Toxic multinodular goiter other diagnostic studies: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Toxic multinodular goiter}} | {{Toxic multinodular goiter}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{Mazia}} | ||
==Overview== | ==Overview== | ||
The most important diagnostic test to differentiate thyroid nodules from each other is fine needle aspiration (FNA). | The most important diagnostic test to differentiate thyroid nodules from each other is [[fine needle aspiration]] ([[FNA]]). | ||
==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
=== Fine needle aspiration === | === Fine needle aspiration === | ||
*The most important diagnostic test to differentiate thyroid nodules from each other is fine needle aspiration (FNA). | *The most important diagnostic test to differentiate thyroid nodules from each other is [[fine needle aspiration]] ([[FNA]]). | ||
*Autonomously functioning ( hot) thyroid nodule is usually not an indication for fine-needle aspiration biopsy. | *Dominant cold nodule present in multinodular goiter is further investigated with [[Needle aspiration biopsy|fine needle aspiration biopsy]].Autonomously functioning (hot) thyroid nodule is usually not an indication for fine-needle aspiration biopsy. | ||
*As FNA is considered as an aggressive procedure, the American Thyroid Association developed the following criteria for FNA indication: | *Benign lesion and a malignant thyroid nodule can only be differentiated with histologic examination for the presence of [[vascular]] or capsular invasion.<ref name="pmid17699987">{{cite journal |vauthors=Cerci C, Cerci SS, Eroglu E, Dede M, Kapucuoglu N, Yildiz M, Bulbul M |title=Thyroid cancer in toxic and non-toxic multinodular goiter |journal=J Postgrad Med |volume=53 |issue=3 |pages=157–60 |year=2007 |pmid=17699987 |doi= |url=}}</ref> | ||
*As [[FNA]] is considered as an aggressive procedure, the American Thyroid Association developed the following criteria for [[FNA]] indication: | |||
** Nodules ≥ 1 cm with intermediate or high suspicion US pattern | ** Nodules ≥ 1 cm with intermediate or high suspicion US pattern | ||
** Nodules ≥ 1.5 cm with low suspicion US pattern | ** Nodules ≥ 1.5 cm with low suspicion US pattern | ||
** Nodules ≥ 2 cm with very low suspicion US pattern (e.g., spongiform). Observation an alternate option | ** Nodules ≥ 2 cm with very low suspicion US pattern (e.g., spongiform). (Observation is an alternate option) | ||
**For nodules that do not meet the above criteria, FNA is not required, including nodules < 1 cm (with some exceptions) and purely cystic nodules.<ref name="pmid26462967">{{cite journal |vauthors=Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L |title=2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer |journal=Thyroid |volume=26 |issue=1 |pages=1–133 |year=2016 |pmid=26462967 |pmc=4739132 |doi=10.1089/thy.2015.0020 |url=}}</ref> | **For nodules that do not meet the above criteria, [[FNA]] is not required, including nodules < 1 cm (with some exceptions) and purely cystic nodules.<ref name="pmid26462967">{{cite journal |vauthors=Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L |title=2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer |journal=Thyroid |volume=26 |issue=1 |pages=1–133 |year=2016 |pmid=26462967 |pmc=4739132 |doi=10.1089/thy.2015.0020 |url=}}</ref> | ||
* Criteria for US-guided FNA: | * Criteria for [[FNA|US-guided FNA]]: | ||
** A higher likelihood of either a nondiagnostic cytology (>25–50% cystic component) | ** A higher likelihood of either a nondiagnostic cytology (>25–50% cystic component) | ||
** A higher likelihood of sampling error | ** A higher likelihood of sampling error | ||
*** Difficult to palpate nodules | *** Difficult to palpate [[nodules]] | ||
*** Posteriorly located nodules | *** Posteriorly located [[nodules]] | ||
*FNA biopsy has a mean sensitivity higher than 80% and mean specificity higher than 90%. | *[[Needle aspiration biopsy|FNA biopsy]] has a mean [[Sensitivity (tests)|sensitivity]] higher than 80% and mean [[Specificity (tests)|specificity]] higher than 90%. | ||
*The accuracy of FNAB in diagnosing thyroid conditions is influenced by | *The accuracy of [[Needle aspiration biopsy|FNAB]] in diagnosing [[thyroid]] conditions is influenced by pathologist's experience and the technical skill of the physician performing the biopsy. | ||
*Thyroid FNAB diagnostic categories and the respective risk of malignancy associated include: | *[[Thyroid]] [[Needle aspiration biopsy|FNAB]] diagnostic categories and the respective risk of malignancy associated include:<ref name="pmid19888858">{{cite journal |vauthors=Cibas ES, Ali SZ |title=The Bethesda System for Reporting Thyroid Cytopathology |journal=Thyroid |volume=19 |issue=11 |pages=1159–65 |year=2009 |pmid=19888858 |doi=10.1089/thy.2009.0274 |url=}}</ref> | ||
**Benign - < 1% | **[[Benign]] - < 1% | ||
**Atypia of undetermined significance (AUS) - 5-10% | **[[Atypia|Atypia of undetermined significance]] (AUS) - 5-10% | ||
**Follicular neoplasm - 20-30% | **[[Follicular neoplasm of thyroid|Follicular neoplasm]] - 20-30% | ||
**Suspicious for malignancy - 50-75% | **Suspicious for [[malignancy]] - 50-75% | ||
**Malignant - 100% | **[[Malignant]] - 100% | ||
===Histologic Findings=== | |||
*On [[microscopic]] [[histopathological]] analysis, several features such as [[adenomatous]] [[hyperplasia]], cubical or cylindrical epithelium, resorption vesicles in the [[colloid]], discrete [[fibrous capsule]], secondary [[nodules]] and co-existing encapsulated adenomatous nodules with degenerative changes of fibrosis, calcification and hemorrhage characteristic findings of multinodular goiter. | |||
*Multinodular goiter is associated with highly variable [[histological]] appearance involving the co-existence of normal sized follicles, microfollicles or macrofollicles within the same gland. | |||
*In multinodular goiter many [[nodules]] may be [[monoclonal]]. A few autonomous nodules may be [[polyclonal]]. | |||
*Micronodular growth pattern is seen in early goiters. Same follicle has cells in the resting phase and proliferating follicular cells with budding intraluminal projections. | |||
*Some [[Follicle|follicles]] have a more uniform appearance of cells. Areas of fresh and old [[hemorrhage]] with [[calcification]] can also be observed on [[histology]]. | |||
==References== | ==References== | ||
Latest revision as of 14:51, 13 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]
Overview
The most important diagnostic test to differentiate thyroid nodules from each other is fine needle aspiration (FNA).
Other Diagnostic Studies
Fine needle aspiration
- The most important diagnostic test to differentiate thyroid nodules from each other is fine needle aspiration (FNA).
- Dominant cold nodule present in multinodular goiter is further investigated with fine needle aspiration biopsy.Autonomously functioning (hot) thyroid nodule is usually not an indication for fine-needle aspiration biopsy.
- Benign lesion and a malignant thyroid nodule can only be differentiated with histologic examination for the presence of vascular or capsular invasion.[1]
- As FNA is considered as an aggressive procedure, the American Thyroid Association developed the following criteria for FNA indication:
- Nodules ≥ 1 cm with intermediate or high suspicion US pattern
- Nodules ≥ 1.5 cm with low suspicion US pattern
- Nodules ≥ 2 cm with very low suspicion US pattern (e.g., spongiform). (Observation is an alternate option)
- For nodules that do not meet the above criteria, FNA is not required, including nodules < 1 cm (with some exceptions) and purely cystic nodules.[2]
- Criteria for US-guided FNA:
- FNA biopsy has a mean sensitivity higher than 80% and mean specificity higher than 90%.
- The accuracy of FNAB in diagnosing thyroid conditions is influenced by pathologist's experience and the technical skill of the physician performing the biopsy.
- Thyroid FNAB diagnostic categories and the respective risk of malignancy associated include:[3]
- Benign - < 1%
- Atypia of undetermined significance (AUS) - 5-10%
- Follicular neoplasm - 20-30%
- Suspicious for malignancy - 50-75%
- Malignant - 100%
Histologic Findings
- On microscopic histopathological analysis, several features such as adenomatous hyperplasia, cubical or cylindrical epithelium, resorption vesicles in the colloid, discrete fibrous capsule, secondary nodules and co-existing encapsulated adenomatous nodules with degenerative changes of fibrosis, calcification and hemorrhage characteristic findings of multinodular goiter.
- Multinodular goiter is associated with highly variable histological appearance involving the co-existence of normal sized follicles, microfollicles or macrofollicles within the same gland.
- In multinodular goiter many nodules may be monoclonal. A few autonomous nodules may be polyclonal.
- Micronodular growth pattern is seen in early goiters. Same follicle has cells in the resting phase and proliferating follicular cells with budding intraluminal projections.
- Some follicles have a more uniform appearance of cells. Areas of fresh and old hemorrhage with calcification can also be observed on histology.
References
- ↑ Cerci C, Cerci SS, Eroglu E, Dede M, Kapucuoglu N, Yildiz M, Bulbul M (2007). "Thyroid cancer in toxic and non-toxic multinodular goiter". J Postgrad Med. 53 (3): 157–60. PMID 17699987.
- ↑ Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016). "2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer". Thyroid. 26 (1): 1–133. doi:10.1089/thy.2015.0020. PMC 4739132. PMID 26462967.
- ↑ Cibas ES, Ali SZ (2009). "The Bethesda System for Reporting Thyroid Cytopathology". Thyroid. 19 (11): 1159–65. doi:10.1089/thy.2009.0274. PMID 19888858.