细针穿刺活检（FNAB）是甲状腺结节的良好诊断工具，然而，对于巨大结节的假阴性率仍存在争议。许多临床医生建议对直径大于4厘米的结节进行手术切除，因为这会增加恶性风险和假阴性率。本研究旨在通过我们医院的病历，检验这种方法的可行性，并调查直径大于4厘米的甲状腺结节中无可疑细胞学特征的恶性发生率。这是针对首尔世宗医院于2017年1月至2022年8月接受术前FNAB检查的453名患者的回顾性分析。在这453名患者中，有140个结节是良性的，119个结节是不确定的。在259名患者中，最终病理结果被分为良性（149个）和癌性（110个）两组，良性组中恶性发生率为38.9%，不确定组中恶性发生率为55.5%。在这些恶性病例中，研究发现在细胞学上被认为是良性和不确定的结节中，有83%是滤泡状癌和滤泡状乳头状癌变体。术前FNAB在具有直径大于4厘米且无可疑细胞学特征的甲状腺结节患者中具有很高的假阴性率和低诊断准确性，因此，诊断性手术可能是一个考虑的治疗选择。版权所有© 2023 Kang, Kim, Lee, Kim, Lee, Kang, Lee, Jeong, Nam, and Chung.

Fine-needle aspiration biopsy (FNAB) is a good diagnostic tool for thyroid nodules; however, its high false-negative rate for giant nodules remains controversial. Many clinicians recommend surgical resection for nodules >4 cm owing to an increased risk of malignancy and an increased false-negative rate. This study aimed to examine the feasibility of this approach and investigate the incidence of malignancy in thyroid nodules >4 cm without suspicious cytology based on medical records in our center.This was a retrospective analysis of 453 patients that underwent preoperative FNAB for nodules measuring >4 cm between January 2017 and August 2022 at Severance Hospital, Seoul.Among the 453 patients, 140 nodules were benign and 119 were indeterminate. Among 259 patients, the final pathology results were divided into benign (149) and cancerous (110) groups, and the prevalence of malignancy was 38.9% in the benign group and 55.5% in the indeterminate group. Among the malignancies, follicular carcinoma and follicular variants of papillary carcinoma were observed in 83% of the cytologically benign group and 62.8% of the indeterminate group.Preoperative FNAB had high false-negative rates and low diagnostic accuracy in patients with thyroid nodules >4 cm without suspicious cytologic features; therefore, diagnostic surgery may be considered a treatment option.Copyright © 2023 Kang, Kim, Lee, Kim, Lee, Kang, Lee, Jeong, Nam and Chung.