title: Repeatedly nondiagnostic thyroid fine-needle aspirations do not modify malignancy risk.
abstract: OBJECTIVE
  Thyroid nodules with nondiagnostic (ND) fine-needle aspirations (FNA) typically undergo repeat sampling. While repeat FNA is often diagnostic, little is known regarding the significance of repeatedly ND aspirates. Limited data suggest there is very low, if any, risk of malignancy for repeatedly ND FNAs.
  
  
  METHODS
  We performed a retrospective analysis of ND thyroid FNAs over a nearly 6-year period at our institution to further address this question.
  
  
  RESULTS
  There were 834 ND thyroid FNAs, representing 694 distinct thyroid nodules. Repeat FNA was performed after an initial ND aspirate in 52% of cases (363/694); 19% (70/363) had at least one additional ND diagnosis on repeat FNA. Surgical follow-up was available for 57 cases. Malignancy was identified histologically in 21% (9/42) of nodules after a single ND FNA and in 20% (3/15) of nodules with 2 or more repeatedly ND aspirates. Accounting for all benign cytologic follow-up, the overall risk of malignancy was 4% [12/303; 3.5% (9/255) following a single ND FNA and 6.3% (3/48) after repeated ND FNAs].
  
  
  CONCLUSIONS
  We observed no modification of malignancy risk when repeated FNAs were ND. Clinical management for an ND aspirate should remain repeat aspiration along with clinical and sonographic correlation.
authors.affiliation: Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass., USA.
authors.forename: Vickie Y
authors.initials: VY
authors.lastname: Jo
authors.forename: Paul A
authors.initials: PA
authors.lastname: Vanderlaan
authors.forename: Ellen
authors.initials: E
authors.lastname: Marqusee
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Krane
mesh_terms: D044963:Biopsy, Fine-Needle / Q000706:statistics & numerical data*; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D006801:Humans; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D013961:Thyroid Gland / Q000473:pathology* / Q000601:surgery; D016606:Thyroid Nodule / Q000145:classification / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery