Skip to main content
Log in

Is fine-needle aspiration (FNA) of multiple thyroid nodules justified?

  • Clinical Research
  • Published:
Endocrine Pathology Aims and scope Submit manuscript

Abstract

Background: The clinical management of patients with solitary thyroid nodule is well established; however, the evaluation of patients with multiple thyroid nodules is controversial. The aim of this study was to assess if there is a correlation between the risk of malignancy and number of thyroid nodules.

Design: The study cohort included 2884 patients (2410 females and 474 males) with 3274 thyroid nodules that underwent FNA under ultrasound guidance between November 1997 and April 2004. Multiple thyroid nodules were aspirated in 360 patients; 2 in 332 (291 females, 41 males), 3 nodules in 26 (23 females, 3 males), and 4 nodules in 2 patients (1 female, 1 male). Subsequent information regarding the histological diagnosis was obtained in the cases that underwent surgical excision.

Results: The average age for patients with single or multiple nodules was the same (51 yr). The FNA specimens were diagnosed as benign (n=1663, 51%), neoplasm (n=880, 27%), suspicious for neoplasm or papillary carcinoma (n=234, 7%), malignant (n=187, 6%), and non-diagnostic (n=310, 9%). Surgical excision was performed in 1135 patients: 993 patients with single nodules and 142 patients with multiple nodules. The surgical pathology diagnosis was benign in 656 nodules (52%) and malignant in 596 nodules (48%). In the malignant category 153 tumors were papillary microcarcinoma (<1 cm). Excluding these cases, the malignancy rate was 39% in patients with single nodules, 41% with two nodules, and 21% with three nodules.

Conclusions: The cancer risk is similar for patients with one or two nodules over 1 cm and decreases with three or more thyroid nodules.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med 328(8):553–559, 1993.

    Article  PubMed  CAS  Google Scholar 

  2. Utiger RD. The multiplicity of thyroid nodules and carcinomas. N Engl J Med 352(23):2376–2378, 2005.

    Article  PubMed  CAS  Google Scholar 

  3. Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med 154(16):1838–1840, 1994.

    Article  PubMed  CAS  Google Scholar 

  4. Mazzaferri EL. Thyroid cancer in thyroid nodules: finding a needle in the haystack. Am J Med 93(4):359–362, 1992.

    Article  PubMed  CAS  Google Scholar 

  5. Marqusee E, Benson CB, Frates MC, et al. Usefulness of ultrasonography in the management of nodular thyroid disease. Ann Intern Med 133(9):696–700, 2000.

    PubMed  CAS  Google Scholar 

  6. Belfiore A, La Rosa GL, La Porta GA, et al. Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity. Am J Med Oct 93(4):363–369, 1992.

    Article  CAS  Google Scholar 

  7. Papini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 87(5):1941–1946, 2002.

    Article  PubMed  CAS  Google Scholar 

  8. McCall A, Jarosz H, Lawrence AM, Paloyan E. The incidence of thyroid carcinoma in solitary cold nodules and in multinodular goiters. Surgery 100(6):1128–1132, 1986.

    PubMed  CAS  Google Scholar 

  9. Burch HB, Burman KD, Reed HL, Buckner L, Raber T, Ownbey JL. Fine needle aspiration of thyroid nodules. Determinants of insufficiency rate and malignancy yield at thyroidectomy. Acta Cytol 40(6):1176–1183, 1996.

    PubMed  CAS  Google Scholar 

  10. Burch HB. Evaluation and management of the solid thyroid nodule. Endocrinol Metab Clin North Am Dec 24(4):663–710, 1995.

    CAS  Google Scholar 

  11. Cochand-Priollet B, Guillausseau PJ, Chagnon S, et al. The diagnostic value of fine-needle aspiration biopsy under ultrasonography in nonfunctional thyroid nodules: a prospective study comparing cytologic and histologic findings. Am J Med 97(2):152–157, 1994.

    Article  PubMed  CAS  Google Scholar 

  12. Mazzaferri EL. Solitary thyroid nodule. 1. Clinical characteristics. Postgrad Med 70(1):98–103, 1981.

    PubMed  CAS  Google Scholar 

  13. Mazzaferri EL. Solitary thyroid nodule. 2. Selective approach to management. Postgrad Med 70(1):107–109, 112, 116, 1981.

    PubMed  CAS  Google Scholar 

  14. Gharib H. Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clinic Proc 69(1):44–49, 1994.

    CAS  Google Scholar 

  15. Yamashita H, Noguchi S, Watanabe S, et al. Thyroid cancer associated with adenomatous goiter: an analysis of the incidence and clinical factors. Surg Today 27(6):495–499, 1997.

    Article  PubMed  CAS  Google Scholar 

  16. Tollin SR, Mery GM, Jelveh N, et al. The use of fine-needle aspiration biopsy under ultrasound guidance to assess the risk of malignancy in patients with a multinodular goiter. Thyroid 10(3):235–241, 2000.

    PubMed  CAS  Google Scholar 

  17. Sachmechi I, Miller E, Varatharajah R, et al. Thyroid carcinoma in single cold nodules and in cold nodules of multinodular goiters. Endocr Pract 6(1):5–7, 2000.

    PubMed  CAS  Google Scholar 

  18. Baloch ZW, Hendreen S, Gupta PK, et al. Interinstitutional review of thyroid fine-needle aspirations: impact on clinical management of thyroid nodules. Diagn Cytopathol 25(4):231–234, 2001.

    Article  PubMed  CAS  Google Scholar 

  19. Kini SR. Guides to clinical aspiration biopsy thyroid. 2nd ed. New York, NY: Igaku-Shoin, 1996.

    Google Scholar 

  20. Oertel YC, Oertel JE. Diagnosis of malignant epithelial thyroid lesions: fine needle aspiration and histopathologic correlation. Ann Diagn Pathol 2(6):377–400, 1998.

    Article  PubMed  CAS  Google Scholar 

  21. Pelizzo MR, Bernante P, Toniato A, Fassina A. Frequency of thyroid carcinoma in a recent series of 539 consecutive thyroidectomies for multinodular goiter. Tumori 83(3):653–655, 1997.

    PubMed  CAS  Google Scholar 

  22. Franklyn JA, Daykin J, Young J, Oates GD, Sheppard MC. Fine needle aspiration cytology in diffuse or multinodular goitre compared with solitary thyroid nodules. BMJ 307(6898):240, 1993.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Zubair W. Baloch MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barroeta, J.E., Wang, H., Shiina, N. et al. Is fine-needle aspiration (FNA) of multiple thyroid nodules justified?. Endocr Pathol 17, 61–66 (2006). https://doi.org/10.1385/EP:17:1:61

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1385/EP:17:1:61

Key Words

Navigation