SUMMARY One hundred and nineteen patients with thyroid nodules underwent fine needle aspiration cytology. Fifty eight were subsequently shown to have multinodular goitre: 36 had a follicular adenoma; 12 follicular carcinoma; and 13 papillary carcinoma on paraffin section. Morphometry performed on the aspirated cells stained by Papanicolaou and Giemsa methods showed significant differences in mean nuclear area and nuclear perimeter between groups of patients with benign thyroid nodules and those with malignant nodules. The wide variation in the mean nuclear areas and perimeters, however, severely limits the diagnostic use of morphometry in individual aspirates.Fine needle aspiration cytology has been widely used in the assessment of thyroid nodules. Many investigators have shown that the technique is valuable,1`5 but others have emphasised limitations and urged caution.6 Although false positive results are rare, the usefulness of the technique has been limited to some extent by difficulties in distinguishing follicular adenomas and multinodular goitres from well differentiated follicular carcinoma and papillary carcinoma of the thyroid. Even in centres where large numbers of aspirates have been processed over many years,7 8 histologically incorrect diagnosis of malignancy occurs in up to 25% of cases.Computed morphometric methods have been introduced to try to improve the diagnostic yield from fine needle aspirates of the thyroid. Some authors have found this to be useful,9' but others have not.'2 13 These published series used Giemsa stained preparations. As most cytopathologists are familiar with Papanicolaou stained preparations, we present the results of morphometric analysis of both Giemsa and Papanicolaou stained preparations of aspirated cells from thyroid nodules of patients subsequently shown by histology to have multinodular goitre, follicular adenoma, follicular carcinoma, or papillary carcinoma. Material and methods STUDY POPULATIONOne hundred and nineteen patients with thyroid nodules were studied. These included 29 men (mean age 44-9 years) and 90 women (mean age 43-7 years).

Stroke poses a significant burden on healthcare and is the second largest cause of death globally. Both medical and surgical interventions to reduce the risk of stroke in asymptomatic patients have been shown to be effective but identifying the target at risk population is more problematic. Screening for carotid artery stenosis offers one pathway for this, as there is some correlation between risk of stroke and extent of stenosis. Identification of patients who are at risk of cardiovascular disease as well as stroke, allows initiation of effective medical treatment of modifiable risk factors to address this risk. In addition, carotid intima-media thickness is a way of assessing systemic atherosclerosis and may be valuable in risk stratification of patients for cardiovascular disease. Given the low prevalence of stenosis in the general population and the risks associated with undergoing surgical intervention, population wide screening is not recommended. This recommendation has not changed over the last 15 years, since the last major studies evaluating management and outcomes were published. However, both medical and surgical/endovascular treatments have advanced over that time. Further studies are underway to compare current treatments for the appropriate management of both symptomatic and asymptomatic patients with stenosis. Two of these trials, ECST-2 and CREST-2, are expected to be completed in the next 2-4 years and the results may initiate changes in the recommendations. The use of carotid intima-media thickness alongside traditional risk scores is controversial and more research is required in this area.

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This study posits that routine radiological reporting of thyroid incidentalomas, with further investigation when clinically appropriate, is warranted. The results suggest that lesion size and CT characteristics are not reliable criteria to triage patients for investigation/biopsy.

Current limitations in service provision and potential future solutions.