Nodular Goiter

Invited commentary

“…Although there have been many reports from centers in North America confirming an over 90% accuracy for detecting malignancy when adequate cytology was provided [4][5][6][7][8][10][11][12][13][14][15][16][17], there are diagnostic limitations of needle biopsy [6][7][8]. While needle biopsy is a useful adjunct in the assessment and management of hypofunctioning thyroid nodules, it should not substitute for careful clinical appraisal of each patient to assess the risk of malignancy even in the presence of a negative biopsy [5][6][7][8].…”

“…recent survey [1] indicated that the incidence of thyroid cancer in the United States increased by 50% from 1947 to 1971 and was accompanied by a striking 2 to 4 fold increase in incidence among whites between the ages of 25 and 35 years, probably due to irradiation-related thyroid cancer [2]. Accordingly, the appropriate detection and treatment of thyroid cancer from an estimated background incidence of nodular goiter in North America of between 4-7% of the population [3,4] demands increased precision in the selection criteria for surgery.…”

“…Detection of cancer in thyroid nodules on the basis of palpation, clinical chemistry and hormone biochemical markers, conventional radiological investigations, scintiscanning, echography, and the response to thyroid feeding lacks specificity and has resulted in a low (10-20%) surgical incidence of malignancy [5][6][7][8][9]. From prospective studies involving routine use of fine needle aspiration biopsy following scintiscan and ultrasound assessment of solitary hypofunctioning thyroid nodules, we have concluded that valuable additional direct diagnostic information can be obtained that is not obtainable by any other currently available clinical or laboratory technique short of surgical biopsy [4][5][6][7][8]. Moreover, when ultrasound is not available, the physical characteristics of a hypofunctioning nodule can be directly determined by needle aspiration biopsy while simultaneously obtaining valuable cytologic information [5][6][7][8].…”

“…More details on this case would be of interest. Our experience [4][5][6][7][8] and that of other North American centers [13,14] have not previously recognized tumor implantation following fine needle biopsy.…”

Cytomorphological Profile of Thyroid Lesions on Fine Needle Aspiration Cytology

“…Fine needle aspiration (FNA) cytology plays a pivotal role in screening thyroid lesions, once a clinical suspicion has been set in. Given the high prevalence of nodules, combined with the impracticability of surgically excising all nodules, FNA plays a vital role as a screening test [2,3] . The Bethesda system for reporting of thyroid FNA aims at standardization of reports and makes the cytology report unambiguous and clinically relevant.…”