Isthmectomy: A Conservative Operation for Solitary Nodule of the Thyroid Isthmus

Purpose : To assess the results obtained in patients with nontoxic uninodular goiter confined to the isthmus undergoing isthmectomy.

Methods : Between April 1994 and June 2006, 330 consecutive patients with nontoxic uninodular goiter underwent thyroidectomy at our institution. In 31 patients, lesions were limited to the thyroid isthmus with evidence of benign or undetermined pathology on ultrasound-guided fine-needle aspiration biopsy. Total isthmectomy was performed. Results : Preoperatively, thyroid nodules on ultrasonography were solid in 26 patients and mixed with cystic and solid components in 2. The mean size of nodules was 2.43 (± 0.88) cm. No intraoperative or postoperative complications occurred. Histological examination showed nodular hyperplasia in 29 cases, follicular adenoma in 1 and papillary thyroid carcinoma in 1. The patient with papillary carcinoma underwent bilateral lobectomy 7 days later. A total of 24 patients (77.4%) attended clinical visits at follow-up (mean 70, 57 months). Ultrasonographic scanning revealed thyroid nodules in 17 patients, in 16 of which nodules range from one to five (0.5 to 2 cm in size) and further surgery was not indicated. One patient with a 4-cm nodule and tracheal displacement found at ultrasonography 2 years after isthmectomy had inconclusive results of FNAB. This patient was re-operated for completion thyroidectomy, which was successfully performed without technical difficulties. The detection of recurrent nodules was independent of the time elapsed since thyroid isthmectomy.

Conclusions : These findings document the feasibility and efficacy of isthmectomy in solitary thyroid nodules confined to the isthmus.     

超声引导下颈中间丛阻滞联合甲状腺囊下阻滞用于微波消融甲状腺结节

目的 观察超声引导下颈中间丛阻滞（ICPB）联合甲状腺囊下阻滞用于微波消融甲状腺结节的价值。方法 前瞻性纳入68例单发结节性甲状腺肿患者,随机将其分为干预组（n=34）和对照组（n=34）。对干预组于超声引导下ICPB联合甲状腺囊下阻滞消融,对照组于常规局部浸润麻醉后行甲状腺结节微波消融,对比组间一般资料、术中及术后情况,消融过程及消融后2、4、8及24 h分别记为T1、T2、T3、T4及T5。评价ICPB联合甲状腺囊下阻滞用于微波消融甲状腺结节的价值。结果 最终60例入组,干预组、对照组各30例;干预组患者T1~T3期间心率-血压乘积（RPP）及T1~T4期间视觉模拟量表（VAS）评分均显著低于对照组（P均<0.05）,而T2及T3期间40项恢复质量（QoR-40）评分显著高于对照组（P均<0.05）。干预组术中接受利多卡因者占比及剂量、术后口服对乙酰氨基酚占比及剂量均显著低于对照组（P均<0.05）。干预组术后未见明显并发症,对照组术后4例声嘶、2例呕吐。结论 超声引导下ICPB联合甲状腺囊下阻滞用于甲状腺结节微波消融安全性较高,可提供有效围手术期镇痛。     

Papillary thyroid carcinoma in children: risk factors and complications of disease recurrence

Introduction

Optimal treatment of recurrent papillary thyroid carcinoma (PTC) in children remains controversial. We reviewed our experience with recurrent PTC to better identify children diagnosed with it.

Aims

The objective of this study was to determine the risk factors, optimal treatment, complications, and prognosis of recurrent PTC in children.

Methods

This is a retrospective review of all thyroid resections for children aged 18 years or younger who have PTC at a single institution from 1987 to 1999.

Results

Thirty-six children, 7 boys (19%) and 29 girls (81%), underwent initial cervical exploration for PTC. Lymph node involvement was noted in 25 patients (69%); however, there was no distal disease. An equal number of children underwent subtotal thyroidectomy (n = 18) and total (n = 18) thyroidectomy as their initial operation. Papillary thyroid carcinoma recurrences developed in 17 patients (47%) a median of 7 months (range, 1-43 months) after their initial operation. Recurrence was more common for patients with lymph node involvement (P < .01) and multiple nodules (P < .05) at presentation. Recurrence developed in 5 patients after subtotal thyroidectomy and in 12 patients after total thyroidectomy. Sixteen children with recurrent PTC had a second operation and 6 required a third operation. Total operative complications included 2 patients with permanent hypocalcemia and 1 patient with permanent recurrent laryngeal nerve injury, all of whom had a total thyroidectomy. No patient died; however, 3 continue to harbor disease. Mean follow-up for patients with PTC was 65 months (range, 15 to 144 months).

Conclusions

Thyroid resection combined with selective use of radioactive iodine ablation is a safe and effective treatment for recurrent PTC in children. The best predictors of this recurrent disease are lymph node involvement and multiple thyroid nodules at presentation.     

Purulent Thyroiditis-a Clinical Study of 5 Cases

Between 1 January 1990 and 31 December 2006, 13279 patients were operated on due to various forms of goitre, of which five cases were diagnosed with purulent thyroiditis-one child aged 8, three women and one man all between 35 and 81 years of age. The course of the disease was unusual. In three of the patients cancer was suspected. In all of the patients hard nodules were discovered within the thyroid gland, ultrasonographically heterogeneous and hypo-echogenic, although scintigraphic examination showed “cold” nodules. The child presented regional lymph node enlargement. Except in one case, all patients were apyretic.

The rapid growth of the thyroid gland and symptoms of compression were observed in 2 cases. In one of them, trache-ostomy was required. Fine needle aspiration biopsy of the thyroid gland revealed the presence of profuse purulent infiltration in one case. Neither thyroid dysfunction nor autoimmune changes were detected. A subtotal thyroidectomy was performed in all patients. In the paediatric case, the enlarged lymph nodes were also resected. In 3 cases, thyroid abscess was diagnosed and drained and staphylococcus epidermidis, streptococcus epidermidis and streptococcus pyogenes were found. Microscopic examination proved the presence of aspergillus fumigatus in one case. Antibiotic therapy was applied postoperatively and all the patients recovered.

Conclusions: 1. The clinical course of purulent thyroiditis leads to a diagnostic challenge. The surgical treatment of purulent thyroiditis allows for a faster recovery for the patient.     

甲状腺良性结节微波消融和手术切除临床疗效和安全性对比分析

目的对比分析甲状腺良性结节患者微波消融和手术切除的临床效果和安全性。方法收集100例甲状腺良性结节患者影像和临床资料,其中微波消融术治疗44例53个结节(消融组),外科手术治疗56例60个结节(手术组)。比较2组患者治疗后1、3、6、12个月结节消退率,观察结节体积随时间变化趋势,并比较2组术后不良反应、住院时间等情况。结果消融组治疗后1、3、6、12个月结节消退率分别为54.55%、72.73%、95.45%、95.45%,手术组均为100%,治疗后1、3个月结节消退率消融组低于手术组(P均0.001),治疗后6、12个月结节消退率2组间差异无统计学意义(P均=0.245)。消融组术后结节体积随时间呈下降趋势,6个月前结节体积缩小幅度较大,6个月后结节体积缩小幅度降低。消融组术后甲状腺功能低下发生率低于手术组(P=0.019),血肿、感染、声音嘶哑、甲状旁腺损伤发生率2组间差异无统计学意义(P均0.05)。消融组平均住院时间短于手术组(t=-8.499,P=0.001)。结论微波消融技术治疗甲状腺良性结节能保证疗效,且并发症少、创伤小、住院时间短,其临床应用前景广阔。     

2017版甲状腺影像报告和数据系统诊断甲状腺良恶性结节的价值

目的探讨2017版美国放射学院甲状腺影像报告和数据系统(TI-RADS)在评估甲状腺良恶性结节中的价值。方法采用2017版TI-RADS分类诊断标准,回顾性分析1 039例患者共1 109个甲状腺结节的声像图特征;以粗针穿刺活检或手术病理学结果为金标准,评价2017版TI-RADS对不同类别结节的诊断效能。结果良性结节551个,恶性结节558个;良恶性结节的成分、回声类型、纵横比、边界、有无钙化差异均有统计学意义(P均0.05)。TI-RADS 2～5类结节中,恶性率分别为0、5.45%(3/55)、22.29%(39/175)和58.84%(516/877),差异有统计学意义(P0.001)。以TI-RADS分类≥4为标准,诊断甲状腺恶性结节的敏感度、特异度、准确率、阳性预测值和阴性预测值分别为99.46%(555/558)、9.80%(54/551)、54.91%(609/1 109)、52.76%(555/1 052)和94.74%(54/57)。结论根据2017版TI-RADS分类评估恶性甲状腺结节具有临床应用价值,但特异度较低,分类标准尚需进一步完善。     

甲状腺囊实性皱缩结节临床特点分析

目的 分析甲状腺囊实性结节皱缩的临床特点及皱缩前后的超声和CT影像学特征，提高皱缩后甲状腺结节的诊断准确率。方法 选取2018年6 月至2019年6月在中国医科大学附属第一医院接受超声检查并经细针穿刺细胞学检查或手术后病理学检查证实为良性甲状腺囊实性结节病人41例。分析病人病史，分析结节皱缩前后病灶的大小、形态、回声、边界及钙化等超声图像特征和甲状腺增强CT的影像学特点，描述术中所见情况。结果 41例病人均证实为结节性甲状腺肿。结节皱缩平均经历（11.52±9.56）个月。结节皱缩前最大径平均值（25.6±8.2）mm，皱缩后最大径平均值（10.2±4.1）mm。结节皱缩后均为低回声实性结节，其中35例包膜不完整，29例结节内部可见点状强回声，8例周边及内部出现环状强回声。按照TI-RADS分级系统，结节皱缩前37例为3级，3例为2级，1例4a级；结节皱缩后19例为4a级，22例为4b级。5例行手术治疗病人术前甲状腺增强CT提示结节边缘轻度强化，形成与正常腺体相隔离的不规则条带，结节内部均匀低密度，增强后强化不明显。术中见肿物包膜完整，质地不均，局灶可见胶质或钙化结构。结论 病史的询问和前后超声结果的对比至关重要。皱缩的结节具有一定的超声和CT影像学特征，结合病史可与恶性结节相区分，避免过度的有创性检查及不必要的手术治疗。     

2017年美国放射学会甲状腺影像报告与数据系统鉴别甲状腺良恶性结节

目的 探讨2017年美国放射学会（ACR）推荐的甲状腺影像报告与数据系统（TI-RADS）对鉴别甲状腺良恶性结节的应用价值。方法 回顾性分析经手术病理确诊的497个甲状腺结节的超声资料,采用2017年ACR TI-RADS分类对结节评分和分类,与病理结果对照,采用ROC确定最佳临界评分,计算TI-RADS分类诊断良恶性结节的敏感度、特异度和准确率。评价高年资与低年资医师采用此最佳临界评分诊断甲状腺良恶性结节的效能和一致性。结果 采用2017年ACR TI-RADS分类诊断甲状腺恶性结节的ROC曲线下面积为0.883（P<0.001）,最佳临界评分为5分,敏感度86.22%,特异度78.68%。以TI-RADS评分> 5分归为恶性结节,高年资和低年资医师诊断的敏感度、特异度、准确率分别为78.22%（176/225）、76.47%（208/272）、77.26%（384/497）和77.33%（174/225）、74.26%（202/272）、75.65%（376/497）,二者诊断良恶性结节具有中等一致性（Kappa=0.581）。结论 2017年ACR TI-RADS具有较高临床应用价值,鉴别甲状腺良恶性结节的最佳界值为5分。     

甲状腺结节微波消融术后体温及炎性指标变化规律及其意义

目的观察微波消融(MWA)治疗甲状腺结节后患者体温及炎性指标变化,并探讨其意义。方法选取93例接受MWA治疗的甲状腺结节患者(160枚结节)。测量消融前及消融后30 min、12 h、24 h及48 h时腋下体温;于消融前及消融后24 h检测白细胞(WBC)、中性粒细胞百分比(NEU%)、红细胞沉降率(ESR)、C反应蛋白(CRP)、白细胞介素-1(IL-1)、IL-2、IL-6、IL-8及肿瘤坏死因子(TNF)水平。结果93例均一次性完全消融,消融时间60~862 s,平均(259.11±209.85)s。消融前后各时间点腋下体温总体比较差异无统计学意义(F=0.384,P=0.820)。消融后24 h,患者WBC、IL-6、IL-8、TNF均高于消融前(P均<0.05),消融前后NEU%、ESR、CRP、IL-1、IL-2差异无统计学意义(P均>0.05)。结论MWA治疗甲状腺结节可引起部分炎性因子改变,但程度较轻,术后患者体温轻微波动。     

Expression of bcl-2 in Papillary Thyroid Cancers and its Prognostic Value

Purpose: Papillary thyroid cancer has a good prognosis. This favourable prognosis may be attributed to the apoptotic tendency of the cancer cells. This study aims to evaluate the expression of bcl-2, which is an antidote of apoptosis, and aims to evaluate the value of bcl-2 as a prognostic marker in papillary thyroid cancer. Material-Methods : Bcl-2 expression in the archival materials of 31 patients with papillary thyroid cancer was examined with immunohistochemical methods using bcl-2 and p-53 stains. The results were compared with 31 normal thyroid tissue specimens, which consisted of the contralateral lobes of these patients. The results were then analyzed in accordance with the clinical features of the patients.

Results : Thirty (96.7%) patients of the control group were positive for bcl-2 whilst one (3.3%) was negative. The staining for bcl-2 was positive in 12 (%75) patients with microcarcinomas (p < 0.05) and 13 (86.6%) with papillary cancers (p > 0.05). Two cases of the papillary cancer group were admitted to the hospital with local recurrence (6.4%) and both were positive for bcl-2 (p > 0.05). All cases (4/31), whose MACIS scores were higher than 7 were positive for bcl-2. Twenty-one of 27 cases whose MACIS scores were lower than 7 (77.7%) were positive for bcl-2 (p > 0.05). All tumours of this series were negative for p-53 immunstaining.

Conclusion : The rate of bcl-2 expression in microcarcinomas of papillary thyroid cancer decreases when compared to normal thyroid tissue. This may be an early sign of oncogenesis, and a reason for the favourable prognosis in microcarcinomas. However, bcl-2 cannot be used as a prognostic marker.     

54例隐匿性甲状腺癌诊治的回顾性分析

目的探讨隐匿性甲状腺癌的诊断方法及手术方式.方法：回顾性分析54例隐匿性甲状腺癌患者的临床病理资料,采用SPSS 13.0统计软件进行t 检验、卡方检验及Kaplan-Meier生存曲线分析.结果：超声检查者54例,其中检出微小结节43例,CT检查者27例,其中14例发现甲状腺占位,9例有淋巴结转移;成功随访46例,其中甲状腺腺叶、峡部切除术者（腺叶、峡部切除组）32例,行甲状腺腺叶、峡部切除、改良颈淋巴结清除术（腺叶、峡部切除、淋巴结术组）者14例,死亡4例;腺叶、峡部切除组平均生存时间（84.0±29.5）个月,腺叶、峡部切除、淋巴结术组（75.6±36.8）个月（P=0.486）.结论：辅助检查是隐匿性甲状腺癌的必要诊断方法,手术为治疗隐匿性甲状腺癌的主要手段.     

超声引导下细针穿刺抽吸甲状腺结节标本质量的影响因素

目的 观察超声引导下细针穿刺抽吸（US-FNA）甲状腺结节标本质量的影响因素。方法 选取388例接受US-FNA的甲状腺结节患者（共436个结节）,根据标本背景的血液成分、细胞数目、存留组织框架及细胞破坏程度将其分为诊断优越组（n=325）和非诊断优越组（n=111）,比较其超声特征,主要包括结节最大径、形态、边界、回声、钙化及血供,分析影响US-FNA标本质量的因素。结果 组间甲状腺结节最大径、内部钙化及Adler血供差异均有统计学意义（P均<0.05）。甲状腺结节最大径及钙化为US-FNA标本质量的影响因素（P=0.010、0.002）。结论 超声所见甲状腺结节最大径及钙化为其US-FNA标本质量的影响因素。     

甲状腺疾病射频消融治疗现状与争议

近年来,超声引导下射频消融技术已被应用于甲状腺良性结节及不可手术的复发甲状腺癌。然而,甲状腺疾病的射频消融治疗存有争议。射频消融的操作者在熟练掌握操作技巧、颈部解剖及甲状腺疾病相关的理论基础上更要严格把握其应用指征。甲状腺良性结节的治疗中射频消融不被推荐作为常规手段,无症状者无须行侵入性处理;另外消融技术由于缺乏相关安全性、有效性的循证医学证据,分化型甲状腺癌的治疗中射频消融更不能作为其初始治疗手段,只有当病人病情较重无法手术或身体条件无法耐受手术时,才可将射频消融作为可选方案。甲状腺结节无论良恶性,凡具有手术指征,均应将手术作为首选治疗方案。国内多家甲状腺治疗中心均报道了一批射频消融后甲状腺癌残留再次手术的病例。对于消融后再手术的甲状腺癌病人,由于手术风险难度增加,手术方法可部分参考局部晚期的甲状腺癌病人诊治策略,建议由经验丰富的甲状腺外科医生实施来降低手术并发症发生率。     

Who needs a fine-needle biopsy? A comparison of the ATA and ACR TI-RADS guidelines in a single-centre retrospective study

The 2015 American Thyroid Association (ATA) and 2017 American College of Radiology: Thyroid Imaging, Reporting and Data System (ACR TI-RADS) guidelines are two popular guidelines adopted to stratify sonographic risk of malignancy for thyroid nodules, and to select cases for fine-needle aspiration (FNA). To understand the test performance of the two systems in predicting thyroid malignancy, 164 thyroidectomy cases performed in a regional hospital in Hong Kong between January 2021 and June 2022 were reviewed. Sonographic images of the index nodule in each case were retrospectively classified into different risk categories using the ATA and ACR TI-RADS guidelines, respectively, followed by retrieval of cytological and pathological results, for comparison. The index nodule was proven malignant in 26.8% of cases in the final pathology. There was a strong and positive correlation between the ATA and ACR TI-RADS risk categories assignment (r_s = .931, p < .001). Recommending FNA according to the ATA had a better sensitivity for malignancy than using the ACR TI-RADS (81.8% vs 72.7%), at the expense of a lower specificity (10.8% vs 40.8%). The sensitivity for malignancy of both systems could be further improved if all fluorodeoxyglucose (FDG)-avid nodules were investigated with FNA regardless of sonographic features and size. There was a statistically significant association between “nodules with FDG avidity and nodules recommended for FNA by the ACR TI-RADS guideline” and an eventual malignant thyroid nodule (p = .002).     

年轻女性甲状腺癌的临床分析

目的探讨年轻女性甲状腺癌的临床特点,以期提高对该疾病的诊治水平。方法回顾性分析近10年连续收治的74例年轻甲状腺癌患者的临床资料,术前体检大多数甲状腺结节无质硬和固定的表现。术前患者均行B超检查,其中有61例患者(82.43%)B超示多发性结节;43例行同位素检查,有41例发现甲状腺结节,其中冷、凉和温结节分别为14,18,9例;11例行细针穿刺细胞活检,2例阴性,1例提示细胞有异型,3例提示癌疑,5例提示乳头状癌。结果病理检查70例为甲状腺乳头状癌,3例为滤泡状癌,1例为髓样癌,且大多数患者同时伴有其他甲状腺良性疾病;有28例(37.84%)出现颈部淋巴结转移,与同期中老年女性甲状腺癌颈淋巴结转移率16.46%(27/164)相比,差异有显著性(P<0.05)。有2例于术后3年内因远处转移而死亡。结论年轻女性甲状腺癌患者易发生淋巴结转移;结节的质地和活动度不应作为判断其良恶性的手段;应对B超发现的结节进行细化,对直径>1.0cm的实质性结节建议行手术治疗,对直径>2.0cm的混合性结节须行同位素和细针穿刺细胞活检检查,以免漏诊。     

Value of fluorodeoxyglucose positron emission tomography in characterizing clinically‐significant thyroid carcinomas

Background: Despite the rising incidence of thyroid incidentalomas, their clinical significance remains unclear. The present study aimed to determine whether fluorodeoxyglucose positron emission tomography (FDG‐PET) is associated with a significantly higher risk of clinically‐significant thyroid carcinoma (CSC) in incidentalomas than other non‐functional imaging modalities. Methods: Over a 2‐year period, 89 patients were identified as having a thyroid incidentaloma. All patients had either surgery or fine needle aspiration cytology (FNAC) with a 12‐month follow up to confirm the nature of the incidentaloma. Surgery was carried out for nodules with malignant or indeterminate FNAC result, or those with in a retrosternal location, with size > 4 cm or local symptoms. Results: A total of 21 (23.6%) patients had their incidentaloma detected by FDG‐PET (PET group) and 68 (76.4%) by non‐PET imaging modalities (non‐PET group). Differentiated thyroid carcinoma was confirmed in 18 (20.2%) patients. The rate of malignancy was 61.9% in the PET group and 7.4% in the non‐PET group (P = 0.001). After excluding the occult microcarcinomas, the risk of malignancy reduced to 14.6%, but the difference in malignancy rate became more marked between the PET and non‐PET group (42.9% vs 2.9%, P = 0.001). The maximum standardized uptake value on FDG‐PET was similar between benign and malignant lesions (P = 0.124). Conclusion: The overall risk of CSC in thyroid incidentalomas was 14.6%. Those detected by FDG‐PET were significantly more likely to harbour CSC than those by non‐functional modalities. Incidentalomas with focal FDG uptake should be thoroughly investigated with USG and FNAC.     

Color Doppler Sonography in Cold Thyroid Nodules for Malignancy Prediction

The aim of the present study was to assess the usefulness of thyroid nuclear medicine studies, fine needle aspiration biopsy (FNAB) and color doppler sonography in the evaluation of thyroid nodules. Our study group consists of 81 patients with a solitary hypoactive thyroid nodule or with multinodular goiter having dominant nodule. Perinodular and intranodular blood flow, diameter of inferior thyroid artery and its flow velocity were the parameters measured by color doppler sonography. Also estimation of arterio-venous (A-V) shunt formation was another important parameter indicating the angioneogenesis. Results were not significant to distinguish the malignant and benign thyroid nodules (p > 0.05); 66% (n: 14) of 21 patients who had A-V shunt, had the final diagnosis of thyroid carcinoma. These data revealed sensitivity, specificity, negative and positive predictive values of color doppler sonography in carcinoma diagnosis among the patients with solitary hypoactive nodules or multinodular goiters having dominant nodule, as corresponding: 66%, 100%, 83% and 100%.

In conclusion, arterio-venous shunt detected with color doppler sonography was the only parameter having high predictive value for malignancy. Recent studies on this topic imply that color doppler sonography will take place in algorithm of thyroid nodule evaluation.     

221例甲状腺癌的外科治疗体会

目的 探讨甲状腺癌的诊断和外科治疗方法。方法 回顾性分析我院2003年1月-2007年12月间收治的221例甲状腺癌患者的临床资料。甲状腺次全切除161例，甲状腺全切57例，姑息性手术3例。除3例行姑息性手术外其余所有患者均常规颈部中心区淋巴清扫。结果 术后病理检查证实有淋巴转移者为40．3％（89／221）。术后并发症包括5例短暂喉返神经麻痹，37例短暂低血钙抽搐，1例永久性甲状旁腺功能低下，2例术后颈部血肿。本组患者术前B超检查均发现甲状腺内实性或囊实性低回声结节，其中结节内伴微钙化灶者79例（35．7％）。获得随访187例患者，随访率为84．6％，随访6月～5年，除未分化癌患者术后7月死亡，其余患者均存活。结论 患侧甲状腺＋峡部＋对侧甲状腺大部分切除＋中心区淋巴清扫是甲状腺癌的主要手术方式，术前高频B超检查提示甲状腺结节内沙砾微钙化灶对甲状腺癌的术前诊断有重要意义。     

Standard-radical vs. function-preserving surgery of benign nodular goiter—a sonographic and biochemical 10-year follow-up study

Background  The necessary extent of thyroid resection in benign nodular goiter is under debate. The aim of our study was to compare the long-term outcome of different thyroid resection modes with special interest in the incidence of recurrent nodules and the use of oral thyroid hormone medication. Materials and methods  We performed a follow-up examination of 109 patients (23 men and 86 women) having been operated for benign nodular goiter at our department 10 years ago. Unilateral resections and function-preserving resections of at least one thyroid lobe were classified as function-preserving (FP). Total thyroidectomy, Dunhill’s operation and bilateral subtotal thyroidectomy were rated as standard-radical (STR). On follow-up, we recorded current oral thyroid hormone medication, thyroid function tests and ultrasound of the neck. Results  Seventy-three patients had FP resection (67%), while 36 were STR-operated (33%). The subsequent medical treatment was performed by dedicated endocrinologists (n = 19), internists (n = 11) or primary-care physicians (n = 59). Twenty patients had no medical attendance. Recurrent nodules were found in 13 cases in the FP group (18.6%) vs. 3 cases in the STR group (2.5%; p < 0.001). In both groups, about 80% of patients used thyroid hormone medication 10 years after operation. Conclusion  There was no advantage in thyroid function tests nor lesser medication in the FP group. The risk for recurrent nodules was significantly higher in the FP than in the STR-operated patients. The data of this study have been presented in oral form at the Meeting of the German Endocrine surgeons (CAEK 2006 Duisburg) and at the German Surgical congress (Munich 2007).     

Suspicious thyroid nodules 4 cm require a diagnostic lobectomy regardless of their benign fine needle aspiration results

Background/objectiveThe diagnostic accuracy of fine needle aspiration biopsy (FNAB) seems limited in large thyroid nodules with Bethesda Cat. 2 result. We aimed to determine the incidence of carcinoma with benign cytology and the reason for the high false-positive rate in thyroid nodules ≥4 cm.MethodsThe records of 103 patients with thyroid nodules ≥4 cm with preoperative cytological diagnosis of Bethesda Cat. 2 who underwent thyroidectomy were consecutively reviewed. Characteristics between patients with malignant vs. benign pathology were compared.ResultsForty patients (38.8%) had malignancy. Malignancy was subclassified into follicular variant of papillary thyroid carcinoma (43%), minimally invasive follicular thyroid carcinoma (20.0%), and minimally invasive Hurthle cell thyroid carcinoma (10.9%). Patients with malignant cytology had significantly more suspicious ultrasound findings than those with benign cytology (p = 0.001).ConclusionsPreoperative FNAB showed high false-negative rates in patients with thyroid nodules ≥4 cm with benign cytology. These nodules have a high malignancy rate with suspicious ultrasound findings.