For the initial examination of patients with thyroid nodules, coarse needle aspiration biopsy may be an appropriate diagnostic tool and may reduce the need for surgery, according to a study in the journal Thyroid. In addition, coarse needle aspiration biopsy showed good diagnostic accuracy for malignancies, a low complication rate, and reduced the need for unnecessary surgery, the researchers said. Dr. JungHwanBaek of the University of Ulsan College of Medicine in South Korea analyzed data from 632 patients (mean age, 50.8 years, 136 men) who had undergone a coarse needle aspiration biopsy at the University of Ulsan College of Medicine from October 2008 to December 2011. The researchers aimed to determine the role of coarse needle aspiration biopsy as a first-line diagnostic tool for the initial detection of thyroid nodules. Coarse needle aspiration biopsies were performed on patients for the following reasons: suspicious ultrasonographic features (n=145), severe calcification (n=118), vascular nodules (n=88), predominance of cystic nodules (n=3), and physician’s habitual preference (n=278). Eight of the 634 biopsies (1.3%) showed a Bethesda classification of 1. A final diagnosis was obtained in 73% of the biopsies, and 26.7% were not adequately followed up after the initial diagnosis of thyroid nodules. 19% of the 211 malignant nodules underwent surgery after diagnosis, and 7.1% of the biopsies showed specific pathologic findings. A total of 254 benign nodules; 9.8% were diagnosed after surgery, 20.1% showed benign results at least twice by fine needle aspiration biopsy and/or coarse needle aspiration biopsy, and 70.1% showed benign results on coarse needle aspiration biopsy 1 year after stable nodule presentation. The final result was determined by crude needle aspiration biopsy in 94.2% of cases and was inconclusive in 5.9% of cases. 30% of diagnoses were malignant. The diagnosis of malignant nodules by gross needle aspiration biopsy had 97.6% diagnostic accuracy, 90% sensitivity, 100% specificity, 100% positive predictive value, and 92.3% negative predictive value. The unnecessary surgery rate was 0.5 percent. The researchers wrote, “This study demonstrated that the diagnostic rate by gross needle aspiration biopsy led to a decrease in the diagnostic rate of the Bethesda classification1, a decrease in the rate of inconclusive results, and an increase in the diagnostic accuracy of the initial detection of thyroid nodules. The positive predictive value of gross needle aspiration biopsy was 100%, thus reducing unnecessary procedures. There were no independent risk factors associated with inconclusive results. These findings suggest that crude needle aspiration biopsy is an excellent diagnostic tool for patients with primary detection of thyroid nodules.”