Large Thyroid Nodules Linked to High Malignancy Risk
Elsevier Global Medical News Author - MG Sullivan PARIS (EGMN) - Patients with a non-decisive fine-needle aspiration for large non-diagnostic thyroid nodules or lesions of undetermined significance should be considered for surgery because more than half of these large nodules can be malignant. In a review of 156 patients with non-decisive fine-needle aspirations (FNAs), nodule size was a major determinant in surgical referral, Dr. Susana Mascarell said at the International Thyroid Congress. "Nodules of this size were associated with a malignancy rate of up to 60%," said Dr. Mascarell of the John H. Stroger Jr. Hospital of Cook County, Chicago. FNA is considered the main diagnostic tool in deciding which patient to refer to surgery. "However," Dr. Mascarell said, "the FNA results may not be helpful when the cytology specimen is non-diagnostic or qualifies as a follicular lesion of undetermined significance - both classifications that are part of the new six-level FNA classification system suggested by the National Cancer Institute." When an FNA comes back as non-decisive on such specimens, the clinician must choose between surgery and clinical follow-up as the next step. Unfortunately, said Dr. Mascarell, there are no hard-and-fast rules about which management path to choose. Molecular markers are becoming more important in the decision, but can't be relied upon in every patient, she said. "When these markers are present in high concentrations, they are up to 99% accurate in identifying malignant nodules and so are a very helpful tool. But only 40% of nodules are positive for [...]