|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 1 | Page : 45
Malignancy in thyroid nodule - Preoperative role of ultrasound and fine-needle aspiration cytology
Amitabh Jena1, Rashmi Patnayak2, Suresh Vaikkakara3, Alok Sachan3, Amarchala Yadagiri Lakhmi4
1 Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
2 Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
3 Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
4 Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
|Date of Web Publication||5-Jan-2016|
Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati - 517 507, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jena A, Patnayak R, Vaikkakara S, Sachan A, Lakhmi AY. Malignancy in thyroid nodule - Preoperative role of ultrasound and fine-needle aspiration cytology. Thyroid Res Pract 2016;13:45
|How to cite this URL:|
Jena A, Patnayak R, Vaikkakara S, Sachan A, Lakhmi AY. Malignancy in thyroid nodule - Preoperative role of ultrasound and fine-needle aspiration cytology. Thyroid Res Pract [serial online] 2016 [cited 2019 Jun 16];13:45. Available from: http://www.thetrp.net/text.asp?2016/13/1/45/173255
In the article, “Thyroid cancer: Controversy about overdiagnosis versus the perils of under diagnosis” by Unnikrishnan et al., few valid points are discussed. As they have stated in India, the problem may be due to under diagnosis rather than overdiagnosis. Data from different centers from all the regions of our vast country should be encouraged and analyzed systematically to know the true incidence and prevalence of various thyroid malignancies. In a recently conducted study in our center in South India, we had 162 cases of solitary thyroid nodules (STN) detected clinically. For 146 patients with clinically detected STN, ultrasonography (USG) findings were available. USG findings of solid echogenicity, presence of microcalcification in nodule, and associated cervical lymphadenopathy were more associated with malignancy as per final histopathology reports. All our patients underwent fine-needle aspiration cytology (FNAC) before surgery. Based on these reports, we performed hemithyroidectomy of the involved side and opted for either frozen section or for routine histopathological examination. In view of frozen section report of malignancy in thyroid nodule, completion thyroidectomy was done. The complications such as postoperative hypocalcemia were seen in 8.9% of our patients and recurrent laryngeal nerve injury in 2.7% patients. Hence, complications should not deter us from diagnosing and operating a thyroid malignancy.
Remonti et al. in a large meta-analysis have stated that only USG features do not provide reliable information regarding the risk of malignancy in a given patient. They should be evaluated in relation to clinical and FNAC findings. In addition, they have also advocated standardization of elastography techniques.
In our country, all these may not be possible and financially viable. But, definitely pooling of all the available data from various small and large centers would help to generate reliable data regarding incidence and prevalence. This will help in arriving at consensus guidelines for the management of thyroid malignancies.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Unnikrishnan AG, Bhatt AA. Thyroid cancer: Controversy about over diagnosis versus the perils of under diagnosis. Thyroid Res Pract 2015;12:43-5.
Jena A, Patnayak R, Prakash J, Sachan A, Suresh V, Lakshmi AY. Malignancy in solitary thyroid nodule: A clinicoradiopathological evaluation. Indian J Endocrinol Metab 2015;19:498-503.
Remonti LR, Kramer CK, Leitão CB, Pinto LC, Gross JL. Thyroid ultrasound features and risk of carcinoma: A systematic review and meta-analysis of observational studies. Thyroid 2015;25:538-50.