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Preoperative diagnostic tests for operable thyroid disease
D B de Roy van Zuidewijn1, I Songun, J Hamming
1Department of Surgery, University Hospital, Leiden, The Netherlands.
World Journal of Surgery
|July 1, 1994
Summary
Fine-needle aspiration biopsy (FNAB) is a valuable tool for diagnosing thyroid nodules. "Uncertain" FNAB results should be treated as potentially malignant, improving diagnostic accuracy for thyroid cancer.
Area of Science:
- Endocrinology
- Oncology
- Pathology
Background:
- Fine-needle aspiration biopsy (FNAB) is increasingly used for thyroid nodule evaluation.
- Thyroid scintigraphy remains a common diagnostic method for differentiating benign from malignant thyroid lesions.
Purpose of the Study:
- To evaluate the diagnostic accuracy of FNAB and thyroid scintigraphy in distinguishing benign from malignant thyroid nodules.
- To compare the effectiveness of FNAB and scintigraphy in a surgical patient cohort.
Main Methods:
- Retrospective analysis of 350 patients undergoing thyroid surgery between 1977 and 1990.
- Histologic confirmation of FNAB in 265 patients and analysis of 247 thyroid scintigraphies.
- Division of patients into two groups (1977-1986 and 1986-1990) with scintigraphy results analyzed in the latter group.
Main Results:
- FNAB results of "malignant or probably malignant" had a positive predictive value of 81.9%.
- FNAB results of "benign or probably benign" had a negative predictive value of 95.0%.
- "Uncertain" FNAB results were associated with malignancy in 21.4% of cases, suggesting they should be managed as potentially malignant.
Conclusions:
- FNAB is a reliable diagnostic method for thyroid nodules, with "uncertain" results requiring careful consideration.
- Treating "uncertain" FNAB results as potentially malignant enhances diagnostic sensitivity to 93.0% and specificity to 66.1%.
- Thyroid scintigraphy findings, such as "cold" solitary nodules, require correlation with FNAB results for accurate diagnosis.