Indications for FNAB in patients with small thyroid nodules

Are there any indications for fine-needle aspiration biopsy in a patient with a thyroid nodule <1 cm in diameter?

Leonard Wartofsky, MD: The American Thyroid Association (ATA) guidelines indicate that thyroid nodules ≥1 cm should be needled. That is a recommendation. For nodules <1 cm there is still a risk of cancer and one cannot ignore these nodules.

Whether I would needle such a small nodule would depend on the ultrasound features. If such a nodule showed microcalcifications, if it was taller than it is wide, if it had blurring of the margins or increased vascular flow on Doppler evaluation, I would definitely needle such a nodule. I have many patients in my practice with proven thyroid carcinoma that started the evaluation with a small, 5- or 6-millimeter nodule. Such nodules can even present with distant metastases.