Thyroid adenoma diagnostic study of choice: Difference between revisions

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{{xyz}}
{{Thyroid adenoma}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{RAK}} {{Ammu}}
== Overview ==
== 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 ==
== Diagnostic Study of Choice ==


=== Study of choice ===
=== Study of choice ===
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* 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 test|Thyroid function tests]] should be assessed in all patients with thyroid nodules as the primary diagnostic step in all patients with a [[Neck masses|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.


OR
====Biopsy====
* One approach used to determine the type of [[adenoma]] is fine needle [[biopsy]], which some have described as the most cost-effective, sensitive, and accurate test.<ref>{{cite journal
| last        = Hamberger
| first      = B
| year        = 1982
| title      = Fine-needle aspiration biopsy of thyroid nodules. Impact on thyroid practice and cost of care
| journal    = Am J Med
| volume      = 73
| pages      = 381–384
| pmid        = 7124765
| doi=10.1016/0002-9343(82)90731-8
| issue=3
}}
</ref><ref>{{cite journal
| last        = Mazzaferri
| year        = 1993
| title      = Management of a Solitary Thyroid Nodule
| journal    = N Engl J Med
| volume      = 328
| pages      = 553–9
| pmid        = 8426623
| doi=10.1056/NEJM199302253280807
| issue=8
}}
</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.
====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 [[tumor]]s do not have any evidence of infiltration.
* Colloid nodules are distinguished by an apparently gelatinous mass of [[colloid]] both surrounding and contained within [[follicular cell]]s.
* Colloid nodules are not surrounded by a [[fibrous capsule]] of compressed tissue; however, they are surrounded by flattened [[epithelium|epithelial]] cells. Both the number of cells and the type of colloid may vary considerably.<ref>{{cite web |url=http://www.thyroidmanager.org/chapter%206d/fnabiopsy-frame.htm |title=Fine-Needle Aspiration Biopsy of the Thyroid Gland, Chapter 6d.  |author=Diana S. Dean, M.D. Hossein Gharib, M.D. |date=10 October 2010 |publisher=thyroidmanager.org |accessdate=26 September 2011}}</ref>


The following result of [gold standard test] is confirmatory of [disease name]:
* [Result 1]
* [Result 2]


OR
{{Familytree/start}}
 
{{Familytree|boxstyle=background: #E0FFFF;| | | | | | | | | | | | | | A01 | |17=|18=|20=|21=|22=|23=|24=|25=|26=|27=|28=|29=|30=|31=|32=|A01= A patient with thyroid nodule}}
[Name of the investigation] must be performed when:
{{Familytree|boxstyle=background: #E0FFFF;| | | | | | | | | |,|-|-|-|-|^|-|-|-|-|.| | | | | | | | | | | | | | | | | | |}}
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
{{Familytree|boxstyle=background: #E0FFFF;| | | | | | | | | B01 | | | | | | | | B02 | | | | | | | | | | | | | | | |B01= Normal [[thyroid stimulating hormone]]|B02= Low [[thyroid stimulating hormone]]|}}
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
{{Familytree|boxstyle=background: #E0FFFF;| | | | | | |,|-|-|^|-|.| | | | | | | |!| | | | | | | | | | | | | | |}}
 
{{Familytree|boxstyle=background: #E0FFFF;| | | | | | C01 | | | C02 | | | | | | C03 | | | | | | | | | | | | | | | | | |C01= <1cm suspicious nodule|C02= >1cm nodule|C03=Thyroid nuclear scan}}
OR
{{Familytree|boxstyle=background: #E0FFFF;| | | | | | |!| | | | |!| | | | |,|-|-|^|-|-|-|.| | | | | | | | | | | | | | | | | | | |}}
 
{{Familytree|boxstyle=background: #E0FFFF;| | | | | | D01 | | | D02 | | | | D03 | | | | D04 | | | | | | | | | | | | | | |D01= Ultrasound guided fine needle aspiration cytology|D02= Fine needle aspiration cytology|D03= Hot nodule|D04= Cold nodule}}{{Familytree|boxstyle=background: #E0FFFF;| | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | |}}
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
{{Familytree|boxstyle=background: #E0FFFF;| | | | | | | | | | | | | | | | | | | | | | | E05 | | | | | | | | |33=|34=|E05= Fine needle aspiration cytology}}
 
{{Familytree/end}}
OR
 
The diagnostic study of choice for [disease name] is [name of the investigation].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
 
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
 
=== Name of Diagnostic Criteria ===
 
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
 
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
OR
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Latest revision as of 14:46, 30 April 2019

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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

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. Both the number of cells and the type of colloid may vary considerably.[3]


 
 
 
 
 
 
 
 
 
 
 
 
 
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

  1. ↑ 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.
  2. ↑ Mazzaferri (1993). "Management of a Solitary Thyroid Nodule". N Engl J Med. 328 (8): 553–9. doi:10.1056/NEJM199302253280807. PMID 8426623.
  3. ↑ 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.

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