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hyroid nodules are common clinical lesion with a prevalence of 4 to 7% in the general population. Most are ultimately determined to be benign, but approximately 5% are malignant. Recent literature suggests that each patient with thyroid nodule should undergo a complete evaluation that includes a detailed history and physical examination these reports suggest that thyroid function tests radioactive scan, and ultrasonography add useful information. These measures however, cannot distinguish with certainly benign from malignant lesions. High-risk categories classically are defined by older age, male gender, history of radiation exposure, family history. The presence of a solitary, fixed” cold” hard or growing nodule, hoarseness, lymphadenopathy, fixation, nonregression with thyroid hormone treatment, and a solid or complex mass on ultrasound.
Before the advent of fine-needle aspiration (FNA), preoperative clinical data coupled with intraoperative frozen section were the only means available to make intraoperative decisions. FNA has greatly increased the amount of information available and has a greater than 80% accuracy in most series.
A particular problem still exists with the management of ”follicular” lesions on FNA. Complete histological assessment of lesion architecture is needed for determination of capsular and vascular invasion thereby distinguishing follicular adenoma from well-differentiated follicular carcinoma for example a frequent finding on FNA is the presence of abundant follicular cells with or without colloid, this may be expected on aspiration of normal thyroid tissue but it is also observed in pathologic states. Additionally, a small thyroid nodule may be missed despite ultrasound guidance of FNA. More information is usually needed for patients whose lesions consist of follicular cells with scant or absent background colloid.
Our goal was to evaluate the clinical work up of patients with thyroid nodules to correlate factors which may predict benign or malignant disease. We evaluated preoperative FNA and post operative histopathological examination to determine relative accuracy and usefulness in guiding management of thyroid nodules. We analyzed outcomes of patients with equivocal FNA findings, e.g. ”follicular” to determine the final pathologic diagnosis of these lesions