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FNA before surgery does not influence surgery type, need for more surgery
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Performance of fine-needle aspiration before surgery in patients with a multinodular goiter with compressive symptoms did not influence the type of surgery performed, short-term outcomes or need for subsequent surgeries, according to study findings.
“Current guidelines from the [American Thyroid Association] recommend surgery for patients with a goiter and symptoms related to compression of the trachea or esophagus,” the researchers wrote. “However, there are no guidelines at this time to determine whether these patients, who ultimately require surgery, need a preoperative [fine-needle aspiration] of specific nodules to determine the extent and/or type of surgery.”
Tessey C. Jose, MD, an endocrinologist at the Cleveland Clinic in Weston, Florida, and colleagues evaluated 80 patients with multinodular goiter and compressive symptoms and no prior fine-needle aspiration (FNA) at initial presentation to determine whether FNA before surgery influences the type of thyroid surgery performed, incidence of thyroid cancer or need for successive procedures. Of the participants, 57.5% underwent FNA before surgery and 42.5% were referred to surgery without FNA.
The cytology results of the FNA among those who underwent FNA before surgery were 50% benign, 7% suspicious for malignancy, 13% atypia of undetermined significance/follicular lesion of underdetermined significance, 6.5% malignant, 4% follicular neoplasm and 8.6% nondiagnostic.
Prevalence of malignancy was 54% (41% macrocarcinoma) in the FNA-before-surgery group and 62% (38% macrocarcinoma) in the non-FNA group.
No significant differences were found between the groups for the rate of total/subtotal thyroidectomies, lobectomies/partial thyroidectomies, neck lymph node dissections or rate of subsequent surgeries.
“FNA has become the standard of care, and it is easy for practitioners to fall into an automated reflex of performing an aspiration on patients presenting with a multinodular goiter with or without compressive symptoms,” the researchers wrote. “Our study suggests that presurgical FNA for patients with compressive [multinodular goiter] does not alter surgical management or outcomes at 26 months; therefore, we recommend against this practice.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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