Fine-needle aspiration of normal thyroid tissue may result in the misdiagnosis of microfollicular lesions.
BACKGROUND
Inadvertent sampling of normal thyroid tissue surrounding a nodule may occur when clinically inexperienced personnel perform fine-needle aspiration (FNA) or when a nodule is small. Because the cytologic characteristics of normal thyroid tissue are not well known, we prospectively studied 42 patients undergoing thyroidectomy.


METHODS
FNA was performed from the grossly normal contralateral lobe during thyroidectomy. Cytopathologists examined the slides without knowing the source of the tissue.


RESULTS
FNA of grossly normal thyroid tissue was adequate for interpretation in 32 of 42 patients, and in nine of 42 cases it was interpreted as unremarkable. However, the remaining specimens were classified as microfollicular lesions (18), mixed macromicrofollicular lesions (three), Hürthle cell lesion (one), and papillary thyroid carcinoma (one).


CONCLUSIONS
FNA of grossly normal thyroid tissue suggested a microfollicular lesion in 18 (56%) patients, a result that would raise the possibility of a follicular carcinoma and often lead to the recommendation for operation. When FNA is performed, normal thyroid tissue surrounding a nodule should be avoided, and the possibility of a sampling error should be considered when a microfollicular pattern is obtained in a patient with a small nodule.
Mowschenson
P M
PM
Department of Surgery, Beth Israel Hospital, Boston, Mass.
Hodin
R A
RA
Wang
H H
HH
Upton
M
M
Silen
W
W
D001707:Biopsy, Needle; D003951:Diagnostic Errors; D006801:Humans; D013961:Thyroid Gland / Q000473:pathology*; D013965:Thyroidectomy