Although the complications are comparable between the two approaches, conventional thyroidectomy involves less operative time. However, MIVAT offers distinct advantages to selected patients in terms of very good to exellent cosmetic results and reduced postoperative distress.

With the widespread use of sensitive imaging techniques, which include neck visualization, a conspicuous number of thyroid nodules emerge and demand attention. Most lesions are benign, asymptomatic, and do not warrant treatment. In case of cancer diagnosis, most are small, intrathyroidal and indolent neoplasms that can safely be managed conservatively. There is a pronounced need for more cost-effective, risk-adapted approaches to the management of this highly prevalent condition, taking the voice of the patient into consideration. Thus, the present guidelines aim at providing a clinical practice guide for the initial work-up and the subsequent management of adult individuals harbouring thyroid nodules. Importantly, these guidelines are not intended to cover the management of thyroid malignancy. The manuscript and the specific recommendations were developed by reconciling the best available research evidence with the knowledge and clinical experience of the panellists and updates aspects of a number of previous European Thyroid association guidelines.

A silver staining technique was applied to 51 thyroid smears. The numbers of silver‐stained nucleolar organizer regions (AgNORs) were counted, and the mean AgNOR and nuclear area per cell were determined with an image analyzer. The mean AgNOR count per cell was significantly higher in malignant than in benign lesions, but there was a considerable overlap. The mean AgNOR area and the mean SD of the AgNOR area per cell were significantly higher in carcinomas than in benign lesions (P = 10–9 and P = 5 × 10–10, respectively) and there were only two and one benign cases, respectively, of overlap. A strong correlation was observed between the mean AgNOR area and the mean nuclear area (r = 0.88), the former being a better discriminator between benign and malignant lesions. The AgNOR technique may contribute to routine thyroid cytopathology. Diagn Cytopathol 1996;14:140–144. © 1996 Wiley‐Liss, Inc.

In order to determine whether the iodine intake influences the diagnostic power of ultrasound-guided fineneedle aspiration cytology (US-FNAC), patients with nontoxic nodular goiter from an area with sufficient iodine intake (IS) (n 5 938, median iodine excretion [MIE] 5 103 mg/L) and from an iodine-deficient (ID) area (n 5 3601, MIE = 75 mg/L) were investigated. Elevated rates of multinodularity (59.6% vs. 49.6%, p , 0.001), nonpalpable nodules (47.6% vs. 37.3%, p , 0.001) and nondiagnostic US-FNACs (8.8% vs. 5.1%, p 5 0.008), and a lower malignancy rate (1.2% vs. 2.3%, p 5 0.006) were found in the ID area. Follicular tumors were encountered among positive findings. Cytohistologic comparison (ID, n 5 416; IS, n 5 97) revealed that the sensitivity, specificity, and diagnostic accuracy of US-FNAC were similar in the two areas (95.5% vs. 92.3%, 78.3% vs. 71.1%, 82.4% vs. 80.6%, IS vs. ID area, respectively), while a lower malignancy rate and a higher ratio of benign to malignant tumors were observed in the ID than in the IS area (10.1% vs. 22.6%, p , 0.001, and 4.38 vs. 1.50, p , 0.001, respectively).