Evaluation of various types of needle biopsies of the thyroid

Thyroid needle biopsy has been used at the Cleveland Clinic since 1948 in more than 2,000 instances without serious complications. In the years 1979 and 1980, there were 481 needle biopsies performed, and the patients have been followed from 1 to 3 years. One hundred fourteen needle biopsies were with the 18‐gauge needle, 119 were with the fine needle, and 248 were Tru‐cut® biopsies. One hundred fourteen of the patients had 2 kinds of biopsies at the same time, usually Tru‐cut® and fine needle. The Trucut® needle biopsy gave the highest percentage of success in obtaining diagnostic material with only a 4% failure in the hands of the surgeon using it most often. Aspiration with an 18‐gauge needle and fixing the aspirate to form a cell block was found to be a safe and satisfactory way of obtaining material from cysts or nodules too small to be safely and easily sampled by a Tru‐cut® technique. The fine‐needle (ABC) biopsy is safe, simple, and economical and provides material sufficient to diagnose all types of thyroid cancer except the low‐grade follicular type. This limits to some extent the usefulness of the ABC biopsy. Even with Tru‐cut® core biopsies, it is often impossible to distinguish between cellular adenomas and low‐grade adenocarcinomas. Since approximately one‐third will prove to be malignant, surgery is adviced for these patients. The most significant accomplishment of the routine use of needle biopsy in the diagnosis of thyroid nodules has been the diagnosis of malignancy in more than 5% of the patients with nodules. This has permitted us to avoid surgery in 87% of all patients with thyroid nodules. As a result, in the time period reviewed, 21 of the 46 patients (47%) who had thyroid surgery had malignant tumors.