الفهرس 
Anatomy and Sonographic Anatomy of the Thyroid GlandOnly 14 pages are availabe for public view
 |  | from | 162 |  |  |
| | | from | 162 | | |
Abstract
Figure (1): Thyroid gland anatomy 6
Figure (2): Nerve supply of the thyroid gland 8
Figure (3): Follicles of the thyroid gland, consisting of a layer of simple epithelium enclosing a colloid-filled cavity 9
Figure (4): Distribution of thyroid arteries with associated laryngeal nerve, anterior view 11
Figure (5): Distribution of thyroid arteries with associated laryngeal nerve, posterior view 13
Figure (6): Thyroid gland, anterior and lateral views. 14
Figure (7): Distribution of thyroid veins 16
Figure (8): Normal thyroid with anatomic land marks 18
Figure (9): Normal thyroid ultrasound in transverse view 19
Figure (10): Sonogram of the left lobe of the thyroid gland in the transverse plane showing a rounded lobe of a goiter 20
Figure (11): Hyperechoic nodule 24
Figure (12): Hypoechoic nodule 24
Figure (13): Isoechoic nodule 24
Figure (14): Mixed cystic solid nodule with hypoechoic solid component 25
Figure (15): Marked hypo-echogenicity of a pathologically proven papillary thyroid carcinoma 26
Figure (16): Solid nodule 27
Figure (17): A predominantly solid nodule with scattered cystic spaces 27
List of Figures Cont...
Fig. No. Title Page No.
Figure (18): A predominantly cystic nodule 28
Figure (19): An entirely cystic nodule with comet-tail artifact 28
Figure (20): Cystic papillary carcinoma 30
Figure (21): Two benign hyperplastic nodules (N1 and N2) The solid component is central, concentric and smooth margin 30
Figure (22): Spongiform appearance of thyroid nodule 32
Figure (23): Two types of echogenic foci are seen in this nodule 32
Figure (24): Microcalcifications within thyroid nodule 33
Figure (25): Entirely cystic nodule shows multiple comet- tail artifacts 33
Figure (26): Hypoechoic solid nodule with both micro and macrocalcifications 34
Figure (27): Hypoechoic solid nodule with a lobulated margin 36
Figure (28): Isoechoic nodule with thin regular halo 36
Figure (29): Taller-than-wide nodule in the left lobe of thyroid 37
Figure (30): Peripheral vascularity in a spongiform nodule 38
Figure (31): Peripheral and intranodular vascularity in a hypoechoic nodule 38
Figure (32): Metastatic lymph nodes 40
Figure (33): Chart showing five categories on the basis of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) lexicon 42
List of Figures Cont...
Fig. No. Title Page No.
Figure (34): Nonpalpable thyroid lesions with US characteristics of malignancy. 46
Figure (35): Rapidly growing mass in the left thyroid lobe of a 57-year-old man with chronic Hashimoto thyroiditis. 47
Figure (36): Diffuse enlargement of the thyroid gland in an 85-year-old man with a history of colon cancer 50
Figure (37): Transverse US image shows a localized subcapsular hematoma (arrows) that developed in the thyroid gland after FNA. 50
Figure (38): Axial CT scan shows extensive hemorrhages in thyroidal (*) and perithyroidal (arrows) locations after FNA in a thyroid lesion in a patient who was undergoing long-term aspirin therapy 51
Figure (39): Parallel positioning of the fine-gauge needle for thyroid nodule biopsy 52
Figure (40): Perpendicular positioning of the fine-gauge needle for thyroid nodule biopsy 54
Figure (41): Aspiration (a) and non aspiration (b) techniques for needle biopsy of thyroid nodules 55
Figure (42): Distribution of cases with thyroid nodules according to their demographic data regarding gender. 68
Figure (43): Pie chart shows the TIRADS of the thyroid nodules among the studied groups. 69
Figure (44): Pie chart shows the side of the thyroid nodules among the studied groups 70
List of Figures Cont...
Fig. No. Title Page No.
Figure (45): Pie chart shows the echogenicity of the thyroid nodules among the studied groups 70
Figure (46): Pie chart shows the performance (diagnostic quality categories percentage) of both FNAC and FNNAC techniques among the studied groups 71
Figure (47): The distribution of TIRADS of the thyroid nodules between FNAC and FNNAC technique study groups. 73
Figure (48): The distribution of echogenicity of the thyroid nodules between FNAC and FNNAC technique study groups. 74
Figure (49): The distribution of side of the thyroid nodules between FNAC and FNNAC technique study groups. 74
Figure (50): Mair’s cytological scoring system and mean score for each parameter for each study group. 76
Figure (51): Mair’s cytological scoring system and the average total score (mean) per case for each study group. 76
Figure (52): Comparison of performance and diagnostic quality categories percentage with each technique. 77
Figure (53): FNNAC smear of papillary thyroid carcinoma showing nuclear enlargement, nuclear grooves (A) and intranuclear pseudo inclusions (B) (x400) 78
List of Figures Cont...
Fig. No. Title Page No.
Figure (54): FNNAC smear of benign follicular nodule showing groups of follicular cells with few follicles formation (arrows) in colloid background (x400). 79
Figure (55): FNAC smear of hurthle cell neoplasm showing hurthle cells with abundant finely granular cytoplasm and rounded central or eccentrically located nuclei in bloody background (x400). 79
Figure (56): Case 1, FNNA technique, Mair’s cytological scoring (8) 82
Figure (57): Case 2, FNNA technique, Mair’s cytological scoring (7) 84
Figure (58): Case 3, FNNA technique, Mair’s cytological scoring (8) 86
Figure (59): Case 4, FNA technique, Mair’s cytological scoring (3) 88
Figure (60): Case 5, FNA technique, Mair’s cytological scoring (4) 90
Figure (61): Case 6, FNNA technique, Mair’s cytological scoring (7) 92
Figure (62): Case 7, FNA technique, Mair’s cytological scoring (6) 94
Figure (63): Case 8, FNA technique, Mair’s cytological scoring (5) 96
Figure (64): Case 9, FNNA technique, Mair’s cytological scoring (7) 98
Figure (65): Case 10, FNA technique, Mair’s cytological scoring (5) 100
ABSTRACT
Background: Thyroid nodules are frequent among the general population. Ultrasound is the most commonly used imaging technique in the evaluation of thyroid nodules, Fine needle cytology (FNC) has been routinely used as the baseline investigation for diagnosis of nodular thyroid disease. Its advantages include minimal invasion and high sensitivity, specificity, and accuracy.
Objective: To compare the diagnostic quality of FNC sample obtained by aspiration versus non-aspiration techniques, aiming to improve the overall quality of FNC and hence better evaluation of thyroid nodules avoiding repeating FNC and unnecessary thyroidectomies.
Patients and Methods: Our study was conducted on 40 adult patients with thyroid nodules, whose ages range between 25 and 70 years old and were referred to undergo FNA procedures.
Results: 40 patients with thyroid nodules were included in this study, our results showed statistically significant improvement in overall quality of the samples obtained by the non-aspiration (FNNAC) technique with less cellular trauma, less background blood, better preservation of cellular architecture and less cellular degeneration, however, there was no significant difference in the amount of the cellular material obtained and shows statistically significant difference regarding the diagnostic quality of the samples with more diagnostically superior samples were acquired by the FNNAC than by FNAC (50% and 5% respectively), while FNAC acquired more diagnostically adequate samples than FNNAC (75% and 50% respectively), non-diagnostic samples were only 20% with FNAC and 0% with FNNAC.
Conclusion: Both aspiration and non-aspiration techniques can be implemented and used for acquiring cytology samples, however, non-aspiration technique (FNNAC) was associated with overall better-quality samples with statistically significant better performance compared to FNAC. Non-aspiration technique is more convenient for both the patient and for the operator.