Revamped fine needle aspiration biopsy measures may boost safety, cut costs for older patients

Recent research published in Current Problems in Diagnostic Radiology suggests new strategies in thyroid fine needle aspiration (FNA) to avoid biopsies may be safer and more cost effective in older patients.

In the study, published online March 2, researchers noted thyroid nodules are present in 50 to 60 percent of the population and “biopsy of thyroid nodules in the veteran population is common, and in our experience, these nodules are almost always benign,” wrote Sean D. Raj, MD, with the department of radiology at Baylor University Medical Center and American Radiology Associates in Dallas, and colleagues.

The team conducted a retrospective study of 351 successive all ultrasound-guided FNA of thyroid nodules. The average patient age was 65.7, and 81 percent of participants were male.

Radiologists used the Society of Radiologists in Ultrasound (SRU) Consensus Statement in 2005 to review sonographic patterns and implement a positive predictive value (PPV) of malignancy.

Four sonographic patterns were 100 percent specific for benignity, including “spongiform,” “cyst with a colloid clot,” “giraffe” and “white knight” patterns.

Researchers then implemented a prospective avoidance of 125 FNA lesions marked as a benign pattern over 23 months—nine were malignant, resulting in PPV of 7.2 percent and cost savings of $477,000.

“Implementation of these strategies in this patient population, specifically avoiding biopsy of lesions with sonographic patterns of benignity, is adaptable to other practice settings while improving patient care and optimizing allocation of clinical resources,” wrote Raj et al. “This approach and simple modification to thyroid nodule evaluation will improve diagnostic efficiency and result in a marked decrease in patient morbidity, emotional and physical burdens associated with FNA, and minimize healthcare costs.”