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. 2012;7(11):e49078.
doi: 10.1371/journal.pone.0049078. Epub 2012 Nov 19.

Malignancy risk analysis in patients with inadequate fine needle aspiration cytology (FNAC) of the thyroid

Talib Al Maqbali  1 , Miroslav Tedla, Martin O Weickert, Hisham Mehanna
Affiliations

Malignancy risk analysis in patients with inadequate fine needle aspiration cytology (FNAC) of the thyroid

Talib Al Maqbali et al. PLoS One. 2012.

Abstract

Background: Thyroid fine needle aspiration cytology (FNAC) is the standard diagnostic modality for thyroid nodules. However, it has limitations among which is the incidence of non-diagnostic results (Thy1). Management of cases with repeatedly non-diagnostic FNAC ranges from simple observation to surgical intervention. We aim to evaluate the incidence of malignancy in non-diagnostic FNAC, and the success rate of repeated FNAC. We also aim to evaluate risk factors for malignancy in patients with non-diagnostic FNAC.

Materials and methods: Retrospective analyses of consecutive cases with thyroid non diagnostic FNAC results were included.

Results: Out of total 1657 thyroid FNAC done during the study period, there were 264 (15.9%) non-diagnostic FNAC on the first attempt. On repeating those, the rate of a non-diagnostic result on second FNAC was 61.8% and on third FNAC was 47.2%. The overall malignancy rate in Thy1 FNAC was 4.5% (42% papillary, 42% follicular and 8% anaplastic), and the yield of malignancy decreased considerably with successive non-diagnostic FNAC. Ultrasound guidance by an experienced head neck radiologist produced the lowest non-diagnostic rate (38%) on repetition compared to US guidance by a generalist radiologist (65%) and by non US guidance (90%).

Conclusions: There is a low risk of malignancy in patients with a non-diagnostic FNAC result, commensurate to the risk of any nodule. The yield of malignancy decreased considerably with successive non-diagnostic FNAC.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart showing details of the thyroid non diagnostic FNAC and their cytological and histological correlation.
See this image and copyright information in PMC

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