Study note

Fine-needle aspiration cytology of thyroid nodules

THE CONTEXT
Fine-needle aspiration cytology (FNAC) helps evaluate thyroid nodules selected by their ultrasound appearance, but some diagnoses require histology.

Indications and diagnostic capability

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Perform FNAC, ideally under ultrasound guidance, on all nodules that do not meet a fully benign U2 ultrasound classification.
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FNAC reliably identifies papillary thyroid carcinoma.
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FNAC cannot distinguish benign follicular adenoma from follicular carcinoma because this distinction requires histological criteria, including capsular and vascular invasion.

Value of ultrasound guidance

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FNAC is highly sensitive and specific; ultrasonography improves its performance further.
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For nodules with both cystic and solid components, ultrasound guidance allows the solid element to be targeted for biopsy.
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