engleski

Evaluation of ultrasound.guided fine needle aspiration cytology in multinodular goiter of the thyroid

Objective: The management of thyroid nodules remains a controversy among physicians.The primary challenge in the management of a multinodular thyroid gland is to rule out malignancy and to avoid surgical procedures in patients with benign disease. Clinical, scintigraphic, echographic and cytologic methods are currently used in the evaluation of multinodular goiter. The present study was undertaken to assess the value of ultrasound-guided fine needle aspiration cytology and prevalence of tumor lesions in multinodular thyroid disease. Methods: During the 7-year period, the number of nodules preoperatively aspirated under ultrasound guidance from both thyroid lobes in 80 patients for cytologic analysis ranged from two to eight.The findings obtained by ultrasonography and fine needle aspiration cytology were compared with postoperative pathohistology. Results: Among 80 patients operated on multinodular lesions, tumors were found in 65(81%)and benign lesions in only 15(19%).Out of 65 tumors, there were 29(45%) carcinomas and 36(55%)adenomas.An accurate preoperative cytologic diagnosis was made in a very high proportion of papillary carcinomas (20/22 ; 91%), whereas in two cases this type of carcinoma was diagnosed as follicular carcinoma. Accurate cytologic diagnosis was also reached in one Huerthle carcinoma, three follicular and four medullary carcinomas.The overall sensitivity of the cytologic method was 85% and specificity 88%, yielding a diagnostic value of 85%. Conclusions: Current morphological diagnosis of the nodules in multinodular goiter requires thorough preoperative examinations, however, ultrasound-guided fine needle aspiration cytology should be done routinely in the evaluation of the nature and structure of thyroid nodules in multinodular goiter, thus helping clinicians to choose appropriate therapeutic strategy.We conclude that: (1) certain follicular adenomas may display cytologic features mimicking papillary carcinoma:(2)as in follicular neoplasms, aspirates of Huerthle cell adenomas cannot be differentiated from Huerthle cell carcinomas ; (3) with adequate sampling, false negative results can be markedly reduced. The data strongly supports thyroid FNA as an important preoperative diagnostic tool.

thyroid gland; multinodular goiter; FNA

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