Thyroid adenoma diagnostic study of choice: Difference between revisions
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* Fine needle aspiration biopsy remains the most important diagnostic modality for evaluating patients with a thyroid nodule. A major limitation of fine needle aspiration biopsy, however, is the inability to distinguish a follicular adenoma from a follicular carcinoma. | * Fine needle aspiration biopsy remains the most important diagnostic modality for evaluating patients with a thyroid nodule. A major limitation of fine needle aspiration biopsy, however, is the inability to distinguish a follicular adenoma from a follicular carcinoma. | ||
==== | ====Biopsy==== | ||
== | |||
* One approach used to determine the type of adenoma is fine needle biopsy (FNB), which some have described as the most cost-effective, sensitive, and accurate test.<ref>{{cite journal | * One approach used to determine the type of adenoma is fine needle biopsy (FNB), which some have described as the most cost-effective, sensitive, and accurate test.<ref>{{cite journal | ||
| last = Hamberger | | last = Hamberger | ||
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</ref> | </ref> | ||
* [[Needle aspiration biopsy|Fine needle aspiration biopsy]] or ultrasound-guided [[Needle aspiration biopsy|fine needle aspiration biopsy]] usually yields sufficient thyroid cells to assess the [[pathology]], although in some cases, the suspected nodule may need to be removed surgically for pathological examination. | * [[Needle aspiration biopsy|Fine needle aspiration biopsy]] or ultrasound-guided [[Needle aspiration biopsy|fine needle aspiration biopsy]] usually yields sufficient thyroid cells to assess the [[pathology]], although in some cases, the suspected nodule may need to be removed surgically for pathological examination. | ||
===Key Biopsy Findings in Thyroid adenoma=== | ====Key Biopsy Findings in Thyroid adenoma==== | ||
* Areas of [[hemorrhage]], [[fibrosis]], [[calcification]], and cystic change are common in thyroid (follicular) adenoma, particularly in larger lesions. | * Areas of [[hemorrhage]], [[fibrosis]], [[calcification]], and cystic change are common in thyroid (follicular) adenoma, particularly in larger lesions. | ||
* Encapsulated [[tumor]]s do not have any evidence of infiltration. | * Encapsulated [[tumor]]s do not have any evidence of infiltration. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2] Ammu Susheela, M.D. [3]
Overview
There is no single diagnostic study of choice for the diagnosis of thyroid adenoma, but thyroid nodules can be diagnosed based on an ultrasound examination of the neck, a screening serum TSH level, and fine needle aspiration biopsy.
Diagnostic Study of Choice
Study of choice
- There is no single diagnostic study of choice for the diagnosis of thyroid adenoma, but thyroid nodules can be diagnosed based on an ultrasound examination of the neck, a screening serum TSH level, and fine needle aspiration biopsy.
- Thyroid function tests should be assessed in all patients with thyroid nodules as the primary diagnostic step in all patients with a neck mass.
- Fine needle aspiration biopsy remains the most important diagnostic modality for evaluating patients with a thyroid nodule. A major limitation of fine needle aspiration biopsy, however, is the inability to distinguish a follicular adenoma from a follicular carcinoma.
Biopsy
- One approach used to determine the type of adenoma is fine needle biopsy (FNB), which some have described as the most cost-effective, sensitive, and accurate test.[1][2]
- Fine needle aspiration biopsy or ultrasound-guided fine needle aspiration biopsy usually yields sufficient thyroid cells to assess the pathology, although in some cases, the suspected nodule may need to be removed surgically for pathological examination.
Key Biopsy Findings in Thyroid adenoma
- Areas of hemorrhage, fibrosis, calcification, and cystic change are common in thyroid (follicular) adenoma, particularly in larger lesions.
- Encapsulated tumors do not have any evidence of infiltration.
- Colloid nodules are distinguished by an apparently gelatinous mass of colloid both surrounding and contained within follicular cells. Colloid nodules are not surrounded by a fibrous capsule of compressed tissue. However, they are surrounded by flattened epithelial cells.[3] Both the number of cells and the type of colloid may vary considerably.[4]
| A patient with thyroid nodule | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Normal thyroid stimulating hormone | Low thyroid stimulating hormone | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| <1cm suspicious nodule | >1cm nodule | Thyroid nuclear scan | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ultrasound guided fine needle aspiration cytology | Fine needle aspiration cytology | Hot nodule | Cold nodule | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Fine needle aspiration cytology | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Hamberger, B (1982). "Fine-needle aspiration biopsy of thyroid nodules. Impact on thyroid practice and cost of care". Am J Med. 73 (3): 381–384. doi:10.1016/0002-9343(82)90731-8. PMID 7124765.
- ↑ Mazzaferri (1993). "Management of a Solitary Thyroid Nodule". N Engl J Med. 328 (8): 553–9. doi:10.1056/NEJM199302253280807. PMID 8426623.
- ↑ Dr. Alpha Tsui (10 October 2010). "Thyroid cytology" (PDF). thyroidmanager.org. Retrieved 26 September 2011.
- ↑ Diana S. Dean, M.D. Hossein Gharib, M.D. (10 October 2010). "Fine-Needle Aspiration Biopsy of the Thyroid Gland, Chapter 6d". thyroidmanager.org. Retrieved 26 September 2011.