[The thyroid nodule: cytomorphofunctional profile-therapeutic approach]

Analyzing a cohort of 16,400 thyroid nodules, sequentially examined since 1982, the value of preoperative echo-guided fine needle aspiration cytology (FNA) in discriminating benign lesion from malignant ones, has been assessed. Ultrasonography provides a useful support not only to guide the diagnostic FNA methodology, but also monitoring therapeutic procedure: evacuation of cyst, alcoholic sclerotization, laser therapy, effects of treatment on the size of the nodular structure. The correct interpretation of the imaging pictures should be rationally anchored to both clinical criteria and to circumstantial anamnestic analysis, as well as to physical examination, laboratory tests, instrumental systems, cytomorphological patterns, immunohistologic and biomolecular studies. The FNA sampling under ultrasonography guidance offers an absolute diagnostic reliability, and it can be confidently applied for planning surgical strategy. By adopting this safe, non invasive, accurate diagnostic tool, that offers the advantage of eliminating unnecessary operation for benign lesions, the number of operation is strikingly reduced, while it allows to identify an higher surgical frequency of malignancy, yielding a prevalence of about 3% of thyroid nodules. FNA is a very profitable cost-effective diagnostic tool, reducing 20% the cost of care, for the evaluation and treatment of patient with thyroid nodule. Preliminary results on the molecular pattern of thyroid nodules, obtained applying a new methodological system, the Laser Capture Microdissection, are underlined; in the next issue of this journal it will be analytically illustrated the diagnostic role of this innovative procedure that appears very promising in obtaining information on the molecular derangements of a single thyroid cell, even at a precancerous stage; thus a preventive surgical treatment of a thyroid nodule genetically characterized can be predicted.