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Review
. 2016 May 20;113(20):353-9.
doi: 10.3238/arztebl.2016.0353.

Fine Needle Aspiration in the Investigation of Thyroid Nodules

Joachim Feldkamp  1 , Dagmar Führer, Markus Luster, Thomas J Musholt, Christine Spitzweg, Matthias Schott
Affiliations
Review

Fine Needle Aspiration in the Investigation of Thyroid Nodules

Joachim Feldkamp et al. Dtsch Arztebl Int. .

Abstract

Background: Thyroid nodules are a common finding in Germany. Most are benign; thyroid cancer is very rare. The challenge for the physician is to diagnose malignant tumors early. Fine needle aspiration is an important tool for this purpose.

Methods: This review is based on pertinent articles (1980-2014) retrieved by a selective search in PubMed and on the current recommendations of guidelines issued by the specialty societies in Germany and abroad.

Results: Clinical, ultrasonographic, and scintigraphic criteria are used to identify high-risk nodules, which are then further studied by fine needle aspiration. Important ultrasonographic criteria for malignancy are low echodensity (positive predictive value [PPV]: 1.85), microcalcifications (PPV: 3.65), irregular borders (PPV: 3.76), and intense vascularization. Fine needle aspiration of the thyroid gland is an inexpensive and technically straight - forward diagnostic procedure that causes little discomfort for the patient. It helps prevent unnecessary thyroid surgery and is used to determine the proper surgical strategy if malignancy is suspected. The cytological study of fine needle aspirates enables highly precise diagnosis of many tumor entities, but follicular neoplasia can only be diagnosed histologically. In the near future, molecular genetic methods will probably extend the diagnostic range of fine needle aspiration beyond what is currently achievable with classic cytology.

Conclusion: Fine needle aspiration biopsy of the thyroid gland in experienced hands is an easily performed diagnostic procedure with very little associated risk. It should be performed on ultrasonographically suspect nodules for treatment stratification and before any operation for an unclear nodular change in the thyroid gland.

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Figures

Figure
Figure
Diagnostic algorithm for the evaluation of a thyroid nodule detected on ultrasonography; TSH, thyroid-stimulating hormone
See this image and copyright information in PMC

Comment in

  • Increasing Importance.
    Scholz T. Scholz T. Dtsch Arztebl Int. 2017 Jan 9;114(1-02):25. doi: 10.3238/arztebl.2017.0025a. Dtsch Arztebl Int. 2017. PMID: 28143641 Free PMC article. No abstract available.
  • Critical Assessment Is Missing.
    Schmidt M, Schäfer W. Schmidt M, et al. Dtsch Arztebl Int. 2017 Jan 9;114(1-02):25-26. doi: 10.3238/arztebl.2017.0025b. Dtsch Arztebl Int. 2017. PMID: 28143642 Free PMC article. No abstract available.
  • Unanswered Questions.
    Backus E. Backus E. Dtsch Arztebl Int. 2017 Jan 9;114(1-02):26. doi: 10.3238/arztebl.2017.0026a. Dtsch Arztebl Int. 2017. PMID: 28143643 Free PMC article. No abstract available.

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