The potential impact of needle biopsy on surgery for thyroid nodules

Current techniques with fine and cutting needle biopsies permit greatly improved selection of patients with thyroid nodules for operation. A diagnosis of definite or probable carcinoma was confirmed in 95% of 76 patients, and the addition of the category of indeterminate cellular nodule resulted in an overall frequency of carcinoma in 86%. Therefore, the frequency of operations for benign thyroid nodules was dramatically decreased. Critical for the use of needle biopsy of the thyroid is experience in obtaining an adequate and representative sample of the nodule, as well as in cytologic and histologic interpretation of the tissue. Results of needle biopsy of thyroid nodules should be correlated with clinical findings even though the latter criteria provide a much less accurate index of the need of operation. The frequency of carcinoma in patients selected for operation can be increased from the 15% to 30% experienced in the past to a level of approximately 85% by needle biopsy. Thyroid nodules that are recognized as cellular by needle biopsy, but in which carcinoma cannot be ruled out should be treated surgically. Improved selectivity for operation for thyroid nodules has not yet significantly reduced the total number of patients undergoing operation in our practice. Some thyroid nodules that would have been treated nonoperatively in the past are now recognized as needing surgery. Operative eradication of nodules that have been considered clinically benign and managed as such in the past, but which are now recognized as being actual or possible carcinoma by needle biopsy conceivably will reduce the frequency of anaplastic or invasive carcinoma in the future. Falsenegative results have been recognized in 1% or less of patients. A preoperative diagnosis of thyroid carcinoma by needle biopsy permits an immediate, definitive surgical procedure, and changes the operative approach for such patients. Needle biopsy of thyroid nodules can reduce procrastination in making a decision for a surgical or medical approach to the management of thyroid nodules. Résumé Chez les malades atteints de nodules thyroïdiens, la ponction et la biopsie à l'aiguille sont d'excellents critères d'indication opératoire. Chez 76 malades, un diagnostic certain ou probable de cancer a été confirmé dans 95% des cas; si l'on y ajoute les nodules où le type cellulaire est indéterminé, la fréquence globale des cancers est de 86%. Le nombre d'opérations pour nodules thyroïdients bénins a donc ét