- >4 cm nodules that are cytology class II should have molecular marker testing due to high rate of false negative cytology on big nodules.
- Suspicious thyroid nodules ≥4 cm require diagnostic lobectomy if the moleicular is suspicious regardless of their benign fine needle aspiration results.
- Large nodules need more than just a Class II cytology to avoid surgery. Molecular Classifier should be benign as well.
- Call me for evaluation before you feel safe with a large >4 cm nodule called benign by cytology.
- 310-393-8860 or email to firstname.lastname@example.org.
- Ask for Alicia.
The diagnostic accuracy of fine needle aspiration biopsy (FNAB) seems limited in large thyroid nodules with Bethesda Cat. 2 result. We aimed to determine the incidence of carcinoma with benign cytology and the reason for the high false-positive rate in thyroid nodules ≥4 cm. Methods The records of 103 patients with thyroid nodules ≥4 cm with preoperative cytological diagnosis of Bethesda Cat. 2 who underwent thyroidectomy were consecutively reviewed. Characteristics between patients with malignant vs. benign pathology were compared. Results Forty patients (38.8%) had malignancy. Malignancy was subclassified into follicular variant of papillary thyroid carcinoma (43%), minimally invasive follicular thyroid carcinoma (20.0%), and minimally invasive Hurthle cell thyroid carcinoma (10.9%). Patients with malignant cytology had significantly more suspicious ultrasound findings than those with benign cytology (p = 0.001). Conclusions Preoperative FNAB showed high false-negative rates in patients with thyroid nodules ≥4 cm with benign cytology. These nodules have a high malignancy rate with suspicious ultrasound findings.