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Fine Needle Aspiration of the Thyroid

Fine needle aspiration (FNA) of the thyroid has been utilized as a diagnostic method for 40 years. The main purpose of thyroid FNA is to differentiate nodules that require surgery from those that do not. The sensitivity of thyroid FNA ranges from 65% to 99%, and its specificity 72% to 100%. Ultrasound-guided FNA of the thyroid is recommended, especially for sampling of a small, deep nodule.One to four aspirations suffice in single nodular lesion measuring less than 3 cm in diameter. Although the criteria used to establish specimen adequacy are somewhat controversial, most institutions require the presence of follicular cells. FNA diagnosis of thyroid disease is a clinicocytologic diagnosis, and correlation with clinical findings is mandatory for success. At our institution, diagnostic FNA lesions are subdivided into the following general diagnostic categories: benign, indeterminate, and malignant. Benign lesions include lesions with the diagnosis of benign thyroid nodule, nodular goiter, and thyroiditis. Indeterminate lesions include cellular follicular lesion, follicular neoplasm and Hurthle cell neoplasm. Malignant neoplasms include papillary carcinoma, high-grade follicular carcinoma, medullary carcinoma, anaplastic carcinoma, large cell lymphoma, and metastatic carcinoma. No clinical or laboratory test is sensitive and specific einough to distinguish reliably whether a follicular neoplasm identified on FNA is benign or malignant This position may be changed with the development of molecular approaches to the diagnosis. CD 44v6 and galectin-3 seem to be most promising tumor markers for thyroid malignancies of follicular epithelial cell origin.

Thyroid diseases; pathology; Thyroid neoplasms; pathology; Biopsy; needle; Cytodiagnosis

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