Suspicious thyroid nodules 4 cm require a diagnostic lobectomy regardless of their benign fine needle aspiration results

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Authors: Hyeung Kyoo Kim ; Soo Young Kim ; Yong Sang Lee ; Euy Young Soh ; Hang-Seok Chang ; Cheong Soo Park

MeSH: Adenocarcinoma, Follicular* / pathology ; Biopsy, Fine-Needle ; Humans ; Retrospective Studies ; Thyroid Cancer, Papillary / diagnosis ; Thyroid Cancer, Papillary / surgery ; Thyroid Neoplasms* / diagnostic imaging ; Thyroid Neoplasms* / surgery ; Thyroid Nodule* / diagnostic imaging ; Thyroid Nodule* / surgery ; Thyroidectomy

Keywords: Benign cytology ; Biopsy ; Cancer incidence ; Large thyroid nodule ; Malignancy

Abstract: Background/objective: The diagnostic accuracy of fine needle aspiration biopsy (FNAB) seems limited in large thyroid nodules with Bethesda Cat. 2 result. We aimed to determine the incidence of carcinoma with benign cytology and the reason for the high false-positive rate in thyroid nodules ≥4 cm.

Methods: The records of 103 patients with thyroid nodules ≥4 cm with preoperative cytological diagnosis of Bethesda Cat. 2 who underwent thyroidectomy were consecutively reviewed. Characteristics between patients with malignant vs. benign pathology were compared.

Results: Forty patients (38.8%) had malignancy. Malignancy was subclassified into follicular variant of papillary thyroid carcinoma (43%), minimally invasive follicular thyroid carcinoma (20.0%), and minimally invasive Hurthle cell thyroid carcinoma (10.9%). Patients with malignant cytology had significantly more suspicious ultrasound findings than those with benign cytology (p = 0.001).

Conclusions: Preoperative FNAB showed high false-negative rates in patients with thyroid nodules ≥4 cm with benign cytology. These nodules have a high malignancy rate with suspicious ultrasound findings.