Steps to Improve Accuracy of FNA and Lead to Better Nodule Management
| Step | Explanation |
|---|---|
| Biopsy performed by expert in thyroid pathologies | Offers better thyroid examination; accumulates experience with FNA |
| Experienced cytopathologist reviews slides | Improves cytologic interpretation |
| Caution with small (<1 cm) or large (>4 cm) nodules | Increased chance of misdiagnosis; US FNA improves accuracy |
| 3-6 aspirates from different nodule sites | Improves cytologic sampling |
| Re-biopsy if cytology is nondiagnostic | About 50% will be diagnostic on re-aspiration |
| Nondiagnostic cytology is not negative | Risk of cancer is low but not ruled out |
| Aspirates with no follicular cells are nondiagnostic | These should not be considered negative for malignancy |
| Excise nodules yielding suspicious cytology | 20-40% chance of malignancy |
| Excise clinically suspicious, cytologically benign nodules | Clinical impression overrides FNA diagnosis |
|
FNA, fine-needle aspiration; US-FNA, FNA with ultrasonographic guidance.
*Modified from Gharib ( 2 ). By permission of Mayo Foundation for Medical Education and Research. | |
From: Fine-Needle Aspiration of the Thyroid Gland
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