Thyroidcancer is the most common endocrine malignancy in the United States.
Approximately 53,990 new cases are expected to be diagnosed in 2018. Thyroid
nodules are a common clinical finding especially after the increased use of
high resolution imaging such us Ultrasound (US) technology, computed tomography
and magnetic resonance imaging but thyroid nodules have a low risk of malignancy
of between 5 to 10%. Clinical evaluation to diagnose malignancy includes a
careful clinical evaluation, TSH evaluation, a thyroid US exam and a
Fine-Needle Aspiration Biopsy (FNAB) of nodules. Thyroid FNAB is the most
accurate test for determining malignancy and is the recommended diagnostic test
in the initial evaluation of thyroid nodules by the American Thyroid
Association and the American Association of Clinical Endocrinologists .
Thebiopsy technique often uses aspiration to obtain cells or fluid from the
thyroid nodule using a needle attached to a syringe. The conceptual basis of a
fine needle aspiration biopsy is pulling back on the syringe plunger creates a
suction (negative pressure) to aspirate cells from a thyroid nodule into the
needle for cytological examination. A nonscientific survey of the 10
endocrinologists at Boston Medical Center who perform thyroid fine needle
biopsies showed 1 physician use 0-1 milliliter (mL), 4 physicians use 2-3mL, 3
physicians use 4-6mL and 2 physicians use > 6mL of aspiration during a FNAB.
When asked why they used this volume, there was no scientific basis or
knowledge of expert guidelines to support their clinical habit.
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