Introduction: According to the literature, fine needle aspiration biopsy (FNAB) should be the first line test to assess thyroid nodules. The value of fine needle aspiration biopsy in the differential diagnosis of "cold" thyroid nodules is discussed.
Methods: 105 consecutive patients undergoing surgery for solitary cold nodule or a dominant cold nodule in multinodular goiter and having a preoperative fine needle aspiration biopsy, are analysed.
Results: The cytologic results were benign in 48 cases, malignant in 8 cases and indeterminate (follicular neoplasia) in 29. Twenty biopsies were inadequate. Excluding inadequate and indeterminate biopsy results and calculating microcarcinomas (as incidental findings) as "true negative", sensitivity was 56%, specify 94% and accuracy 88%. There was a negative predictive value of 92% and a positive predictive value of 63%.
Conclusions: Fine needle aspiration biopsy is helpful as an additional test. The indication for surgery for a "cold" thyroid nodule must be established in conjunction with clinical findings and other investigation procedures.