title: Negative Fine-Needle Aspiration in Patients with Goiter: Should We Doubt It?
abstract: BACKGROUND
  Epidemiologic studies demonstrated higher incidence of thyroid cancer in patients with multinodular goiters compared to the general population. The aim of this study was to evaluate the risk of finding significant thyroid cancer in patients undergoing thyroidectomy for presumed benign disease.
  
  
  METHODS
  The records of 273 patients operated for indications other than cancer or indeterminate cytology were reviewed and analyzed.
  
  
  RESULTS
  202 (74%) patients had a preoperative fine-needle aspiration (FNA) performed. FNA was benign in 96% of patients and non-diagnostic in 4%. Malignancy was unexpectedly found in 50 (19%) patients. Papillary carcinoma constituted 94% of cancers and 86% of cancers were incidental microcarcinomas. Only 7 (2.6%) patients of the entire cohort had tumors greater than 1 cm, of those only 3 had a previous benign FNA (false-negative rate 1.5%).
  
  
  CONCLUSIONS
  The rate of significant thyroid cancer found unexpectedly in resected goiters is extremely low. A negative FNA excludes significant cancer with near certainty.
authors: Department of General Surgery, Rambam Health Care Campus, Haifa, Israel. m_mekel@rambam.health.gov.il.|Technion - Israel Institute of Technology, Haifa, Israel. m_mekel@rambam.health.gov.il.
authors: Michal
authors: M
authors: Mekel
authors: Department of General Surgery, Rambam Health Care Campus, Haifa, Israel. hgilshtein@gmail.com.
authors: Hayim
authors: H
authors: Gilshtein
authors: Department of General Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
authors: Abbas
authors: A
authors: Al-Kurd
authors: Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.|Technion - Israel Institute of Technology, Haifa, Israel.
authors: Bishara
authors: B
authors: Bishara
authors: Department of General Surgery, Hillel Yaffe Medical Center, Hadera, Israel.
authors: Michael M
authors: MM
authors: Krausz
authors: Department of General Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
authors: Herbert R
authors: HR
authors: Freund
authors: Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.|Technion - Israel Institute of Technology, Haifa, Israel.
authors: Yoram
authors: Y
authors: Kluger
authors: Department of General Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
authors: Ahmed
authors: A
authors: Eid
authors: Department of General Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
authors: Haggi
authors: H
authors: Mazeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002648:Child; D003581:Cytodiagnosis; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D005260:Female; D006042:Goiter / Q000175:diagnosis*; D006044:Goiter, Nodular / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D013964:Thyroid Neoplasms / Q000175:diagnosis; D016606:Thyroid Nodule / Q000175:diagnosis; D055815:Young Adult