What is the role of fine-needle aspiration biopsy (FNAB) in the diagnosis of thyroid nodule?

Updated: Jan 09, 2018
  • Author: Steven K Dankle, MD; Chief Editor: George T Griffing, MD  more...
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Answer

FNAB has emerged as the most important step in the diagnostic evaluation of thyroid nodules. [15] Data from numerous studies have established FNAB as highly accurate, with mean sensitivity higher than 80% and mean specificity higher than 90%. The accuracy of FNAB in diagnosing thyroid conditions highly depends on the cytopathologist's expertise and experience and the technical skill of the physician performing the biopsy. In addition, FNAB is highly cost-effective compared with traditional workups that heavily depended on nuclear imaging and ultrasonography. Routine use of FNAB in the evaluation of thyroid nodules can reduce the need for diagnostic thyroidectomy by 20-50% while increasing the yield of cancer diagnoses in thyroid specimens by 15-45%.

When FNAB of a thyroid nodule provides adequate cellular material for analysis, the specimen can be assigned into one of several different diagnostic classifications. In an effort to improve the communication and clarity of thyroid cytopathology, the National Cancer Institute convened a conference in 2007 to address the current status of FNAB of thyroid nodules. This conference developed a consensus for terminology known as the Bethesda System for Reporting Thyroid Cytopathology. The recommended thyroid FNAB diagnostic categories in this system include benign, atypia of undetermined significance, follicular neoplasm, suspicious for malignancy, malignancy, and nondiagnostic. [16]


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