Low false-negative rate of cytology in thyroid nodules >or= 4 cm.

OBJECTIVE To report the results of cytology and histology obtained for a series of systematically resected thyroid nodules >or= 4 cm. METHODS A group of 151 patients with thyroid nodules >or= 4 cm was submitted to surgery despite the cytology result. RESULTS Malignancy was confirmed histologically in 22.5% of the patients. Excluding cases of insufficient material, cytology was benign in only 3/31 carcinomas (90.3% sensitivity). The frequency of malignancy was 35% among nodules with indeterminate cytology (follicular neoplasm), and there was a predominance (77%) of papillary carcinoma. The negative predictive value of benign cytology was 96.4%. CONCLUSIONS The false-negative rate of cytology in thyroid nodules >or= 4 cm does not justify systematic resection of these nodules in asymptomatic patients with benign cytology.