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. 1990 Aug 11;301(6747):318–321. doi: 10.1136/bmj.301.6747.318

Management of isolated thyroid swellings: a prospective six year study of fine needle aspiration cytology in diagnosis.

E L Cusick 1, C A MacIntosh 1, Z H Krukowski 1, V M Williams 1, S W Ewen 1, N A Matheson 1
PMCID: PMC1663628  PMID: 2203493

Abstract

OBJECTIVE--To audit the accuracy and impact on the frequency of operation of fine needle aspiration cytology of isolated thyroid swellings. DESIGN--Prospective analysis over six years of cytological predictions compared with histological findings. SETTING--Thyroid clinic serving the Grampian region. PATIENTS--395 Consecutive patients presenting with an isolated thyroid swelling, 307 of whom underwent surgical excision. Analysis was confined to a subgroup of 283 patients with satisfactory aspirates who were operated on. RESULTS--The positive predictive value of aspiration cytology for detecting malignant disease was 100% and the sensitivity 83%. The sensitivity for the detection of neoplasia (frank malignancy together with follicular adenomas) was 76%. The specificity was 58% and the overall accuracy 69%. Recalculation of data in previous papers with strict criteria showed the accuracy of aspiration cytology to be variable and lower than is widely accepted. Since the introduction of aspiration cytology 21% fewer operations for isolated thyroid swellings have been performed. CONCLUSIONS--As a basis of selection for surgical excision of isolated thyroid swellings according to prediction of neoplasia fine needle aspiration cytology is less reliable than is widely accepted. It is an adjunct to management rather than a definitive test, and negative cytological results do not exclude neoplastic disease. Further study should take account of the implications of repeated clinic attendances for review and aspiration as these may culminate in delayed surgical treatment.

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Selected References

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  1. Al-Sayer H. M., Krukowski Z. H., Williams V. M., Matheson N. A. Fine needle aspiration cytology in isolated thyroid swellings: a prospective two year evaluation. Br Med J (Clin Res Ed) 1985 May 18;290(6480):1490–1492. doi: 10.1136/bmj.290.6480.1490. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Ashcraft M. W., Van Herle A. J. Management of thyroid nodules. II: Scanning techniques, thyroid suppressive therapy, and fine needle aspiration. Head Neck Surg. 1981 Mar-Apr;3(4):297–322. doi: 10.1002/hed.2890030406. [DOI] [PubMed] [Google Scholar]
  3. Droese M. Stellenwert der Zytologie in der Diagnostik der Schilddrüsentumoren. Verh Dtsch Ges Pathol. 1977;61:283–286. [PubMed] [Google Scholar]
  4. Esselstyn C. B., Jr, Crile G., Jr Needle aspiration and needle biopsy of the thyroid. World J Surg. 1978 May;2(3):321–329. doi: 10.1007/BF01561505. [DOI] [PubMed] [Google Scholar]
  5. Franklyn J. A., Fitzgerald M. G., Oates G. D., Sheppard M. C. Fine needle aspiration cytology in the management of euthyroid goitre. Q J Med. 1987 Dec;65(248):997–1003. [PubMed] [Google Scholar]
  6. Gershengorn M. C., McClung M. R., Chu E. W., Hanson T. A., Weintraub B. D., Robbins J. Fine-needle aspiration cytology in the preoperative diagnosis of thyroid nodules. Ann Intern Med. 1977 Sep;87(3):265–269. doi: 10.7326/0003-4819-87-3-265. [DOI] [PubMed] [Google Scholar]
  7. Hamberger B., Gharib H., Melton L. J., 3rd, Goellner J. R., Zinsmeister A. R. Fine-needle aspiration biopsy of thyroid nodules. Impact on thyroid practice and cost of care. Am J Med. 1982 Sep;73(3):381–384. [PubMed] [Google Scholar]
  8. Hawkins F., Bellido D., Bernal C., Rigopoulou D., Ruiz Valdepeñas M. P., Lazaro E., Perez-Barrios A., De Agustin P. Fine needle aspiration biopsy in the diagnosis of thyroid cancer and thyroid disease. Cancer. 1987 Mar 15;59(6):1206–1209. doi: 10.1002/1097-0142(19870315)59:6<1206::aid-cncr2820590629>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  9. Joensuu H., Klemi P., Eerola E. DNA aneuploidy in follicular adenomas of the thyroid gland. Am J Pathol. 1986 Sep;124(3):373–376. [PMC free article] [PubMed] [Google Scholar]
  10. Löwhagen T., Granberg P. O., Lundell G., Skinnari P., Sundblad R., Willems J. S. Aspiration biopsy cytology (ABC) in nodules of the thyroid gland suspected to be malignant. Surg Clin North Am. 1979 Feb;59(1):3–18. doi: 10.1016/s0039-6109(16)41729-9. [DOI] [PubMed] [Google Scholar]
  11. Löwhagen T., Willems J. S., Lundell G., Sundblad R., Granberg P. O. Aspiration biopsy cytology in diagnosis of thyroid cancer. World J Surg. 1981 Jan;5(1):61–73. doi: 10.1007/BF01657837. [DOI] [PubMed] [Google Scholar]
  12. Rosen I. B., Wallace C., Strawbridge H. G., Walfish P. G. Reevaluation of needle aspiration cytology in detection of thyroid cancer. Surgery. 1981 Oct;90(4):747–756. [PubMed] [Google Scholar]
  13. Schnürer L. B., Widström A. Fine-needle biopsy of the thyroid gland: a cytohistological comparison in cases of goiter. Ann Otol Rhinol Laryngol. 1978 Mar-Apr;87(2 Pt 1):224–227. doi: 10.1177/000348947808700213. [DOI] [PubMed] [Google Scholar]
  14. Silverman J. F., West R. L., Larkin E. W., Park H. K., Finley J. L., Swanson M. S., Fore W. W. The role of fine-needle aspiration biopsy in the rapid diagnosis and management of thyroid neoplasm. Cancer. 1986 Mar 15;57(6):1164–1170. doi: 10.1002/1097-0142(19860315)57:6<1164::aid-cncr2820570617>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  15. Walfish P. G., Hazani E., Strawbridge H. T., Miskin M., Rosen I. B. A prospective study of combined ultrasonography and needle aspiration biopsy in the assessment of the hypofunctioning thyroid nodule. Surgery. 1977 Oct;82(4):474–482. [PubMed] [Google Scholar]

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