In our experience with 121 patients 18 (15 percent)
thyroid nodules studied by needle biopsy were considered indeterminate relative to the presence of a low-grade, well-differentiated
carcinoma. For 11 of the 18 patients, operation was performed with
carcinoma identified in two (18 percent). Although experience reduced this problem, the frequency of
carcinoma justifies operation for patients with indeterminate
thyroid nodules by needle biopsy, unless other factors dictate otherwise. Inadequate results of fine-needle aspiration biopsy requires a determination of
therapy on the basis of other clinical factors. However, permanent disappearance or great reduction in size following aspiration of cystic nodules, repeat biopsy, and biopsy with large needles are important in supporting nonoperative
therapy. The indeterminate and inadequate cases must be considered in assessing reports of the use of needle biopsy of
thyroid nodules. The large size of a
thyroid nodule and previous external
radiation therapy are factors supporting operative treatment. Improved selection of patients with benign
thyroid nodules for
thyroid hormone suppression
therapy is needed--thyroid-releasing
hormone testing may be of help.