Twenty-eight patients with a clinical diagnosis of sinonasal Wegener's granulomatosis were referred for imaging during the period 1990-2001. Of these, 10 had clinical symptoms and signs con ned to the nose and sinuses and 18 had classical systemic Wegener's. The computed tomography (CT) and magnetic resonance (MRI) scans of the series were reviewed by a panel of one otolaryngologist and two radiologists. From the total of 28 patients, 85.7 per cent showed non-speci c mucosal thickening in the nasal cavity or paranasal sinuses, 75 per cent showed evidence of bone destruction, and 50 per cent new bone formation in the walls of the sinus cavities. In addition the orbit was affected in 30 per cent of patients.The diagnosis of systemic Wegener's granulomatosis is made clinically but the condition may present characteristic features on imaging by CT and MRI. In a patient without a history of previous sinonasal surgery, a combination of bone destruction and new bone formation on CT is virtually diagnostic of Wegener's especially when accompanied on MRI by a fat signal from the sclerotic sinus wall. These changes are important diagnostically in localized sinonasal Wegener's granulomatosis where the clinical diagnosis may be uncertain and the cANCA test can be negative.

Salivary gland FNA is crucial in the distinction of non-neoplastic from neoplastic lesions, emphasizing the fact that FNA is an excellent triage tool for surgery. Salivary gland FNA has a high sensitivity and specificity. However, it is important to interpret the cytological diagnoses in the light of clinical findings and imaging. Diagnostic pitfalls are seen in a minority of cases and could potentially be overcome with the help of recently described diagnostic and prognostic markers.

Objective: To compare the outcomes and evaluate the relative risk of thyroid cancer by using the UK thyroid fine-needle aspiration (FNA) cytological diagnostic categories, with the main objective being the clarity of patient management. Study Design: Results of thyroid FNA reported as Thy3a, Thy3f, Thy4, and Thy5 were correlated with histological outcomes. The specificity and positive predictive value (PPV; risk of malignancy) for each reporting category was assessed. Results: Of a total of 873 thyroid FNAs, 237 (27%) were reported as ‘abnormal’: 40 (4.6%) as Thy3a, 119 (13.6%) as Thy3f, 20 (2.2%) as Thy4, and 58 (6.6%) as Thy 5. The final outcomes were available in 136 (57%) cases which underwent surgical resection (25, 60, 55, and 74% of Thy3a, Thy3f, Thy4, and Thy5, respectively). The known outcomes of the Thy3a category were too low to be statistically significant. The specificity and PPV of the Thy3f, Thy4, and Thy5 (equivalent to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) IV, V, and VI) categories were 50, 50, and 100% and 28, 64, and 100%, respectively. The PPV of Thy3f for diagnosis of ‘neoplasms’ (benign and malignant) was 63%. Conclusion: The current thyroid FNA classification system used in the UK, which is comparable to TBSRTC, offers a sound basis for clear communication on which the management of patients with abnormal thyroid FNA findings can be based. Categories Thy3f, Thy4, and Thy5 carry a progressively rising risk of malignancy, justifying their continuing use. Diagnostic category Thy5 ‘malignant’ is robust and can be used as a sure indication of a definitive surgical management.

Thyroid nodules with TIRADS scores 4C and 5 should be considered for single definitive surgery in view of the high malignant rate.