title: Optimal timing for a repeat fine-needle aspiration biopsy of thyroid nodule following an initial nondiagnostic fine-needle aspiration.
abstract: BACKGROUND
  In the case of a nondiagnostic thyroid fine-needle aspiration (FNA) biopsy result, recent guidelines from the Bethesda system recommend repeat thyroid FNA after 3 months to prevent false-positive results. We aimed to examine our institutional data to determine whether the 3-month period affects the diagnostic yield of repeat biopsies.
  
  
  METHODS
  A retrospective review of patient records over a 5-year period at our institution was performed. Patients who required repeat FNA due to nondiagnostic results were included. The time between the FNA biopsies, adequacy of the FNA specimens, as well as the surgical pathology diagnosis were analyzed.
  
  
  RESULTS
  We identified 317 patients who required a repeat FNA. Of these, 96 (30.3%) patients had repeat FNAs less than 3 months after initial biopsy, while 221 (69.7%) patients had repeat FNAs in greater than 3 months. One hundred five patients were referred to our clinic with an initial nondiagnostic biopsy from an outside institution. Repeat FNA was nondiagnostic in 35 patients (11.04%) in the total study population. There was no difference in satisfactory diagnostic yield between repeat FNAs performed greater than 3 months (201 patients, 90.95%) or less than 3 months (81 patients, 84.38%) after the initial biopsy (P = .117). Of the 35 patients with repeat nondiagnostic biopsy, 17 patients underwent diagnostic lobectomy and 3 (17.6%) patients were found to have malignant disease.
  
  
  CONCLUSIONS
  Early (<3 months) repeat FNA does not affect diagnostic yield of the subsequent sample. Patients with suspicious thyroid nodules could therefore receive a repeat FNA as soon as needed, rather than waiting 3 months. The shortened biopsy interval would alleviate stress on patients with benign nodules and expedite surgical intervention in patients with malignancy.
authors.affiliation: Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Deniwar
authors.affiliation: Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA.
authors.forename: AbdulRahman Y
authors.initials: AY
authors.lastname: Hammad
authors.affiliation: Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA.
authors.forename: Daniah Bu
authors.initials: DB
authors.lastname: Ali
authors.affiliation: Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA.
authors.forename: Nuha
authors.initials: N
authors.lastname: Alsaleh
authors.affiliation: Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA.
authors.forename: Maha
authors.initials: M
authors.lastname: Lahlouh
authors.affiliation: Department of Pathology & Laboratory Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Sholl
authors.affiliation: Department of Pathology & Laboratory Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Moroz
authors.affiliation: Department of Otolaryngology, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Aslam
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Thethi
authors.affiliation: Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA. Electronic address: Ekandil@tulane.edu.
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
mesh_terms: D044963:Biopsy, Fine-Needle; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000175:diagnosis; D016606:Thyroid Nodule / Q000473:pathology*; D013997:Time Factors
keywords: Bethesda criteria; Bethesda recommendations; Fine-needle aspiration; Repeat FNA; Thyroid cancer; Thyroid nodule