Has fine-needle aspiration biopsy changed thyroid practice?
OBJECTIVE
To assess the influence of fine-needle aspiration (FNA) biopsy on the management of nodular thyroid disease.


METHODS
We retrospectively evaluated the effect of the availability of FNA biopsy on thyroid surgical practice at our institution by comparing the data for two study periods--1975-1976 (before the introduction of FNA) and 1985-1986 (5 years after its introduction).


RESULTS
The study inclusion criteria were fulfilled by 1,451 patients. In 1975-1976, 938 patients had thyroid operations at our institution. FNA biopsy was introduced into our practice in 1980. In 1985-1986, 513 patients underwent a thyroid surgical procedure. Before the FNA era, the frequency of carcinoma in patients selected for thyroidectomy was 18%, whereas after FNA became available, it increased to 25% (P< 0.0001). When patients were selected for surgical treatment because of either "suspicious" or malignant cytologic results, the yield of carcinoma increased to 40%.


CONCLUSIONS
These data suggest that FNA biopsy has improved selectivity for operation in patients with nodular thyroid disease and has reduced the number of patients who undergo thyroidectomy for benign disease. The result is an increasing yield of malignant lesions found at surgical intervention. FNA biopsy has had a substantial cost-saving effect on thyroid practice.
Hadi
M
M
Division of Endocrinology/Metabolism and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
Gharib
H
H
Goellner
J R
JR
Heerden
J A
JA