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|Year : 1992 | Volume
| Issue : 2 | Page : 60-1
Analysis of 105 uninodular goitres.
RD Bapat, SH Shah, RG Relekar, A Pandit, SD Bhandarkar
Dept of Surgery, Seth GS Medical College and KEM Hospital, Parel, Bombay, Maharashtra.,
R D Bapat
Dept of Surgery, Seth GS Medical College and KEM Hospital, Parel, Bombay, Maharashtra.
Data on 105 solitary thyroid nodules, confirmed at surgery to be solitary, is presented. Six (5.7%) were malignant, 4 papillary and 2 follicular. The sensitivity and the specificity of 131I radionuclide thyroid scan (n = 90) were 100% and 24% respectively. Similarly, the sensitivity and specificity of fine needle aspiration cytology (n = 65) was 75% and 100% respectively. In both instances, the "gold standard" was the histopathology of the surgically removed nodule. In order to avoid unnecessary surgery, without missing malignancy, we would recommend the combination of radionuclide thyroid scan and FNAC for investigation of solitary thyroid nodules.
Keywords: Adult, Biopsy, Needle, standards,Evaluation Studies, Female, Hospitals, University, Human, India, epidemiology,Iodine Radioisotopes, diagnostic use,Male, Sensitivity and Specificity, Thyroid Nodule, diagnosis,epidemiology,surgery,Thyroidectomy,
|How to cite this article:|
Bapat R D, Shah S H, Relekar R G, Pandit A, Bhandarkar S D. Analysis of 105 uninodular goitres. J Postgrad Med 1992;38:60
Different series have reported a prevalence rate of 20-60% for carcinoma in surgically removed solitary thyroid nodules,,,,,,. We present our data on 105 surgically removed uninodular goitres, which were subjected to detailed histopathological examination with Special reference to the presence or absence of malignancy.
Two hundred and ninety thyroidectomies were done from January 1984 to March 1991 in one of the surgical services of the Department of Surgery of a large teaching hospital after evaluation by the endocrinologist. One hundred and five of these (65 females and 40 males, median age 35 years) were proved to have solitary nodules at surgery.
All these patients had a detailed clinical evaluation. T4, T3 and TSH were estimated in all. Rectilinear thyroid scans using131 I was carried out in 90 patients. Fine needle aspiration cytology (FNAC) was performed in 65 cases. (FNAC was started in 1985 and hence, the smaller number of paitents who had FNAC). All patients who had an FNAC also had scan data.
Three patients were reported to have findings suggestive of a malignancy on FNAC. They were immediately operated upon. The remaining 102 cases were treated with suppression therapy using 0.2 mg levothyroxine sodium per day for a period of 3 months. They underwent surgery at the end of that period because the nodule either did not regress in size or in fact enlarged. Hemithyroidectomy was done in 74 cases, nodulectomy in 14, partial thyroidectomy in 13, subtotal thyroidectomy in 3 and near total thyroidectomy in 1. The surgical specimens were examined carefully for any macroscopic signs of malignancy and then subjected to detailed histopathological examination in multiple sections.
Of the 105 patients, 103 were euthyroid and two hyperthyroid. The radionuelide thyroid scan (n= 90) showed the nodule to be cold in 70 cases, hot in 2 cases (referred to as hyperthyroid above), non-delineable from the rest of the gland in 9 cases; in the remaining 9 cases, the nodule showed a patchy uptake. For the sake of analysis, the last three groups were clubbed together as ‘Not- Cold’.
Adequate material was obtained for examination in all the 65 cases in whom FNAC was done. Findings suggestive of carcinoma were reported in 3 of these cases. Histopathology confirmed the diagnosis of malignancy in them. One patient who’s FNAC did not reveal any evidence of malignancy, was found to have it on histopathological examination. Two more patient in whom FNAC was not performed, were found to have malignancy on histopathology, bringing the total number of documented malignancies to 6 of 105 surgically removed uninodular goitres. Of these, 4 cases were of papillary carcinoma and two of follicular carcinoma.
[Table - 1] shows the association between radionuclide thyroid scan and the final histopathology report. As seen from the table, the sensitivity of the thyroid scan was 100% and the specificity 24%.
[Table - 2] shows the association between FNAC and histopathology (n=65). The sensitivity of FNAC was 75% and the specificity was 100%.
The uninodular goitre presents a problem regarding a decision for surgery because of the variable prevalence of malignancy in such nodules,,,,,,. The prevalence of 5.7% in the present series is lower than in the other series. The aim of investigations in patients with solitary thyroid nodules is to avoid unnecessa % surgery without missing a case of malignancy.
Radionuelide thyroid scan in this series was 100% sensitive and 24% specific in this respect. On the other hand, FNAC was 75% sensitive but 100% specific. This experience agrees with that of the other reported series ,,,. It would appear, that a combination of radionuclide thyroid scan and FNAC would serve the objective stated above better than either of the tests done alone. Further, ultrasonography of the thyroid is accurate in determining the physical characteristics of a solitary nodule but inaccurate in detecting the presence of neoplasia. This again would suggest that the decision to operate on a single thyroid nodule may be taken up by using a combination of radionuclide thyroid scan and FNAC of the nodule, in addition to a careful history and clinical examination of the patient. The very low specificity of a radionuelide scan might make it appear as a superfluous investigation compared to FNAC. However, the ability of a hot nodule to rule out malignancy in a solitary nodule would make it a useful investigation complementary to FNAC. Hence, we recommend this combination in investigating solitary thyroid nodules.
We thank the Dean Dr. (Mrs) PM Pai, King Edward Memorial Hospital, for allowing us to use the hospital data.
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[Table - 1], [Table - 2]