, histologically aggressive lymphoma. Ann Intern Med 1987; 107:25–30PubMedGoogle Scholar
  50. 50.
    Sasai K, Yamabe H, Haga H, et al. Non-Hodgkin’s lymphoma of the thyroid. A clinical study of twenty-two cases. Acta Oncol 1996; 35:457–62PubMedGoogle Scholar
  51. 51.
    Devine RM, Edis AJ, Banks PM. Primary lymphoma of the thyroid: a review of the Mayo Clinic experience through 1978. World J Surg 1981; 5:33–8CrossRefPubMedGoogle Scholar
  52. 52.
    Ansell SM, Grant CS, Habermann TM. Primary thyroid lymphoma. Semin Oncol 1999; 26:316–23PubMedGoogle Scholar
  53. 53.
    Udelsman R, Chen H. The current management of thyroid cancer. Adv Surg 1999; 33:1–27PubMedGoogle Scholar
  54. 54.
    Roeher HD, Simon D. Surgical therapy of thyroid cancer. G Chir 1999; 20:5–8PubMedGoogle Scholar
  55. 55.
    Klyachkin ML, Schwartz RW, Cibull M, et al. Thyroid lymphoma: is there a role for surgery? Am Surg 1998; 64:234–8PubMedGoogle Scholar
  56. 56.
    Cha C, Chen H, Westra WH, Udelsman R. Primary thyroid lymphoma: can the diagnosis be made solely by fine-needle aspiration? Ann Surg Oncol 2002; 9:298–302CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2006

Authors and Affiliations

  • David Y. Greenblatt
    • 1
  • Todd Woltman
    • 1
  • Josephine Harter
    • 2
  • James Starling
    • 1
  • Eberhard Mack
    • 1
  • Herbert Chen
    • 1
  1. 1.Department of SurgeryUniversity of Wisconsin, H4/750 Clinical Science CenterMadisonUSA
  2. 2.Department of PathologyUniversity of Wisconsin, H4/750 Clinical Science CenterMadisonUSA

Personalised recommendations