title: Utility of repeat cytological assessment of thyroid nodules initially classified as benign: clinical insights from multidisciplinary care in an Irish tertiary referral centre.
abstract: BACKGROUND
  Fine needle aspiration biopsy (FNAB) is the tool of choice for evaluating thyroid nodules with the majority classified as benign following initial assessment. However, concern remains about false negative results and some guidelines have recommended routine repeat aspirates. We aimed to assess the utility of routine repeat FNAB for nodules classified as benign on initial biopsy and to examine the impact of establishing a multidisciplinary team for the care of these patients.
  
  
  METHODS
  We performed a retrospective review of 400 consecutive patients (413 nodules) who underwent FNAB of a thyroid nodule at our hospital between July 2008 and July 2011. Data recorded included demographic, clinical, histological and radiological variables.
  
  
  RESULTS
  Three hundred and fifty seven patients (89 %) were female. Median follow-up was 5.5 years. Two hundred and fifty eight (63 %) nodules were diagnosed as benign. The rate of routine repeat biopsy increased significantly over the time course of the study (p for trend = 0.012). Nine Thy 2 nodules were classified differently on the basis of routine repeat biopsy; one patient was classified as malignant on repeat biopsy and was diagnosed with papillary thyroid carcinoma. Eight were classified as a follicular lesions on repeat biopsy-six diagnosed as benign following lobectomy; two declined lobectomy and were followed radiologically with no nodule size increase.
  
  
  CONCLUSIONS
  The false negative rate of an initial benign cytology result, from a thyroid nodule aspirate, is low. In the setting of an experienced multidisciplinary thyroid team, routine repeat aspiration is not justified.
authors.affiliation: Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
authors.forename: Nigel
authors.initials: N
authors.lastname: Glynn
authors.affiliation: Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Hannon
authors.affiliation: Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lewis
authors.affiliation: Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hillery
authors.affiliation: Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Mousa
authors.affiliation: Department of Surgery, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
authors.forename: Arnold D K
authors.initials: AD
authors.lastname: Hill
authors.affiliation: Department Radiology, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
authors.forename: Frank
authors.initials: F
authors.lastname: Keeling
authors.affiliation: Department Radiology, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
authors.forename: Martina
authors.initials: M
authors.lastname: Morrin
authors.affiliation: Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Thompson
authors.affiliation: Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
authors.forename: Diarmuid
authors.initials: D
authors.lastname: Smith
authors.affiliation: Department of Pathology, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
authors.forename: Derval
authors.initials: D
authors.lastname: Royston
authors.affiliation: Department of Pathology, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Leader
authors.affiliation: Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland. amaragha@beaumont.ie.
authors.forename: Amar
authors.initials: A
authors.lastname: Agha
mesh_terms: D044963:Biopsy, Fine-Needle; D005188:False Negative Reactions; D006801:Humans; D007494:Ireland; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology*; D016606:Thyroid Nodule / Q000473:pathology*; D013997:Time Factors
keywords: Fine needle aspiration; Thyroid cytology; Thyroid nodule