Recent experience with preoperative fine-needle aspiration biopsy of thyroid nodules in a community hospital.

HYPOTHESIS The application and reliability of fine-needle aspiration (FNA) biopsy in community hospitals may be less efficacious in the clinical assessment of patients with thyroid nodules than in tertiary referral centers. DESIGN Retrospective review. SETTING One community teaching hospital. PATIENTS One hundred eighty-three patients who underwent thyroidectomy after FNA biopsy. INTERVENTIONS Preoperative FNA biopsy cytopathologic testing and thyroidectomy and postoperative histopathologic testing. MAIN OUTCOME MEASURE Preoperative cytopathologic reports were compared with postthyroidectomy histopathologic reports. RESULTS Thyroid cancer was confirmed postoperatively in 70 patients (38%). An FNA biopsy diagnosis of papillary carcinoma (in 29 patients) correlated with a predictive accuracy of 93% (27 patients). Suspicious for papillary carcinoma (n = 14) correlated with malignancy in 8 patients (57%). Indeterminate follicular lesion (n = 60) correlated with malignancy in 18 patients (30%), of whom 16 (89%) had papillary carcinoma (10 patients had follicular variant) and 2 (11%) had follicular carcinoma. Indeterminate Hürthle cell lesion (n = 20) correlated with malignancy in 7 patients (35%). Atypical cell clusters (n = 5) did not correlate with malignancy. Benign FNA biopsy findings (n = 44) in patients who underwent thyroidectomy for other clinical features correlated with malignancy in 8 (18%). Of 11 patients who underwent thyroidectomy for insufficient number of cells after repeated FNA biopsy attempts, 2 (18%) had carcinoma. CONCLUSIONS The accuracy of an FNA biopsy of thyroid nodules in a community hospital setting is comparable to results from major endocrine referral centers. An indeterminate follicular lesion was the most common FNA biopsy indication for thyroidectomy and correlated with the presence of differentiated thyroid cancers in 18 (30%) of 60 patients.