Combined ultrasonographic and cytological studies in the diagnosis of thyroid nodules

Many aspects of thyroid nodule evaluation and management remain controversi al. Widespread application of ultrasonography has resulted in frequent disc overy of incidental nodules in the general population which has created a m anagement dilemma for physicians. In this paper we have introduced a novel approach for evaluation of solid nodules, using an index derived from ultra sonographic and cytologic studies. Briefly thyroid nodules were classified ultrasonographically into four grades, with increasing score numbers (1-4) as progression to malignantly suspicious lesions was present. Similarly, fo ur grades of a cytologic classification of fine needle biopsy aspirates wer e introduced with scores of 1-6 (benign to malignant diagnosis). The sum of the ultrasonographic and cytologic scores were the basis of a diagnostic i ndex: benign (2-4), doubtful (5), suspicious (6) and malignant (7-10). Sixt y patients with an index equal or higher than 6 were submitted to thyroidec tomy and the prevalence of thyroid cancer (n = 46) in the excised nodules w as 76.6%. Most series report a 10% to 30% incidence of malignancy in excise d nodules with suspicious diagnosis. We concluded that using an index deriv ed from combined ultrasonographic and cytologic studies will result in a be tter patient selection for surgery. (C) Societe francaise de biochimie et b iologie moleculaire / Elsevier, Paris.