Royal College of Surgeons in Ireland
Is repeat fine needle aspiration required in thyroid .....pdf (1.13 MB)

Is repeat fine needle aspiration required in thyroid nodules with initial benign cytology? Results from a large Irish series

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journal contribution
posted on 2022-11-24, 16:55 authored by Hafiz M Zia-Ul-Hussnain, Oratile Kgosidialwa, Carmel Kennedy, Mark Quinn, Emma Dolan, Paul Deignan, Mark SherlockMark Sherlock, Christopher Thompson, Diarmuid SmithDiarmuid Smith, James Paul O'NeillJames Paul O'Neill, Arnold HillArnold Hill, Mary Leader, Helen BarrettHelen Barrett, Cliona Ryan, Frank Keeling, Martina Morrin, Amar AghaAmar Agha

Background : Fine needle aspiration (FNA) cytology is the preferred method for assessing thyroid nodules for malignancy. Concern remains about the rate of false negative results. The primary aim of this study is to investigate the malignancy rate of thyroid nodules initially classified as benign (Thy 2).

Methods: We retrospectively examined 658 nodules in 653 (429 female) patients between January 2013 to December 2017. All FNA biopsies (FNABs) were performed under ultrasound (US) guidance by a radiologist with expertise in thyroid pathology. Nodules were cytologically classified according to the UK Royal College of Pathologists guidelines. Decisions about further management were made at a regular thyroid multidisciplinary meeting. Follow up of the Thy 2 nodules was determined based on clinical and radiological criteria.

Results: The mean age (± SD) was 53.2 (14.6) years. Five hundred out of 658 (76.0%) nodules were classified as Thy 2 (benign) after the first FNAB. Of these thyroid nodules initially classified as benign, 208 (41.6%) underwent repeat FNAB and 9 (1.8%) were surgically removed without repeat FNAB. The remainder were followed up clinically and/or radiologically. Seven (1.4%) of nodules initially classified as Thy 2 were later shown to be or to harbor malignancy after a follow-up of 74.5 (± 19.7) months. Papillary thyroid microcarcinomas were found co-incidentally in two thyroid glands of benign nodules, giving a true prevalence of 5/500 (1.0%).

Conclusions: With a well targeted FNAB, the false negative rate of an initial benign thyroid FNA is very low thus routine second FNAB is not required in patients with a thyroid nodule initially deemed benign. Multidisciplinary input is imperative in informing decision making.



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Published Citation

Zia-Ul-Hussnain HM. et al. Is repeat fine needle aspiration required in thyroid nodules with initial benign cytology? Results from a large Irish series. BMC Endocr Disord. 2022;22(1):102

Publication Date

15 April 2022

PubMed ID



  • Beaumont Hospital
  • Surgery
  • Medicine
  • Pathology
  • Otolaryngology Head and Neck Surgery


BioMed Central


  • Published Version (Version of Record)