title: The use of fine-needle aspiration biopsy under ultrasound guidance to assess the risk of malignancy in patients with a multinodular goiter.
abstract: OBJECTIVE
  Fine-needle aspiration biopsy (FNAB) is a commonly performed procedure used in the evaluation of solitary thyroid nodules, in which the risk of malignancy is approximately 5% in most patients. Recently, the use of ultrasound (US) guidance in FNAB has been shown to enhance the diagnostic efficacy of this procedure. However, the risk of malignancy in thyroid nodules occurring within a multinodular goiter (MNG) has not been completely clarified, nor has the optimal means of investigating such nodules using FNAB.
  
  
  METHODS
  We performed a retrospective study of all patients seen over a 4-year period with a MNG that had one or more nodules who underwent FNAB under US guidance. The results from the history and physical examination, thyroid function and antibody tests, radionuclide studies, thyroid sonogram, cytology of aspirated nodules, and surgical pathology were recorded and analyzed.
  
  
  RESULTS
  A total of 93 nodules were aspirated in 61 patients with MNG. Adequate material was obtained in 96% of aspirates on the first attempt. Sixty-seven aspirates in 44 patients yielded benign cytology and 22 aspirates in 15 patients yielded suspicious cytology. All patients with suspicious cytology underwent thyroid surgery. Thyroid cancer was found in 5 of these nodules, including 4 cases of papillary cancer and 1 case of Hürthle cell cancer, and 1 additional patient had occult papillary cancer discovered. The overall malignancy rate in thyroid nodules among the patients with MNG was approximately 5%.
  
  
  CONCLUSIONS
  FNAB under US guidance is a useful diagnostic modality in the evaluation of thyroid nodules in selected patients with MNG. Because the risk of thyroid malignancy in these nodules is comparable to that which exists in solitary thyroid nodules, the possibility of thyroid malignancy should be considered in all patients with MNG.
authors.affiliation: Department of Medicine, Winthrop-University Hospital and The State University at New York at Stony Brook School of Medicine, Mineola, USA. SRTOLLIN@AOL.com
authors.forename: S R
authors.initials: SR
authors.lastname: Tollin
authors.forename: G M
authors.initials: GM
authors.lastname: Mery
authors.forename: N
authors.initials: N
authors.lastname: Jelveh
authors.forename: E F
authors.initials: EF
authors.lastname: Fallon
authors.forename: M
authors.initials: M
authors.lastname: Mikhail
authors.forename: W
authors.initials: W
authors.lastname: Blumenfeld
authors.forename: S
authors.initials: S
authors.lastname: Perlmutter
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000453:epidemiology / Q000473:pathology; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D002291:Carcinoma, Papillary / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006044:Goiter, Nodular / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D013960:Thyroid Function Tests; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D014463:Ultrasonography