General Surgery
نویسنده
چکیده
46 SAJS VOL. 51 NO. 2 MAY 2013 The diagnosis or exclusion of cancer in the thyroid nodule remains a clinical dilemma for general surgeons and endocrinologists. Nodular disease of the thyroid is very common, while cancer is rare; a definite diagnosis of either is difficult to make. The general prevalence of thyroid nodules is very high. They are detectable in 5% of the normal population on clinical examination,[1,2] in over 48% on high-resolution ultrasound,[3] and in over 50% at autopsy. [4] The widespread use of imaging means that many incidental thyroid nodules requiring evaluation are detected. In contrast, thyroid cancer remains a rare disease, with an incidence of only 1 2/100 000 population per year.[5] Papillary carcinoma and follicular carcinoma remain the most common histological subtypes, and in general have very good long-term prognosis and survival rates.[6] Poor prognosis and shorter survival in thyroid cancer are associated with the rare and aggressive anaplastic and medullary histological subtypes,[7] which are relatively easy to diagnose pre-operatively. A confident pre-operative diagnosis of thyroid cancer greatly facilitates appropriate surgical intervention, decreases unnecessary surgery, and is safer for patients. Recent advances in the use of ultrasound and fine-needle aspiration biopsy (FNAB) have resulted in improved pre-operative diagnosis of nodules in many centres.[8,9] These advances include defining ultrasound features that predict malignancy, increased use of ultrasound-guided FNAB (US-FNAB), and standardised reporting of cytopathological specimens. Surgeons doing thyroid surgery at our institution noted that advances in ultrasound and cytology reporting were not consistently applied in the evaluation of thyroid nodules. We undertook this study to evaluate this impression by looking at the correlation between pre-operative investigations and final diagnosis.
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