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[Approach to cytologically-benign recurrent thyroid cysts].

INTRODUCTION
The aim of this study was to determine the incidence of carcinoma in cytologically-benign recurrent thyroid cysts and to evaluate the surgical indications in these patients.


PATIENTS AND METHOD
We reviewed all patients undergoing thyroid surgery between January 1992 and December 2002 for cytologically-benign solitary or dominant cystic nodules in multinodular goiter that recurred after aspiration. Mixed nodules were excluded.


RESULTS
Thirty-four patients (29 women and five men) with a mean age of 43 years (18-76) underwent surgery. Seventy-five percent were solitary nodules and 25% were dominant nodules within a multinodular goiter. The mean number of fine needle aspirations with complete drainage was 2.3 (2-3) per patient with hemorrhagic aspirate in 35%. Total thyroidectomy was performed in multinodular goiters and lobectomy with isthmectomy in solitary nodules. Intraoperative biopsy revealed benign lesions in 91% and was inconclusive in the remainder; no cases of carcinoma were identified. Definitive pathologic findings revealed the nodule to be a papillary carcinoma in 3 patients (8.8%) and occult papillary carcinoma separate from the cyst in 4 patients (11.8%). In all these patients intraoperative biopsy showed benign disease. The risk of malignancy was higher in cysts larger than 3 cm (23% vs 0%; p<0.05).


CONCLUSIONS
Given the incidence of carcinoma, surgical resection should be considered in recurrent cystic thyroid nodules, especially in those larger than 3 cm, regardless cytological study.