Changing trends in thyroid surgery. 38 years' experience.

Although fine needle aspiration (FNA) of thyroid masses has been performed since the 1950s, only recently has it become a common method of diagnosing thyroid malignancy. To assess the trends in thyroid surgery during the last 38 years at this institution, a retrospective study of the total number of cases during 2-year periods of each decade were reviewed, yielding 509 cases. Results showed that the total number of cases and the type of surgical procedure remained stable until recent years when FNA was more commonly used. For the 1987-1988 period, the total number of cases decreased (from an average of 112 per period in 1950-1981 to 60 in 1987-1988), but the percentage of cases with carcinoma was markedly increased (from 6.3% in 1950-51 to 46.7% in 1987-88). The percentage of total thyroidectomies performed increased due to a preoperative pathological diagnosis afforded by FNA. A decrease in surgical complications was also seen (from an average of 4.5% per period in 1950-1981 to 1.6% in 1987-1988). FNA has been shown to reduce the number of patients requiring surgery, increase the percentage of carcinoma in operative cases, increase the number of total thyroidectomies, and increase the percentage of preoperative pathologic diagnoses.