Fine-needle aspiration cytology (FNAC) remains the mainstay in the study of thyroid nodules, with cytologic adequate specimens in almost 85% of cases in expert hands. Apart from the limitation of inadequate samples, there are false negative diagnoses in some cases, particularly in larger (>3 cm) nodules. Considering this, Large-needle biopsy (LNB) could be useful to improve diagnostic precision. We review the pathology reports (PR) of more than 100 patients operated since 2005, in whom LNB had been carried out previously.
Material and methods: We evaluated by LNB 116 thyroid nodules in 114 patients (16 men) aged 1489 years. They included 64 multinodular, one diffuse and 49 uninodular goitres. LNB were carried out with an automated ultrasound guided spring-loaded device of 18G, and two fragments were obtained for each nodule. LNB were classified as follows: Hyperplasic (HYP), Inflammatory (INF), Follicular tumour (FOL), Hürthle cell tumour (HCT), Papillary carcinoma (PTC), Medullary carcinoma (MTC) and others. Surgical specimens (PR) were classified in the same way and then compared.
Results: We found inadequate tissue results in two LNB, one suspicious necrotic tissue showing necrotic CPT in PR. HYP appears in 53 LNB, coincident with nodular hyperplasia in 46 PR, 3 follicular adenomas, three with thyroiditis and one multicentre microscopic CPT. FOL was diagnosed in 15 nodules, two with follicular carcinoma, 10 with adenoma and three hyperplasic. PR included 30 CPT, five of them incidentals, in nodules different of the selected for LNB. LNB diagnosed 21 out of the other 25, being one the necrotic, other HYP in little fragments, and 2 HCT in LNB. Both CMT and one mucoepidermoid carcinoma were correctly identified by LNB.
Conclusion: Our results indicate that LNB could be an useful technique for the evaluation of nodular disease, particularly with high sample accuracy and diagnostic precision.