Cystic thyroid nodules: the dilemma of malignant lesions

Article Abstract:

Fine needle aspiration (FNA) is a technique for tissue or fluid sampling in which aspiration with a fine needle is used to obtain the specimen. This method is used to obtain tissue samples from nodules or node-like growths in the thyroid gland for diagnosis of cystic thyroid malignancy. In contrast to breast cysts, which are almost always benign, cysts in the thyroid gland may often indicate a malignancy. A recent study examined the use of FNA in the diagnosis of cystic thyroid nodules. They found that one third of 221 surgically removed thyroid nodules were cystic, of which 14 percent were malignant. Cystic thyroid nodules are assessed by analyzing the clinical characteristics of the lesions and the results of ultrasound tests and FNA. Ultrasound is a diagnostic technique in which sound waves are used to visualize internal structures. Studies show that the clinical characteristics of the cyst and ultrasound results are unreliable in distinguishing benign from malignant nodules. Most cystic thyroid nodules reflect some form of degenerative process, and fluids found in carcinoma, can be bloody or clear, and all fluids should be sent for analysis. A major problem of diagnosis is when fluid obtained from a cystic nodule by FNA is insufficient for diagnosis. The study showed that two of 12 nodules which produced insufficient fluid on FNA turned out to be malignant. Removal of the cyst is recommended if the cyst recurs, fails to resolve completely, or if ultrasound shows evidence of local invasion or spread of the growth. Other conditions that may be considered in the management of cystic thyroid nodules include paralysis of the vocal cords, extensive disease of the lymph nodes, or prior neck irradiation. Forty to 50 percent of adults reaching the age of 50 years will develop thyroid abnormalities, including the development of cystic thyroid nodules, and not all of these will have to be removed surgically. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Cystic thyroid nodules: the dilemma of malignant lesions

Article Abstract:

Thyroid nodules are abnormal aggregations or groups of cells in the thyroid gland which may be solid or cystic; cysts may contain fluid and/or solid material. Fine needle aspiration (FNA) is a procedure in which a tissue specimen is obtained by aspiration or suction through a fine needle inserted into the tissue. This method is used to determine whether a thyroid nodule is benign or malignant. Among 221 surgically removed thyroid nodules, 71 were cystic and 150 were solid. Ultrasonography, the use of sound waves to visualize internal structures, accurately characterized all but one case of cystic nodules. The patient characteristics, number of solitary nodules, and nodule size were similar for both the cystic and solid nodules. Among cystic nodules, four percent were simple cysts; 82 percent were benign adenomas, a type of glandular tumor; and 14 percent were malignant (as compared to 23 percent of solid nodules that were malignant). Eight-one percent of cystic nodules contained a bloody fluid, and fluid color was similar among the benign and malignant lesions. Examination of the cells obtained by FNA was the most accurate predictor of cancer. Other less predictable factors included local invasion or spreading of the abnormal growths, a history of prior head or neck irradiation, and recurrence or growth of the cyst. The identification of malignancy by cell examination was less frequent in cystic nodules than solid nodules, and the only false-negative result occurred in a cystic lesion. Needle aspirates (or fluid collected by aspiration) was insufficient for diagnosis in 20 percent of patients with cystic papillary carcinoma. The examination of cells obtained by FNA was less sensitive but equally specific in predicting malignancy in a cystic nodule as compared to a solid nodule. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Cancer, Cancer diagnosis

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