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Management of the Solitary Thyroid Nodule

The Alfred Hospital, Monash University Endocrine Surgery Unit, Melbourne, Australia.
The Oncologist (Impact Factor: 4.54). 03/2008; 13(2):105-12. DOI: 10.1634/theoncologist.2007-0212
Source: PubMed

ABSTRACT Thyroid nodules are common, with up to 8% of the adult population having palpable nodules. With the use of ultrasound, up to 10 times more nodules are likely to be detected. Increasing numbers of nodules are being detected serendipitously because of the rising use of imaging to investigate unrelated conditions. The primary aim in investigating a thyroid nodule is to exclude the possibility of malignancy, which occurs in about 5% of nodules. This begins with a thorough history, including previous exposure to radiation and any family history of thyroid cancer or other endocrine diseases. Clinical examination of the neck should focus on the thyroid nodule and the gland itself, but also the presence of any cervical lymphadenopathy. Biochemical assessment of the thyroid needs to be followed by thyroid ultrasound, which may demonstrate features that are associated with a higher chance of the nodule being malignant. Fine-needle aspiration biopsy is crucial in the investigation of a thyroid nodule. It provides highly accurate cytologic information about the nodule from which a definitive management plan can be formulated. The challenge remains in the management of nodules that fall under the "indeterminate" category. These may be subject to more surgical intervention than is required because histological examination is the only way in which a malignancy can be excluded. Surgery followed by radioactive iodine ablation is the mainstay of treatment for differentiated thyroid cancers, and the majority of patients can expect high cure rates.

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    • "The method of choice for the diagnostic evaluation of thyroid nodules is fine needle aspiration biopsy (FNAB) (Bennedbaek et al., 1999; Bennedbaek & Hegedus, 2000; Cooper et al., 2006; Schlumberger, 1998). FNAB is both highly sensitive (65 – 98%) and highly specific (72 – 100%) (Gharib & Goellner, 1993; Mazzaferri, 1993; Sherman, 2003), and provides satisfactory diagnostic results in 80% of cases, with an increase of this percentage after a new FNAB (Gharib & Goellner, 1993). In cases of DTC, FNAB has been shown to be particularly useful in the diagnosis of papillary carcinoma (PC). "
    Thyroid and Parathyroid Diseases - New Insights into Some Old and Some New Issues, 03/2012; , ISBN: 978-953-51-0221-2
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    • "Thyroid diseases occur with a marked higher frequency in women than in men. Papillary thyroid carcinoma usually appears during the reproductive age (30-49 years old), in a ratio of three to five females to one male and has the highest incidence in premenopausal women (Ito and Miyauchi 2009; Pinchera 2007; Yeung and Serpell 2008). Thyroid autoimmune diseases are also five to 10 times more common in women than in men (Vanderpump et al. 1995). "
    Basic and Clinical Endocrinology Up-to-Date, 10/2011; , ISBN: 978-953-307-340-8
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    • "Thyroid nodules are a common medical problem, with studies reporting as high as 50% of the population having a thyroid nodule at autopsy [1]. Thyroid nodules are typically asymptomatic and increasingly discovered incidentally during imaging examinations [2] [3]. Although the majority of thyroid nodules are benign, it is clinically important to diagnose the small malignant population from the rest of the asymptomatic benign nodules. "
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    ABSTRACT: The non-surgical diagnosis of thyroid nodules is currently made via a fine needle aspiration (FNA) biopsy. It is estimated that somewhere between 250,000 and 300,000 thyroid FNA biopsies are performed in the United States annually. However, a large percentage (approximately 70%) of these biopsies turn out to be benign. Since the aggressive FNA management of thyroid nodules is costly, quantitative risk assessment and stratification of a nodule's malignancy is of value in triage and more appropriate healthcare resources utilization. In this paper, we introduce a new method for classifying the thyroid nodules based on the ultrasound (US) elastography features. Unlike approaches to assess the stiffness of a thyroid nodule by visually inspecting the pseudo-color pattern in the strain image, we use a classification algorithm to stratify the nodule by using the power spectrum of strain rate waveform extracted from the US elastography image sequence. Pulsation from the carotid artery was used to compress the thyroid nodules. Ultrasound data previously acquired from 98 thyroid nodules were used in this retrospective study to evaluate our classification algorithm. A classifier was developed based on the linear discriminant analysis (LDA) and used to differentiate the thyroid nodules into two types: (I) no FNA (observation-only) and (II) FNA. Using our method, 62 nodules were classified as type I, all of which were benign, while 36 nodules were classified as Type-II, 16 malignant and 20 benign, resulting in a sensitivity of 100% and specificity of 75.6% in detecting malignant thyroid nodules. This indicates that our triage method based on US elastography has the potential to substantially reduce the number of FNA biopsies (63.3%) by detecting benign nodules and managing them via follow-up observations rather than an FNA biopsy.
    Ultrasonics 05/2011; 51(4):425-31. DOI:10.1016/j.ultras.2010.11.008 · 1.81 Impact Factor
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