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The Value of Fine-Needle Aspiration Biopsy in Nodular Thyroid Disease

Arch Intern Med. 1990;150(11):2409. doi:10.1001/archinte.1990.00390220137034.
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To the Editor. —We read with interest the report by Hamming et al1 on the value of fine-needle aspiration biopsy (FNAB) performed in patients with nodular thyroid disease.

Obviously, there was a large selection bias in this study. Although the authors performed a total of 631 biopsies in 530 patients, they received histologic confirmation in only 169. They further state, "Surgery was performed to confirm or exclude a malignant neoplasm or to remove a nodular goiter for cosmetic or mechanical reasons." The statistical analysis, therefore, does not apply to the general population, but rather to a very select subpopulation that in any event would be sent to surgery and in whom FNAB is superfluous.

The authors state that in the moderate-suspicion group, age less than 20 years was the most important indicator of malignant neoplasm. We find this to be a highly suspicious statement in that within the group


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