Thyroid hormone replacement following lobectomy: Long-term institutional analysis 15 years after surgery

BackgroundThe decision to pursue lobectomy versus total thyroidectomy is highly individualized. The rate of thyroid hormone replacement therapy after lobectomy varies considerably (15%–48%) and studies are limited by short-term follow-up. We sought to assess long-term thyroid hormone replacement therapy-requirement for lobectomy.MethodsPatients undergoing lobectomy from January 2005 to July 2010 at an academic institution were reviewed. Demographic, laboratory, pathology, and thyroid hormone replacement therapy use were compared.ResultsIn total, 235 patients were included. The rate of thyroid hormone replacement therapy after lobectomy was 46.8% (110/235). The majority were female (84.7%), with a mean age of 52 ± 1 years, 97% with benign pathology, and the median duration of follow-up was 7.2 years. Among the 110 thyroid hormone replacement therapy, the mean postoperative thyroid stimulating hormone level 9.08 ± 0.96m IU/L and the time to thyroid hormone replacement therapy-initiation was 621 days; 24% started therapy ≥2 years after surgery. There was no difference in age, sex, or malignancy. Hashimoto thyroiditis was diagnosed in 21.8% patients who underwent thyroid hormone replacement therapy versus 8.0% of those without thyroid hormone replacement therapy (odds ratio 3.2; 95% confidence interval, 1.43–6.79; P < .001). On multivariate analysis, only Hashimoto thyroiditis was independently associated with thyroid hormone replacement therapy use (odds ratio 2.88; 95% confidence interval, 1.3–6.6; P = .012).ConclusionWith long-term follow-up, nearly 50% of patients who underwent lobectomy for benign disease required thyroid hormone replacement therapy and nearly one-quarter of these patients not starting until ≥2 years after surgery. Therefore, patients who undergo thyroid lobectomy should be counseled appropriately and thyroid function followed for a minimum of 2 years.     

术前TSH水平与甲状腺结节良恶性关系

目的：探讨血清促甲状腺激素（TSH）浓度与甲状腺结节良恶性的关系。 方法：回顾性分析近3年间收治的421例甲状腺结节患者的临床资料,其中结节性甲状腺肿347例,甲状腺癌74例。比较良恶性甲状腺结节患者血清TSH浓度差异,并分析TSH浓度与甲状腺结节的恶性风险以及甲状腺癌不同病理类型与血清TSH浓度的关系。 结果：甲状腺癌患者血清TSH浓度明显高于结节性甲状腺肿患者[（2.57±3.32）mIU/L vs. （1.67±2.90）mIU/L]（P<0.05）;甲状腺结节的恶性风险随血清TSH浓度的升高而逐渐升高,当TSH>5 mIU/L时,恶性率为50.0%;甲状腺癌不同病理类型间血清TSH浓度无统计学差异（P>0.05）。 结论：甲状腺结节恶性风险随血清TSH浓度的升高而增加,术前血清TSH测定可以作为甲状腺结节良恶性判断的一个辅助性指标。     

Is patient age associated with risk of malignancy in a ≥4 cm cytologically benign thyroid nodule?

BackgroundCurrent data regarding the risk of malignancy in a large thyroid nodule with benign fine-needle aspiration biopsy(FNAB) is conflicting. We investigated the impact of patient age on the risk of malignancy in nodules≥4 cm with benign cytology.MethodsWe performed a single-institution retrospective review of patients who underwent surgery from 07/2008–08/2019 for a cytologically benign thyroid nodule ≥4 cm. The relationship between malignant histopathology and patient and ultrasound features was assessed with multivariable logistic regression.ResultsOf 474 nodules identified, 25(5.3%) were malignant on final pathology. In patients <55 years old, 21/273(7.7%) nodules were malignant, compared to 4/201(2.0%) in patients ≥55. Patient age ≥55 was independently associated with significantly lower risk of malignancy(OR:0.2,95%CI:0.1–0.7,p = 0.011). Increasing nodule size >4 cm and high-risk ultrasound features were not associated with risk of malignancy(OR:1.0,95%CI:0.7–1.4,p = 0.980, and OR:9.6,95%CI:0.9–107.8,p = 0.066, respectively).ConclusionsPatients <55 years old are 3.7-fold more likely to have a falsely benign FNA biopsy in a nodule≥4 cm.     

TSH suppression in the management of thyroid nodules and thyroid cancer

Clinical and experimental data concerning TSH suppression, by giving exogenous thyroid hormone, in patients with goiter and in patients with thyroid cancer show a beneficial effect. In the goiter patients, TSH suppressive therapy seems most effective in young patients with diffuse or newly discovered goiters, in hypothyroid patients, and in patients with chronic lymphocytic thyroiditis or compensatory thyroid hypertrophy after partial thyroidectomy. With TSH suppressive therapy about 2/3 of thyroid nodules become smaller, but only about 5% to 10% disappear. In patients with differentiated thyroid cancer (papillary, mixed papillary-follicular, and follicular), tumor recurrence, tumor progression, and long-term survival all seem to be influenced favorably by TSH suppressive therapy. Experimental investigations demonstrate that both benign thyroid adenomas and differentiated thyroid carcinomas have TSH receptors situated on the plasma membranes. These TSH receptors appear to be coupled to the activation of adenylate cyclase in a one-to-one relationship. Experimental and clinical studies strongly support the use of thyroid hormone both for the treatment of patients after thyroidectomy for thyroid cancer and as prophylaxis to prevent the development of thyroid cancer in high-risk irradiated patients. The dose of thyroxine recommended for adequate TSH suppression is the lowest dose of thyroxine that will completely block the TSH response to TRH (usually 0.2 to 0.25 mg).Supported in part by a grant from the Veterans Administration.     

TSH水平与甲状腺乳头状微小癌之间的关系探讨

目的探讨促甲状腺激素(TSH)与甲状腺乳头状微小癌之间的关系。方法回顾性分析2006年1月至2016年2月手术治疗的341例甲状腺结节患者,根据病理结果分为两组:甲状腺乳头状微小癌组104例,良性甲状腺结节组237例,收集并比较各组临床实验资料。数据分析采用SPSS 19.0统计软件,计量资料采用(x珋±s)表示,患者在年龄、结节直径、TSH浓度、淋巴结转移与TSH关系比较使用t检验;甲状腺乳头状微小癌发生率与TSH的关系采用χ2趋势检验,以P0.05表示差异具有统计学意义。结果甲状腺乳头状微小癌组患者结节直径平均为(1.92±1.13)cm,低于良性甲状腺结节组患者的(2.82±1.44)cm(t=-5.654,P0.05);甲状腺乳头状微小癌组患者TSH平均为(3.01±1.51)μIU/ml,高于良性甲状腺结节组患者的(1.90±1.32)μIU/ml(t=6.836,P0.05),差异均有统计学意义;按照TSH水平分为0.34μIU/ml、0.34~1.00μIU/ml、1.01~2.00μIU/ml、2.01~5.60μIU/ml和5.60μIU/ml,甲状腺乳头状微小癌组发生比例分别为11.76%、14.29%、23.94%、39.06%和53.33%,检验结果显示TSH水平越高其甲状腺乳头状微小癌的发生率越高(χ2=28.783,P0.05);甲状腺乳头状微小癌伴淋巴结转移患者TSH为(5.07±1.31)μIU/ml、明显高于无淋巴结转移患者的(2.83±1.55)μIU/ml,差异比较有统计学意义(t=5.844,P0.05)。结论 TSH可作为预测甲状腺乳头状微小癌风险的指标之一,可为临床诊断提供参考依据。     

超声弹性分级法鉴别诊断甲状腺实性结节的良恶性

目的探讨超声弹性成像分级法在甲状腺实性结节良恶性鉴别诊断中的价值及不同医师之间的诊断一致性。方法 72例(89个)甲状腺实性结节患者接受超声检查,由2名医师以超声弹性成像分级法进行分级,并将分级结果与术后病理结果进行对比研究。结果医师1以超声弹性成像分级法诊断恶性甲状腺结节的敏感度、特异度、准确率、阳性预测值及阴性预测值分别为82.93%(34/41)、83.33%(40/48)、83.15%(74/89)、80.95%(34/42)、85.11%(40/47);医师2分别为85.37%(35/41)、81.25%(39/48)、83.15%(74/89)、79.55%(35/44)、86.67%(39/45)。两名医师诊断一致率为95.55%,Kappa=0.752。结论超声弹性成像分级法对甲状腺实性结节良恶性鉴别诊断具有较好的应用价值,不同医生独立完成弹性成像的一致性较好。     

能谱CT及其联合甲状腺球蛋白检测对良恶性甲状腺结节的诊断价值

背景与目的 甲状腺结节是一临床常见病。其中恶性结节具有较高转移风险,正确判断甲状腺结节性质对于制定治疗方案和改善预后具有重要意义。目前检查方法均存在局限性,本研究通过探讨能谱CT及其联合多种因素对甲状腺结节性质的诊断效能。方法 回顾性分析2018年8月—2021年3月间收治的甲状腺结节患者资料,按纳入与排除标准选择合适的病例,分析良恶性结节患者的人口学因素、影像资料、能谱数据以及甲状腺功能检验结果,筛选其中有差异的指标,并绘制受试者工作特征曲线（ROC）,以曲线下面积（AUC）评价诊断效能。结果 最终纳入151例患者,男46例,女105例,共计224枚结节,其中良性组结节61枚,恶性组结节163枚。良恶性甲状腺结节患者间具有明显差异的指标包括年龄（P<0.001）、甲状腺球蛋白（Tg）（P<0.001）、甲状腺过氧化物酶抗体（P=0.003）和降钙素（P=0.017）;良恶性结节形态学与能谱参数中方面有明显差异的指标包括边界（P<0.001）、钙化（P=0.03）、囊变（P<0.001）、水含量变化率（RC_WC）（P=0.002）。多项因素回归分析结果性显示,无囊变、RC_WC、Tg、年龄均为恶性结节的危险因素（均P<0.05）。能谱CT单独诊断（能谱参数和影像学特征）的灵敏度为55.7%,特异度为94.4%,准确度为91.0%,AUC为0.783;能谱CT联合Tg诊断甲状腺癌的灵敏度为81.0%,特异度为80.9%,准确度为80.9%,AUC为0.850;能谱CT联合Tg与年龄诊断甲状腺癌的灵敏度为85.7%,特异度为84.6%,准确度为84.7%,AUC为0.905。结论 能谱CT对诊断甲状腺结节的良恶性具有一定的价值,通过能谱CT所获得的RC_WC与影像学特征联合Tg检测并结合患者年龄考虑,对诊断甲状腺结节性质有较高的准确度。     

比较超声弹性成像比值法与评分法鉴别诊断甲状腺结节的价值

目的比较超声弹性成像应变率(SR)比值法与评分法鉴别诊断良恶性甲状腺结节的价值。方法对手术病理证实的69例患者共89个甲状腺结节进行超声弹性成像检查,应用评分法及SR比值法分别构建ROC曲线,得出良恶性结节的诊断界点,比较两种方法诊断甲状腺结节的准确率。结果甲状腺良性结节SR比值为2.78±0.77,恶性结节SR值为5.89±4.03,两者差异有统计学意义(P<0.05)。SR比值法和评分法ROC曲线下面积分别为0.916和0.804,SR比值法的诊断准确率高于评分法(P<0.05)。结论 SR比值法鉴别诊断甲状腺良恶性结节具有较好的临床应用价值。     

CEUS判定甲状腺"冷结节"的性质

目的探讨应用CEUS鉴别诊断放射性核素显像表现为＂冷结节＂的甲状腺结节性病变的良恶性的价值。方法回顾性分析115例ECT表现为＂冷结节＂患者的170个甲状腺结节性病变的CEUS表现,判定结节良恶性,并与病理结果相对照。结果 170个甲状腺结节中,39个CEUS表现为不均匀弱增强,诊断为恶性;131个表现为与周围甲状腺实质同步等/高增强或无增强,诊断为良性。CEUS诊断甲状腺恶性结节的敏感度为91.67%（33/36）,特异度为95.52%（128/134）,准确率为94.71%（161/170）。结论 CEUS可用以鉴别诊断放射性核素显像表现为＂冷结节＂的甲状腺结节的良恶性。     

Incidence of thyroid disease in patients with forefoot deformity

BackgroundHallux valgus and lesser toe deformities are common foot disorders with substantial functional consequences. While the exact etiologies are multi-factorial, it is unknown if certain endocrine abnormalities, such as thyroid dysfunction, may be associated with these pathologies. The current study sought to investigate the prevalence of thyroid disease in patients with hallux valgus or lesser toe deformities.MethodsEvery new patient who presented to our institution’s foot and ankle clinic during a three-month time period was given a survey to determine the presence of a known thyroid disorder. The diagnosis for each visit was then recorded. Additionally, a national, publicly available database was queried for patients diagnosed with thyroid disease and concomitant hallux valgus or specific forefoot pathology. Odds ratios for the presence of thyroid dysfunction were then calculated for each patient group.ResultsThree-hundred and fifty initial visit patient surveys were collected, and 74 (21.1%) patients had a known diagnosis of thyroid disease. The most common diagnoses were primary hypothyroidism (n = 61, 17.4%), secondary hypothyroidism (n = 6, 1.7%), thyroiditis (n = 4, 1.1%), and hyperthyroidism (n = 3, 0.9%). Thyroid disease was present in 16 of 26 patients (61.5%) with a diagnosis of hallux valgus (OR 7.3, CI[3.16–16.99], p < 0.0001). Lesser toe deformities, including hammertoes, mallet toes, bunionettes and crossover toes, were also significantly associated with thyroid disease (OR 5.45, CI[1.83–16.26], p < 0.002). The national database revealed 905,924 patients with a diagnosis of a specific forefoot deformity, and 321,656 of these patients (35.5%) had a concomitant diagnosis of a thyroid condition (OR 2.11, CI[2.10–2.12], p < 0.0001).ConclusionsThe current study suggests a significant association between forefoot pathology and thyroid dysfunction, especially hallux valgus and lesser toe deformities. Increased understanding of these correlations may offer an important opportunity in population health management, both in diagnosis and treatment. While further studies with long-term outcomes are necessary, the early diagnosis of thyroid disease may provide an opportunity to predict and potentially alter the course of forefoot pathology.     

Congenital thyroid hemiagenesis with thyroid nodules—Role of TI-RADS to prevent long term thyroid replacement therapy

BackgroundHemi-agenesis of thyroid is a rare congenital condition with the clinical significance lying only in cases where the remnant tissue is affected by a pathology mandating removal of the gland. Henceforth, the hemi-thyroidectomy technically becomes a total thyroidectomy with a need for long term thyroid replacement therapy.Case summaryWe present a series of three cases noted over a period of two years where preoperative imaging evaluation confirmed the developmental abnormality. Further presence of a thyroid nodule in each of these cases posed a specific clinical situation whereby characterization of nodule appeared mandatory for a rational management involving life-long thyroid replacement therapy due to an ‘apparent total thyroidectomy’, if the remnant gland is removed. Ultrasound TI-RADS is a new system for evidence based sub-classification of thyroid nodules enabling both the surgeon and patient to take a streamlined decision about the overall approach for management.ConclusionProspective nodule characterization based on the thyroid image reporting and data system (TI-RADS), enables the surgeon to decide the treatment strategy sparing the patient of the cost and morbidity associated with long term thyroid replacement therapy.     

声触诊组织量化成像技术鉴别诊断甲状腺影像报告和数据系统4类甲状腺结节

目的探讨声触诊组织量化(VTQ)成像技术对甲状腺影像报告和数据系统(TI-RADs)4类结节的良恶性鉴别诊断价值。方法对88个常规超声评价为TI-RADs 4类的甲状腺结节行VTQ检查。比较VTQ与TI-RADs分类的诊断效能。结果 88个TI-RADs 4类甲状腺结节中,良性结节56个,恶性结节32个。以TI-RADs 4b类和4c类诊断为恶性结节,其诊断敏感度、特异度、阳性预测值、阴性预测值及准确率分别为90.63%(29/32)、57.14%(32/56)、54.72%(29/53)、91.43%(32/35)及69.32%(61/88)。甲状腺恶性结节VTQ值[(3.26±0.94)m/s]明显高于良性结节VTQ值[(2.03±0.61)m/s,t=7.082,P0.001]。VTQ的最佳诊断界值为2.795m/s,其诊断甲状腺结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为78.13%(25/32)、91.07%(51/56)、83.33%(25/30)、87.93%(51/58)及86.36%(76/88)。VTQ值诊断TI-RADs 4类甲状腺结节良恶性的特异度及阳性预测值明显高于TI-RADs分类(P均0.05)。结论 VTQ技术有助于TI-RADs 4类甲状腺结节的良恶性鉴别诊断,值得临床推广。     

超声引导下细针穿刺抽吸活检诊断甲状腺结节

目的探讨超声引导下细针穿刺抽吸活检(US-FNAB)对不同大小甲状腺结节的诊断价值。方法回顾分析在我院接受US-FNAB检查的689例患者736个甲状腺结节,超声测量结节最大径,并将其分为<5mm、5～10mm、>10mm组;对结节US-FNAB细胞学诊断结果与术后病理结果或随访结果进行比较,分析组间差异。结果 736个结节中,细胞学诊断恶性132个,可疑恶性61个,良性476个,不满意44个,不确定23个。经术后病理或临床随访,恶性结节208个,良性结节528个。恶性结节最大径小于良性结节(P<0.001)。5～10mm组结节的细胞学阳性率和实际恶性率均大于<5mm组及>10mm组(P均<0.05)。US-FNAB细胞学诊断甲状腺良恶性结节的敏感度为87.02%(181/208),特异度97.73%(516/528),准确率94.70%(697/736)。不同大小甲状腺结节US-FNAB检查的诊断敏感度、特异度、阳性预测值、阴性预测值及准确率差异均无统计学意义(P均>0.05)。结论 US-FNAB是判断甲状腺结节性质的有效手段,对不同大小结节都有较高诊断价值。     

甲状腺影像报告与数据系统、声触诊组织量化技术及超声造影鉴别诊断甲状腺结节良恶性

目的探讨甲状腺影像报告与数据系统(TI-RADS)分类、声触诊组织量化(VTQ)技术及CEUS对甲状腺结节良恶性的鉴别诊断价值。方法对66例患者69个结节均于术前进行TI-RADS分类、CEUS,观察并分析其CEUS表现。采用VTQ测定结节剪切波速度(SWV),绘制ROC曲线获得SWV的曲线下面积及最佳临界值。计算3种方法单独及两两联合的敏感度、特异度、阳性预测值、阴性预测值及准确率。结果 69个甲状腺结节中,良性37个,恶性32个。3种方法单独诊断时,VTQ诊断甲状腺恶性结节的敏感度最高[87.50%(28/32)],CEUS特异度最高[91.89%(34/37)],两两联合应用时,VTQ和CEUS联合诊断甲状腺恶性结节的敏感度最高[93.75(30/32)]。SWV以2.55 m/s为最佳临界值,ROC曲线下面积为0.808(P0.01)。结论 3种方法均对诊断甲状腺结节良恶性有一定价值,VTQ联合CEUS的敏感度最高,是鉴别甲状腺结节良恶性的可靠检查手段。     

Thyroid lobectomy for indeterminate FNA: not without consequences

Background

Thyroid nodules are exceedingly common, and the cytologic interpretation of fine needle aspiration (FNA) findings has been the reference standard for diagnosing nodules as benign, atypia or a follicular lesion of undetermined significance, suspicious for follicular or Hürthle cell neoplasm, suspicious for malignancy, or malignant. Many patients undergo thyroid lobectomy for indeterminate FNA findings (atypia or a follicular lesion of undetermined significance or suspicious for follicular or Hürthle cell neoplasm), although the risk of malignancy is low. The general data have quoted a 20% risk of hypothyroidism after lobectomy. The purpose of the present study was to determine the risk of hypothyroidism after lobectomy in our diverse population.

Methods

The pathology records from a large county hospital were reviewed to identify patients with indeterminate FNA findings. The incidence of hypothyroidism was determined by the need for thyroid hormone replacement therapy. Categorical variables were compared using the chi-square and continuous variables using the Mann-Whitney U test.

Results

A total of 655 FNAs were performed during the study period, and 60 resulted in indeterminate cases. Of these 60 patients, 17 subsequently underwent diagnostic lobectomy. The mean age was 52.8 ± 16.5 years, 88% were women, and 67% were Hispanic and 22% were African American. Only 6% had a final diagnosis of cancer, and eight patients (47%) became hypothyroid postoperatively.

Conclusions

The incidence of hypothyroidism after diagnostic thyroid lobectomy in our patient population was much higher than previously reported. It is necessary to preoperatively counsel patients about this increased risk, in addition to the usual risks of nerve palsy and bleeding, with thyroid lobectomy. As testing of thyroid nodules evolves, the expense of preoperative testing should be weighed against the increased incidence for lifelong thyroid hormone replacement.     

The final outcome of indeterminate cytology of thyroid nodules in a District General Hospital

Background

Diagnostic thyroid lobectomy is performed to resolve the dilemma of indeterminate (Thy3) cytology of thyroid nodules. But on final histology most nodules are benign thereby subjecting this group of patients to surgery with its associated risks.

Aim

To determine the proportion of cancers in patients with indeterminate thyroid nodules.

Patients and methods

This is a retrospective observational study of 621 patients who underwent fine needle aspiration cytology (FNAC) of their thyroid nodules over a 60 month period in a district general hospital. Patient demographics, cytology and final histology results were extracted from the hospital database.

Results

On final analysis, 48 patients had an indeterminate cytology (7.7%) and 12 patients had cancer in this group (25%) following diagnostic lobectomy.

Conclusion

Till an alternative robust technology becomes widely available we need to continue to perform diagnostic lobectomy in patients with indeterminate cytology in view of the high incidence of thyroid cancer in this group of patients.     

超声造影鉴别诊断甲状腺良恶性结节

目的探讨CEUS鉴别诊断甲状腺良恶性结节的价值。方法回顾性分析62例患者67个甲状腺结节的CEUS表现。结果甲状腺恶性结节CEUS多表现为不均匀增强、边界不清,甲状腺良性结节多表现为周边环状强化。根据不均匀强化诊断恶性结节的敏感度为86.84%,特异度为44.83%,阳性预测值为67.35%,阴性预测值为72.22%;边界不清诊断恶性结节的敏感度81.58%,特异度65.52%,阳性预测值75.61%,阴性预测值73.08%;环状强化诊断良性结节的敏感度41.38%,特异度97.37%,阳性预测值92.31%,阴性预测值68.52%。结论 CEUS对鉴别诊断甲状腺良恶性结节具有一定价值。     

甲状腺良性结节手术后复发的再治疗

目的 探讨甲状腺良性结节手术后复发的相关因素和再治疗原则。方法 对我院18年中51例甲状腺良性结节手术后临床复发者的病理、手术适应证、术式以及再治疗进行回顾性分析。结果 甲状腺良性结节手术后复发与病变性质、单发或多发、手术适应证的掌握及术式的选择密切相关。51例复发者中结节性甲状腺肿29例,甲状腺瘤22例;其中行结节摘除21例,腺叶部分切除16例,一侧腺叶次全切除9例,一侧腺叶切除5例。再手术38例,行一侧腺叶切除19例,一侧叶切加对侧次全切除3例,一侧次全切除7例,双侧次全切除9例;无严重手术并发症。随访32例再手术者,平均7年,仅1例结节性甲状腺肿再复发。结论 对甲状腺瘤和结节性甲状腺肿的正确诊断、明确病变的单发或多发,严格掌握多发性结节性甲状腺肿的手术适应证,并废弃结节摘除和腺叶部分切除术可降低复发率和再手术率。     

Low-risk differentiated thyroid cancer: The need for selective treatment

Background: The well recognized prognostic factors in differentiated carcinoma of the thyroid are age, grade, extracapsular extension, distant metastasis, and size of the tumor. Based on these prognostic factors, we have divided patients into low-, intermediate-, and high-risk categories. Clearly, there are significant differences in these three groups. This article analyzes in depth our data on low-risk thyroid cancer patients. Methods: A retrospective review of 1,038 patients with differentiated carcinoma of the thyroid was undertaken. Various prognostic factors and risk groups were analyzed. Univariate and multivariate analyses were performed, and the survival curves were plotted by the Kaplan-Meier method. The inclusion criteria for the low-risk group were age younger than 45 years, tumors <4 cm in size, low-grade histology, absence of distant metastasis, and absence of extrathyroidal extension. There were 465 patients in the low-risk group. Four hundred three patients had papillary and 62 patients had follicular thyroid cancer. There were 120 male and 354 female patients. Two hundred seventy-eight patients (60%) presented with clinically apparent lymph node metastasis. Results: With a median follow-up of 20 years, the 10- and 20-year survival in this select group was 99%. The local, regional, and distant recurrence rates were 5, 9, and 2% in this series. The analysis of the data showed statistical difference in local recurrence rate between partial lobectomy and total lobectomy (27 vs. 4%; p=0.005). There was no statistical difference in local recurrence rate between total lobectomy compared with total thyroidectomy (4 vs. 1%; p=0.10). The overall failure rate between partial lobectomy and total thyroidectomy (27 vs. 8%) was statistically significant (p=0.04). There was no statistical difference in the overall failure rate between total lobectomy and total thyroidectomy (13 vs. 8%; p=0.06). There was no survival difference between various histologies or nodal status. Conclusions: Patients with low-risk tumors have excellent long-term survival. Nodulectomy or partial lobectomy should be avoided. The intraoperative decisions regarding the extent of thyroidectomy should be based on gross clinical findings and risk group analysis.This work was presented at the 49th Annual Cancer Symposium of the Society of Surgical Oncology, Atlanta, GA, U.S.A., March 21–24, 1996.     

False-negative fine-needle aspiration of thyroid nodules cannot be attributed to sampling error alone

BackgroundThe goal of this study was to determine whether sampling error was the major cause for false-negative fine needle aspiration (FNA) results for thyroid nodules.MethodsPatients who underwent preoperative FNA between 1994 and 2008 were identified, and the results were compared with surgical pathology findings. Other related variables including nodule number and size were also recorded.ResultsExcluding the microcarcinomas, the false-negative rate was 4% (19/479). Sampling errors occurred in only 4 (21%) cases in which the malignant nodule was not actually biopsied. Of the other 15 cases, 8 (53%) were solitary nodules, 8 (53%) were ≥4 cm in size, and 5 (33%) had underlying thyroiditis. Because of the missed diagnosis, 9 patients (47%) had lobectomy only as the initial surgery, which then required a completion thyroidectomy.ConclusionsSampling error is a minor cause for false-negative FNAs, suggesting that there are some inherent limitations to cytological evaluation of the thyroid.