Selection of Patients with Solitary Thyroid Nodules for Operation

Background:Current guidance recommends the use of fine needle aspiration cytology (FNAC) as an essential investigation in patients presenting with a thyroid lump. Current literature suggests that the sensitivity of FNAC in thyroid nodules ranges between 80-90%. However, only very few studies have looked specifically at the sensitivity of FNAC in solely thyroid cancer patients.Aims:The aim of our study was to investigate the value of FNAC as a first-line investigation in patients with thyroid cancer. We aimed specifically to assess the sensitivity of FNAC within this group.Materials and Methods:Patients diagnosed with thyroid cancer between 2000-08 were identified from a local histopathology database. Sixty-seven case notes were retrieved, retrospectively reviewed and analyzed. Analysis included results of FNAC, ultrasound scanning and final histopathological diagnosis.Results:Analysis of the 56 patients who underwent FNAC revealed that a cytological grading of thy3 or greater was only given to 31 cases (55.3%).Conclusion:In this study, FNAC findings of thy3 or greater were reported only in 55.3% of proven thyroid cancer cases. This study highlights the greater diagnostic difficulties of thyroid cancer compared to other thyroid nodules. Our findings suggest that clinicians must interpret the results of this initial investigation with caution and consider the routine use of ultrasound scanning to help guide FNAC.

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“…USS reports were reviewed for any suspicious features of malignancy [Table 2] which may have aided diagnosis. [412–14]…”

Section: Methodsmentioning

confidence: 99%

Investigating the value of fine needle aspiration cytology in thyroid cancer

Mistry

Mani

Murthy

2011

J Cytol

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“…Secondly, even among specialists, disagreements persist on the diagnostic value of FNAB, especially concerning suspicious cytological results and whether or not to operate in the presence of benign cytological findings. North American endocrinologists rely heavily on FNAB results; however, European endocrinologists, especially French ones, perform supplementary testing such as US, and will opt for surgery in cases where there are clinical or US features favouring thyroid malignancies despite benign FNAB results (16,17). These results are in accordance with the study of Hölzer et al (18) on the current patterns of care and disease characteristics for patients with thyroid carcinoma where FNAB of the thyroid is highly recommended in the current Clinical Practice Guidelines available in Germany but FNAB was performed in only 27.4% of the patients.…”

Section: Discussionmentioning

confidence: 99%

Advances in diagnostic practices affect thyroid cancer incidence in France

Leenhardt

Bernier

Boin-Pineau

et al. 2004

European Journal of Endocrinology

204

112

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Objective: To analyse trends in diagnostic practices of thyroid diseases and to relate them to the increase in thyroid cancer incidence in France over time. Design: From 1980 to 2000, a French retrospective multicentric (three endocrinology and three nuclear medicine centres) study of thyroid diseases was conducted on 20 consecutive unselected patients' records, sampled every 5 years in each centre. Methods: Characteristics of the population and diagnosis procedures (thyroid ultrasonography (US), radionuclide scan, cytology and hormonal measurements) were described over time. Changing trends in operated patients and in cancer prevalence were analysed as well as the impact of practices on cancer incidence. Results: The study included 471 patients (82% female, mean age 46.7, range 9-84 years), referred for nodular thyroid diseases (66.7%) or thyroid dysfunctions (33.3%). A significant increase in US (3 to 84.8%) and cytological practices (4.5 to 23%), and a decrease (89.4 to 49.6%) in radionuclide scan procedures were observed over time. Although the proportion of patients undergoing surgery remained constant (24.8%), the prevalence of cancer increased among operated patients from 12.5 to 37% (P ¼ 0.006). In a Cox's proportional hazard model stratified on the clinical characteristics of patients, only the cytological practice, regardless of its results, was significantly associated with the occurrence of cancer: relative risk (RR) ¼ 4.4 (95% confidence interval (CI): 1

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“…In literature, microcalcifi cations are classifi ed as "snowstorm," "peripheral," "fi ne stippled psammomatous (FSP)," "fi ne," and "punctuate" (7, 14,15,16,25,26). All types of microcalcifi cations have been reported as predictive factors for thyroid cancer.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, ultrasonographic fi ndings of thyroid cancers are well described in literature. Calcifi cation, irregular shape, solid hypoechogenity, absence of halo, intranodular hypervascularity and changing margin (blurred or ill-defi ned), alone or in combination of two or more are reported as predictive factors of thyroid cancers (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

Do the calcifications in the thyroid gland predict malignancy?

Güngör¹,

Polat²,

Polat³

et al. 2012

BLL

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Abstract:Background: The purpose of this study was to determine the relationship between calcifi cations in the thyroid gland and malignant thyroid lesions. Methods: From June 2005 -May 2010, 169 patients, who had been operated on for thyroidectomy, were evaluated. The demographic fi ndings were analyzed with regard to ultrasonographic and histopathologic calcifi cations. The relationship between calcifi cations and malignant and benign thyroid lesions was statistically determined by SPSS 10.01 version of Z-test and Chi-square test. Results: Microcalcifi cations were found in 54 patients (31.95 %). Macrocalcifi cation was found in one patient (0.59 %). Malignancy was determined in 29 patients (17.16 %). The rate of malignancy in patients with calcifi cations was 17/55 (30.9 1%). The diagnosis was nodular colloidal goiter in 38 patients (38/55, 69.09 %) with calcifi cations. The rate of calcifi cation in malignant patients was 17/29 (58.62 %). The rate of malignancy in patients without calcifi cation was 12/114 (10.52 %). The difference between the rate of malignancy in patients with calcifi cation and the rate of malignancy in patients without calcifi cation was statistically signifi cant (Z-test, p < 0.001). Conclusion: Microcalcifi cations of the thyroid gland could predict malignant thyroid disease. They should be strictly evaluated by all thyroid cancer diagnostic modalities and surgical treatment should also be considered (Tab. 4, Ref. 29 The high prevalence of thyroid nodules and the risk of malignancy are serious problems in thyroid surgery. Approximately 3 -7 % of adult populations have palpable thyroid nodules; however, only 5 % of clinically detected nodules are malignant (1, 2, 3).Although the incidence of well-differentiated thyroid carcinoma has been reported in up to 36 % in autopsy series, it is proven histopathologically in about 10 % of patients who undergo surgery. Fine-needle aspiration cytology samples are insuffi cient for the diagnosis, and up to 28 % of the patients studied showed nondiagnostic and false positive results (4, 5).Patients with calcifi cations in the thyroid gland are still a clinical dilemma. When a calcifi cation is detected in the gland, a question arises as to whether this is a predictive sign for malignancy or not. Microcalcifi cations were reported in 60 % of malignant nodules (6). The specifi city of microcalcifi cation for malignancy increases in young patients who exhibit single nodules with a snow-storm pattern on ultrasound (7). On the other hand, though the specifi city of microcalcifi cations increase to 95 % for papillary cancer, the sensitivity is low; 29-59 % of papillary carcinomas are seen with microcalcifi cations (8).Calcifi cations may be easily recognized by thyroid ultrasonography (US) or histopathological examination. Although high frequency ultrasound transducers increased the sensitivity of ultrasonography, they are not suffi cient to determine the malignancy. Calcifi cations can be in macro-or microcalcifi cation form. Macrocalcifi cations are great...

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Selection of Patients with Solitary Thyroid Nodules for Operation

Abstract: A combination of the available diagnostic methods provides substantial benefit in the preoperative selection of patients with an isolated thyroid nodule.

Cited by 36 publications

References 24 publications

Investigating the value of fine needle aspiration cytology in thyroid cancer

Investigating the value of fine needle aspiration cytology in thyroid cancer

Advances in diagnostic practices affect thyroid cancer incidence in France

Do the calcifications in the thyroid gland predict malignancy?

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