Aspirin Increases the Risk of Nondiagnostic Yield of Fine-Needle Aspiration and Biopsy of Thyroid Nodules

[helvella]

Looks like anyone who is going to have a Fine Needle Aspiration and Biopsy of their thyroid needs to consider their medication if they are taking aspirin, wafarin or other antithrombotics or anticoagulants.

Be careful though, as you should not just stop these medicines. Discuss and plan.

However, if you just take the odd aspirin for a headache, then it is reasonable to avoid it.

Eur Thyroid J. 2018 Jun;7(3):129-132. doi: 10.1159/000488451. Epub 2018 May 16.

Aspirin Increases the Risk of Nondiagnostic Yield of Fine-Needle Aspiration and Biopsy of Thyroid Nodules.

Khan TS1, Sharma E2, Singh B2, Jammu B2, Chadha A2, Markanday D2, Wu YY3, Bajaj HS2,4.

Author information

1 Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada.

2 LMC Diabetes and Endocrinology, Brampton, Ontario, Canada.

3 Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, Hawaii, USA.

4 Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada.

Abstract

Background:

The link between the diagnostic yield of thyroid fine-needle aspiration and biopsy (FNAB) in patients taking antithrombotic or anticoagulant medications (AT/AC) remains poorly characterized.

Objectives:

We studied the risk of obtaining a nondiagnostic sample with ultrasound-guided thyroid FNAB in patients taking AT/AC medications.

Methods:

This is a retrospective cohort study using medical rec-ords of 556 patients who underwent thyroid FNAB. All cytology samples were reported using the Bethesda classification. For patients with a nondiagnostic cytology, logistic regression was used to calculate OR for patients taking AT/AC medications. Multivariate regression was used to adjust for potential confounding variables including age, cystic ultrasound features, presence of eggshell calcifications, number of passes performed, cystic aspirate on FNAB, and position of the nodule.

Results:

Out of 556 patients, cytology results were available for 547 patients. Of these, 46 subjects were taking aspirin and 1 was on warfarin. Among the entire cohort, 17.5% of the subjects had a nondiagnostic cytology. Among the patients on AT/AC medications, 34% had a nondiagnostic result compared to 16% for those not taking them (OR = 2.70, p = 0.003). The subgroup of patients taking aspirin had similarly higher odds of a nondiagnostic cytology (OR = 2.78, p = 0.002). These differences remained statistically significant after multivariate adjustment.

Conclusions:

This is the first study to demonstrate a 3-fold independently greater risk of a nondiagnostic FNAB cytology in patients taking aspirin. Our results highlight the importance of evaluating the need for continuation of aspirin in patients undergoing thyroid FNAB as this may impact the diagnostic yield of the procedure.

KEYWORDS:

Aspirin; Diagnostic yield; Fine-need aspiration; Fine-needle aspiration and biopsy; Thyroid nodules

PMID: 30023344

PMCID: PMC6047498 [Available on 2018-12-01]

DOI: 10.1159/000488451

ncbi.nlm.nih.gov/pubmed/300...

[nightingale-56]

Thanks for posting this helvella . I was under the impression that Thyroid Patients should not take Aspirin. Can you clarify this for me please?

[helvella Administrator Thyroid UK in reply to nightingale-56]

You could well be right that it isn't the best thing to take! But the only widespread, and thyroid-specific, warning appears to be:

thyrotoxicosis (may be exacerbated by large doses of salicylates)

And we all know how many people are on contraindicated medicines for a host of reasons from over-riding need through prescriber's ignorance.

There are warnings about issues like clotting disorders which might apply to some.

[nightingale-56 in reply to helvella]

Thanks for this answer. So just need to be careful. I seem to remember seeing something about why we should not have Aspirin on TUK.