Contemporary diagnostic approach to the thyroid nodule

Abstract

Thyroid nodules are common, with an estimated incidence of 5%-10% in the United States. The current gold standard for diagnosis is fine needle aspiration biopsy (FNAB). The incidence of indeterminate diagnoses varies from 10% to 25%. Surgical resection is usually indicated to exclude the diagnosis of cancer in these patients. However, only a minority (about 20%) of indeterminate thyroid nodules actually harbor a malignancy, resulting in surgery for diagnostic purposes alone in many patients. The increased detection of benign nodules and microcarcinomas reinforces the need for improved non-operative methods to differentiate benign from malignant disease and discriminate low-risk from high-risk cancers. In this article we present a current, rational diagnostic approach to the patient with a thyroid nodule, evaluate new advances including thyroid genomic and predictor models, and propose the development of prospective trials to incorporate these new additions into clinical decision making. Given how many questions still exist for patients with thyroid nodules, partnership and collaboration, or the "bench to bedside" concept should find its way into most every thyroid surgeon and endocrinologist's lexicon.

Comparing Clinicopathologic and Radiographic Findings Between TT-UMP, Classical, and Non-Encapsulated Follicular Variants of Papillary Thyroid Carcinomas

“…However, it is estimated that up to 7 % of the general population develops clinically palpable thyroid nodules, the widely used, new, and [27,28]. Most thyroid nodules are benign; thyroid cancer represents only 5-24 % of thyroid nodules.…”

Ultrasound-guided fine-needle aspiration of thyroid nodules: assessment of the ideal number of punctures

“…It is important to remind that among the non diagnostic or inconclusive specimens, the risk for malignancy ranges between 4% and 20% (8,17) and in such cases repetition of FNAB is recommended (1) . Also in relation to the technique itself, it is important to remind that there are diagnostic centers that maintain a pathologist in loco during the performance of the punctures, who verifies whether the collected specimens are appropriate before they are sent to the laboratory.…”

“…FNAB still remains as the main step towards diagnosis of thyroid nodules (8) . One of the main advantages of FNAB lies on the fact that such diagnostic method provides a reliable interpretation of thyroid nodules and many times avoids unnecessary surgeries.…”

“…However, in order to avoid surgery, appropriate cytological material must be obtained by FNAB. Non diagnostic specimens are related to failure in puncture technique (operator error), very small nodules, mixed lesions (cystic/solid contents), fibrotic nodules or insufficient number of cells in the specimen (8) . The most common cause for non diagnostic specimens is the failure in aspirating a sufficient number of cells for diagnosis, which occurs in 1% to 15% of the punctures (13) .…”

“…Thyroid nodules represent a frequent clinical problem characterized by small lesions in the thyroid gland that radiologi-benign disease (1,(5)(6)(7)(8) . FNAB has a low complication risk and is the procedure of choice in the evaluation of thyroid nodules, and has led to a significant reduction in the number of patients submitted to surgery (1,5) .…”