Risk of thyroid carcinoma in patients treated surgically with assumed benign cytology in Riyadh, Saudi Arabia

OBJECTIVES: This study aimed to report the rate of thyroid malignancy in benign fine-needle aspirations (Bethesda II) at King Abdulaziz Medical City and evaluate the factors that affect false-negative outcomes of FNA. METHODS: All patients referred for thyroidectomy from 2009 to 2019 were reviewed (n = 1968). Only patients with a benign FNA, corresponding to the Bethesda II, were included (n = 384). Information on age, gender, body mass index (BMI), serum thyroid-stimulating hormone, type of surgery and histopathological outcomes were retrieved. RESULTS: Of the sample (n = 384) with an initial benign FNA, 63 patients had a malignancy on postoperative pathological examination, yielding an overall false-negative rate of 16.4%. The most frequently reported histopathological type was papillary thyroid microcarcinomas (n = 52). For the false-negative group, the mean age was 43.8 years (range 21-70 years) with an 84.1% female predominance. The surgical choice for 74% (n = 46) of cases was total thyroidectomy. Age, gender, thyroid function and BMI did not affect the false-negative rate of benign FNA (p > 0.05). CONCLUSIONS: This study found a higher risk of malignancy compared to the literature related to benign FNA. The risk of malignancy should be considered, even with benign FNA.