Solitary Thyroid Nodule: Diagnosis and Management

Mazzaferri, Ernest L.; Santos, Edith T. de los; Rofagha-Keyhani, Sedigheh

doi:10.1016/s0025-7125(16)30736-2

Cited by 145 publications

(72 citation statements)

References 162 publications

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“…The great majority of thyroid nodules are benign nodules (BN), less than 5% of them being malignant (carcinomas, CA) (3)(4)(5). While cytological examination of fine needle aspirates (FNAC), due to its high sensitivity and specificity, is the best single test for discriminating malignant thyroid nodules, (6)(7)(8)(9)(10) several studies have been performed to establish the ability of thyroid ultrasonography (US) to differentiate benign from malignant thyroid nodules.…”

Section: Introductionmentioning

confidence: 99%

Role of conventional ultrasonography and color flow-doppler sonography in predicting malignancy in 'cold' thyroid nodules

Rago

Vitti

Chiovato

et al. 1998

European Journal of Endocrinology

327

215

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The aim of the present study was to establish the usefulness of conventional thyroid ultrasonography (US) and color flow-doppler (CFD) sonography in the assessment of 'cold' thyroid nodules. One hundred and four consecutive patients with thyroid nodules who were to undergo surgery were examined by US and CFD before thyroidectomy. Conventional US evaluated the presence of a halo sign, hypoechogenicity and microcalcifications. The vascular pattern on CFD was classified as follows: Type I, absence of blood flow; Type II, perinodular blood flow; Type III, marked intranodular blood flow. On histology, 30 nodules were diagnosed as malignant (carcinoma, CA) and 74 as benign nodules (BN). On US, the echographic pattern most predictive for malignancy was absent halo sign, which was found in 20/30 CA and in 17/72 BN (P ¼ 0.0001; specificity 77.0%; sensitivity 66.6%). The most specific combination on US, absent halo sign/microcalcifications, was found in 8/30 CA and in 5/74 BN (P < 0.005; specificity 93.2%, sensitivity 26.6%). The Type III pattern on CFD was found in 20/30 CA and 38/74 BN (not statistically significant). The combination of absent halo sign on US with Type III pattern on CFD was found in 15/30 CA and in 8/74 BN (P < 0.0001; specificity 89.0%, sensitivity 50.0%). The combination of absent halo sign/microcalcifications on US with Type III pattern on CFD was the most specific combination of the two techniques, being found in 5/30 CA and in only 2/74 BN (P < 0.01; specificity 97.2%, sensitivity 16.6%).In conclusion, findings on US and CFD become highly predictive for malignancy only when multiple signs are simultaneously present in a thyroid nodule. Thus the predictive value of these techniques increases at the expense of their sensitivity. Only in a small proportion of patients with thyroid carcinoma is US and CFD information highly predictive of malignancy.

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Section: Introductionmentioning

confidence: 99%

Role of conventional ultrasonography and color flow-doppler sonography in predicting malignancy in 'cold' thyroid nodules

Rago

Vitti

Chiovato

et al. 1998

European Journal of Endocrinology

327

215

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“…[14,15,16] The primary objective of FNAC of the thyroid lesions is to select those patients who require surgeries for neoplastic thyroid disorders from those who have functional or inflammatory abnormalities and who can be followed clinically or treated medically. [17,18] Statistical evidence strongly suggests that the use of fine needle aspiration biopsy has markedly reduced the numbers of thyroidectomies whereas the proportion of carcinomas in the surgically treated population has increased significantly. [19] AIMS AND OBJECTIVES The hospital-based study was undertaken to identify the cytological patterns of thyroid lesions by FNAC and to correlate the cytological and histopathological diagnosis wherever possible.…”

Section: Introductionmentioning

confidence: 71%

Cytological Patterns of Thyroid Lesions: A Hospital-Based Study

Kumbhakar¹

2016

jemds

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BACKGROUNDDiverse cytological patterns of thyroid lesions may occur in the thyroid gland for its various diseases. The thyroid lesions may be nonneoplastic lesions or neoplastic lesions. Most of the thyroid lesions clinically present as thyroid swellings either as thyroid nodules or as diffuse enlargement of the gland itself. Fine Needle Aspiration Cytology (FNAC) is a rapid, easy to perform, minimally invasive and cost-effective first line high diagnostic accuracy test for cytological evaluation of thyroid lesions with minimum complications. The thyroid gland is easily accessible for Fine Needle Aspiration (FNA) procedure due to its superficial location. The accurate cytological diagnosis of the thyroid lesions can direct the treatment modalities of the lesions and reduce unnecessary thyroid surgeries.

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“…A mudança, provavelmente, ocorreu pelo fato do nódulo colóide conter uma estrutura com grande variação morfológica. Conforme pudemos observar, apenas dois dos 41 pacientes estudados apresentaram todas as estruturas citopatológicas iguais nas duas PAAFs (7,8,(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Discussionunclassified

Valor da repunção aspirativa na doença nodular benigna de tireóide

Brito

Graf

Collaço

2001

Arq Bras Endocrinol Metab

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Arq Bras Endocrinol Metab vol 45 nº 3 Junho 2001 246 RESUMOO presente estudo teve por objetivo verificar se um novo exame de punção aspirativa com agulha fina (PAAF) deve ser realizado em pacientes que já foram submetidos a tal procedimento e tiveram o diagnóstico citopatológico compatível com doença nodular benigna de tireóide. Quarenta e um pacientes com o diagnóstico clínico e laboratorial de bócio nodular foram submetidos a duas PAAFs, com intervalo mínimo de seis meses, e comparados quanto aos seus laudos e características citopatológicas. Além do resultado das punções, foram observadas as seguintes características (média±DP): idade= 44,3±13,1 anos; início do aparecimento do nódulo= 5,1±8,1 anos (mediana= 2,0 anos); volume nodular= 18,6±21,6ml (mediana= 9,6ml) e volume tireoidiano= 42,8±30,8ml (mediana= 33,5ml), ambos baseados na ecografia; captação de 131 I em 24h= 13,2±5,4%; níveis de triiodotironina (T3)= 142,0±34,5ng/dl, de tiroxina (T4)= 8,6±1,5µg/dl, de hormônio tireoestimulante (TSH)= 1,7±1,0mUI/L e de tireoglobulina (TG)= 59,3±47,8ng/ml. O estudo demonstrou predominância do sexo feminino (40 de 41); nódulo misto (23 de 41) e frio (29 de 41), com padrão multinodular (23 de 41). Na avaliação citopatológica, o segundo laudo foi idêntico ao primeiro em 40 de 41 pacientes (97,6%), embora houvessem características citopatológicas distintas em 39 dos 41 pacientes estudados (95,1%), apontando para a própria heterogeneidade do nódulo colóide. Concluímos que a PAAF é um método diagnóstico seguro na doença nodular de tireóide. A não concordância nos detalhes citopatológicos das punções seqüenciais revela a grande heterogeneidade da morfologia do bócio colóide. ABSTRACTThis study aimed to verify whether a new fine needle aspiration (FNA) biopsy should be performed in patients who have already been submitted to the procedure with a cytopathologic diagnosis of benign thyroid nodular disease. Forty-one patients with clinical and biochemical diagnosis of nodular goiter were submitted to two fine needle aspiration biopsies with an interval of at least six months, and compared as to their final results and cytopathologic characteristics. Apart the aspiration biopsies the following characteristics were observed (mean±SD): age= 44.3±13.1y; time from initial detection= 5.1±8.1y (median= 2.0 y); nodule volume= 18.6±21.6ml (median= 33.5ml); thyroid volume= 42.8±30.8ml (median= 33.5ml), both based on echography; 24h 131 I thyroid uptake= 13.2±5.4%; triiodothyronine (T3)= 142.0±34.5ng/dl; thyroxine (T4)= 8.6±1.5µg/dl; thyrotropin (TSH)= 1.7±1.0mUI/L; thyroglobulin (TG)= 59.3±47.8ng/ml. The study showed the predominance of female (40/41), mixed (23/41) and cold nodules (29/41), with a multinodular pattern (23/41). On cytopathologic evaluation, the second result was identical to the initial one in 40 out of 41 patients (97.6%), in spite of distinct biopsy characteristics in 39 of the 41 patients studied (95.1%), pointing to the

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Solitary Thyroid Nodule: Diagnosis and Management

Cited by 145 publications

References 162 publications

Role of conventional ultrasonography and color flow-doppler sonography in predicting malignancy in 'cold' thyroid nodules

Role of conventional ultrasonography and color flow-doppler sonography in predicting malignancy in 'cold' thyroid nodules

Cytological Patterns of Thyroid Lesions: A Hospital-Based Study

Valor da repunção aspirativa na doença nodular benigna de tireóide

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