Should all patients with subcentimeter thyroid nodules undergo fine-needle aspiration biopsy and preoperative neck ultrasonography to define the extent of tumor invasion?
BACKGROUND
Decisions involving the management of patients with papillary microcarcinoma are complex. Here we review and consider the literature in this area including two studies published in this issue of Thyroid.


CONCLUSIONS
Thyroid nodules 5 mm or smaller have a high rate of false positive ultrasound findings and often yield inadequate cytology on fine needle aspiration biopsy (FNAB). We conclude that nodules of this size with no other clinical findings should not undergo routine FNAB, even if they appear ultrasonographically suspicious. Biopsying such small nodules evokes major patient anxiety and is likely to yield cytology that is insufficient for diagnosis, especially in the hands of inexperienced ultrasonographers. Periodic ultrasound examination, despite its shortcomings, is likely to be a better option for such patients since their small nodules may spontaneously disappear or fail to grow over time. Those that grow by at least 50% or more might be considered for FNAB, but only if they exceed 5 mm.
Mazzaferri
Ernest L
EL
Medicine, Ohio State University, Division of Endocrinology, Ohio State University, Columbus, Ohio, USA. emazzaferri@cox.net
Sipos
Jennifer
J
D044963:Biopsy, Fine-Needle; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D009333:Neck / Q000000981:diagnostic imaging; D009361:Neoplasm Invasiveness; D011300:Preoperative Care; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology*; D014463:Ultrasonography