title: Value of repeating a nondiagnostic thyroid fine-needle aspiration biopsy.
abstract: OBJECTIVE
  To assess the value of repeating a biopsy when the initial thyroid fine-needle aspiration (FNA) biopsy is nondiagnostic.
  
  
  METHODS
  Between 1990 and 2003, 4,311 thyroid FNAs were performed at the Cleveland Clinic Foundation, of which 220 (5%) were nondiagnostic. Among 189 patients whose medical records were available for retrospective review, 106 underwent a repeated FNA (FNA #2), and 14 had a second repeated FNA (FNA #3). Thyroid ultrasonography was used in the evaluation in 113 FNAs.
  
  
  RESULTS
  The first and second repeated FNAs were diagnostic in 58% (62 of 106 patients) and 50% (7 of 14 patients), respectively. The rate of malignant disease in patients with no repeated FNAs versus 1 or more repeated FNAs was 4.8% (4 of 83) versus 11.3% (12 of 106), respectively. Ultrasound-guided FNA yielded a diagnosis among 33 of 113 biopsies (29.2%), and FNA without ultrasound guidance provided a diagnosis in 30 of 159 biopsies (18.9%). Thus, the use of thyroid ultrasonography significantly improved the likelihood of establishing a diagnosis (P = 0.017). We found that repeating the FNA up to 2 times provides a diagnosis in up to 60% of cases.
  
  
  CONCLUSIONS
  The overall prevalence of thyroid cancer in patients with nondiagnostic FNA is not trivial--8.5% in our study group of 189 patients. An aggressive approach toward nondiagnostic FNA biopsies is recommended, with performance of at least 2 repeated FNA biopsies, preferably with the help of ultrasound guidance.
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Atlanta Medical Center, Atlanta, Georgia 30312-1212, USA.
authors.forename: Israel B
authors.initials: IB
authors.lastname: Orija
authors.forename: Maria
authors.initials: M
authors.lastname: Piñeyro
authors.forename: Charles
authors.initials: C
authors.lastname: Biscotti
authors.forename: S Sethu K
authors.initials: SS
authors.lastname: Reddy
authors.forename: Amir H
authors.initials: AH
authors.lastname: Hamrahian
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis; D007037:Hypothyroidism / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012086:Reoperation; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology; D013964:Thyroid Neoplasms / Q000453:epidemiology / Q000473:pathology*; D016606:Thyroid Nodule / Q000473:pathology* / Q000601:surgery; D013972:Thyrotropin / Q000097:blood; D014463:Ultrasonography
chemical_list: D013972:Thyrotropin