Nondiagnostic thyroid fine-needle aspiration biopsies are no longer a dilemma

Background: Nondiagnostic fine-needle aspiration biopsy (ND-FNAB) of the thyroid leads to unnecessary thyroidectomy. The aims of this study were as follows: (1) to determine the risk of malignancy in ND-FNABs, and (2) to evaluate factors that may identify patients at risk for a ND-FNAB. Methods: A total of 241 patients who underwent FNAB and thyroidectomy were evaluated for factors associated with a ND-FNAB. Results: A total of 215 women and 26 men underwent FNAB and thyroidectomy. ND-FNAs occurred in 51 of 241 (21%) patients. Ultrasound guidance did not reduce the likelihood of a ND biopsy. Patients with nodules greater than 3 cm had more ND-FNAs. Twenty-one of 51 with a ND biopsy underwent a repeat FNAB. Repeat FNAB was ND in 29% of patients. There was malignant disease in 7 of 51 (14%) with a ND-FNAB. Patient age, sex, thyroid function, gland size, multiple nodules, and final pathology were not related to a ND-FNAB (P > .05). Conclusions: Most patients with a ND-FNAB have benign disease and low-risk patients with a ND-FNAB on repeat FNA warrant a more conservative approach.