title: Is one benign fine needle aspiration enough?
abstract: BACKGROUND
  Fine needle aspiration (FNA) is used to diagnose thyroid nodules, but the follow-up of benign FNA is unclear. We sought to determine whether routine repeat FNAs after initial benign FNA reduces false negatives.
  
  
  METHODS
  We identified 265 patients who had at least one benign FNA that either progressed to surgery or had at least one repeat FNA. We reviewed their ultrasonography, FNA cytology, and surgical pathology.
  
  
  RESULTS
  Of 127 patients with initial benign FNA that had surgery, 13 had a malignancy, yielding a 10.2% false-negative rate. Of 22 patients who had surgery after at least two benign FNAs, one had a malignancy, yielding a 4.5% false-negative rate. Initially benign cytology (Bethesda II) was upgraded to a cytology requiring surgical intervention (Bethesda IV-VI) in 7 of 129 (5.4%) patients after two FNAs. Suspicious features on ultrasound, including size >4 cm, calcifications, or increased vascularity were found in 90% of patients with a false-negative FNA.
  
  
  CONCLUSIONS
  The overall false-negative rate of thyroid FNAs is 10.2%, which is reduced to 4.5% with a second benign FNA. Ninety percent of patients with a false-negative FNA had suspicious sonographic features. Reaspiration should be considered in patients with sonographically suspicious nodules.
authors.affiliation: Division of General Surgery, Robert Wood Johnson Medical School, Office of Surgical Education, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA. chernyvs@umdnj.edu
authors.forename: Victoriya S
authors.initials: VS
authors.lastname: Chernyavsky
authors.forename: Beth-Ann
authors.initials: BA
authors.lastname: Shanker
authors.forename: Tomer
authors.initials: T
authors.lastname: Davidov
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Crystal
authors.forename: Oliver
authors.initials: O
authors.lastname: Eng
authors.forename: Kareem
authors.initials: K
authors.lastname: Ibrahim
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kwong
authors.forename: Stanley Z
authors.initials: SZ
authors.lastname: Trooskin
mesh_terms: D018263:Adenocarcinoma, Follicular; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000592:standards*; D002277:Carcinoma; D002291:Carcinoma, Papillary; D002648:Child; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D013048:Specimen Handling / Q000379:methods / Q000592:standards; D000077273:Thyroid Cancer, Papillary; D013959:Thyroid Diseases / Q000473:pathology; D013964:Thyroid Neoplasms / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014463:Ultrasonography; D055815:Young Adult