What are the guidelines for fine needle aspiration biopsy (FNAB) in the diagnosis of papillary thyroid carcinoma (PTC)?

Updated: Jun 18, 2020
  • Author: Ponnandai S Somasundar, MD, MPH, FACS; Chief Editor: Neetu Radhakrishnan, MD  more...
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Answer

Although all the guidelines recommend FNAB as the procedure of choice in the evaluation of solid thyroid nodules, there is variance in the size of the nodule as an indication for FNAB. [65, 8, 67]  AACE/AME/ETA indications for FNAB according to size are as follows [67] :

  • Lesions ≥10 mm with high-risk US features
  • Lesions ≥20 mm with intermediate-risk US features
  • Lesions >20 mm with low-risk US features, but that are increasing in size or associated with a risk history and before thyroid surgery or minimally invasive ablation therapy

Other guidelines provide the following recommendations:

  • >0.5 cm in diameter (ATA) [65]
  • >1 cm in diameter (ESMO) [66]
  • ≥1 cm if suspicious sonographic features are present; ≥1.5 cm for moderately suspicious nodules and ≥2.5 cm for mildly suspicious nodules (NCCN) [8]

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