In this section we will be discussing the latest in General Surgery, Surgical Oncology and Endocrine surgery. Please stay in touch, more articles to come!!
Thyroid nodules and fine needle biopsies
What to do with a thyroid nodule?
Thyroid nodules are common and the vast majority are benign. This means that nothing needs to be done about them. However when we find a nodule, questions over its management always arise.
Multiple nodules within the thyroid are usually due to a disease known as Multinodular Goitre. These are usually left alone. If there is a nodule that grows beyond 1cm, we usually recommend a needle biopsy, this is what is we know as a dominant nodule in the context of multinodular goitre.
Solitary nodules are almost always biopsied.
What do we do after the biopsy?
The needle biopsy stratifies risk. Cytologists use a grading system known as Bethesda. This divides the results of the needle biopsy as follows:
1. Non Diagnostic
2. Benign
3. Atypia of Undetermined significance
4. Suspicious for a follicular neoplasm/Follicular neoplasm
5. Suspicious for malignant
6. Malignant
The risks of maligancy are as follows
1. Repeat FNA
2. 0-3%
3. 10-20%
4. up to 30%
5. Up to 70%
6. Usually malignant
With this standarisation of results we are able to recommend treatment options. Although only surgery will give us a definitive diagnosis, this system allows for a standard recommendation to most patients. We recommend that all patients with a Bethesda score of 3 or more should be referred to a specialist.
Dr. Nicolas Oddone-Baridon