ABSTRACT
ABSTRACT: There is signiˆcant heterogeneity of ˆne-needle aspiration biopsy (FNAB) experience and performance re°ected in the medical literature. Part of this heterogeneity results from indeterminate FNAB diagnoses, especially in normal, hyperplastic, or other benign tissue. The number of indeterminate diagnoses in the many centers that do not report their results can be much higher than the 20−30% reported in the literature. As a consequence, the number of the nodules that are excised still appear excessive. Large-needle aspiration biopsy (LNAB) can reduce the number of surgical operations for benign nodules because it diagnoses as benign about 50% of the nodules with inadequate or indeterminate follicular FNAB ˆndings. These effects are explained by the larger needle size (LNAB vs. FNAB), which is more adequate for the investigation of these nodules. Many molecular and genetic tests have been recently developed and proposed for improving diagnostic accuracy of preoperative FNAB cytology. Among the tissue molecular markers, galectin-3 is the most widely investigated for improving accuracy of preoperative diagnosis of thyroid nodules. LNAB provides a much more abundant and adequate substrate for galectin-3 immunodetection than FNAB. Decision trees and clinical algorithms that assist the evaluation of thyroid nodules with inadequate or indeterminate follicular FNAB ˆndings can include LNAB and galectin-3 immunodetection on LNAB.
