Cutting-needle thyroid biopsy in the pre-operative evaluation of isotopically cold, solitary, solid thyroid nodules

ABSTRACT

A solitary, solid, cold thyroid nodule needs further scrutiny as a significant number of them may be malignant. We evaluated the use of a cutting-needle biopsy in this situation for its safety and utility in reliably differentiating a benign from a malignant lesion. Out of 116 patients with solid, solitary, cold nodules screened initially, 66 had cutting-needle biopsy carried out. These patients were divided into four categories; malignant [n= 4], suspicious [n = 19], benign [n = 39] and inadequate [n=4, excluded from the subsequent analysis] on the cutting-needle biopsy results. All the patients underwent surgical excision of the lesion and the excised material was examined by an independent pathologist, to be divided into benign [n=58] and malignant [n=4] lesions. The second pathologist was unaware of the previous needle biopsy result. Three out of four lesions considered to be malignant on needle biopsy were confirmed to be so. One was a benign lesion. 1 out of 19 suspicious lesions on the needle biopsy turned out to be malignant on subsequent examination, while all 39 benign lesions were confirmed to be so on excision biopsy examination. Considering malignant and suspicious lesions together as "potentially malignant" gives this procedure a sensitivity of 100% and a specificity of 17.4% in detecting malignancy in such thyroid nodules