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Am J Surg. 2013 Nov;206(5):778-82. doi: 10.1016/j.amjsurg.2013.04.001. Epub 2013 Jun 24.

Sex variability of fine-needle aspiration reliability in the diagnosis of malignancy in thyroid nodules ≥4 cm.

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  • 1The DeWitt Daughtry Family Department of Surgery, Division of Surgical Endocrinology, University of Miami Leonard M. Miller School of Medicine, 1120 NW 14th Street (M-875), Clinical Research Building, 4th Floor, Miami, FL 33136, USA. Electronic address:



The effect of sex on fine-needle aspiration (FNA) diagnosis of thyroid cancer remains unknown. This study determines the reliability of FNA when evaluating thyroid nodules ≥4 cm in women and men.


Prospectively collected data of 1,068 patients who underwent FNA and thyroidectomy at a tertiary medical center were retrospectively reviewed. Data were stratified by sex and thyroid nodule size ≥4 cm.


The FNA false-negative rate for thyroid malignancy in women and men was 17% and 0%, respectively. FNA was less predictive of malignancy in women (odd ratio = 31.7; 95% confidence interval, 19.2 to 52.5; P < .0001) compared with men (odds ratio = 51.7; 95% confidence interval, 11.8 to 225.1; P < .0001) with thyroid nodules ≥4 cm.


For the diagnosis of malignancy in large thyroid nodules, FNA may be less reliable in women compared with men. This study advocates using a more aggressive approach that includes surgical resection for definitive diagnosis in women with thyroid nodules ≥4 cm.

Copyright © 2013 Elsevier Inc. All rights reserved.


Fine-needle aspiration; Sex; Thyroid nodules ≥4 cm

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