Joel I. Hamburger

The diagnosis of malignant follicular neoplasms of the thyroid by needle biopsy

To test the value of needle biopsy for a diagnosis of follicular thyroid malignancy, we compared needle biopsy and surgical diagnoses for 1005 patients. There were 67 follicular carcinomas, 34 Hurthle cell carcinomas, and 39 follicular variants of papillary carcinoma. Malignancy was diagnosed or suspected by biopsy for 114 of the cancers (82%), considered “possible” for 24 (17%), and misdiagnosed as “benign” in 2. Sensitivity of fine‐needle biopsy (FNB) for the diagnosis of 39 cancers approximated that of large‐needle biopsy (LNB) for 101 cancers 2 cm or larger. Diagnostic specificity for cancer varied with the degree of cytologic or histologic abnormality. Specificity of FNB was comparable to LNB on nodules large enough for both procedures. Specificity of FNB on nodules too small for LNB was substantially less. The sensitivity of needle biopsy allows selection of many follicular nodules for observation. Knowledge of the probability of cancer for each cytologic or histologic diagnosis is useful in determination of the need for thyroid surgery.

Signet ring cell lymphoma of the thyroid: a case report.

The first case of extranodal signet ring cell lymphoma involving the thyroid gland is reported in a 53-year-old woman with Hashimotos thyroiditis. Since 1978, 24 cases of signet ring cell lymphoma, all involving primarily nodal tissue, have been documented in the literature. This rare neoplasm is believed to be a variant of non-Hodgkins follicular lymphoma, which may be mistaken for metastatic poorly differentiated adenocarcinoma.

Are Silent Thyroiditis and Postpartum Silent Thyroiditis Forms of Chronic Thyroiditis or Different (New) Forms of Viral Thyroiditis

Subacute (granulomatous) thyroiditis has been regarded as a distinct clinical entity with characteristic histologic findings since the reports of Mygind and De Quervain which appeared near the turn of the century. The 1950 report of Crile and Rumsey1 is noteworthy because of the clear description of the variable clinical aspects of the disease, from the typical acute presentation to the less clinically overt form, which they designated chronic to indicate the ease with which the diagnosis may be missed. Many patients have hyperthyroidism with low 24-h radioactive iodine uptake (RAIU) which resolves spontaneously in several weeks. This is caused by a discharge of stored thyroid hormone occurring when the inflammatory process produces disruption of the thyroid follicles. As the disease resolves there is commonly a phase of hypothyroidism lasting for about 1 month. Within 3 to 6 months recovery is usually complete. Only a small proportion are left with goiter and even fewer have permanent hypothyrodism. In 10% of the patients the disease is unilateral initially.2 It may then spread over a few weeks to involve the rest of the gland.3,4

Is Needle Aspiration of the Cystic Thyroid Nodule Effective and Safe Treatment

In 1955 one of us (JMM) first expressed dissatisfaction with the use of surgical lobectomy for diagnostic purposes in thyroid nodule patients.1 This attitude was in part related to the observation that some thyroid nodules are cysts, many of which can be eliminated by simple needle puncture.2–6 In a retrospective study, 88 of 425 surgically excised solitary or dominant nodules proved to be unilocular cysts, 2 cm or more in diameter. The development of techniques utilizing ultrasound to differentiate cystic from solid thyroid nodules has made it simpler to select nodules for aspiration. Nevertheless cyst aspiration is still not widely employed.

Is Lymphoma of the Thyroid a Disease Which Is Increasing in Frequency

It has been said that primary lymphoma of the thyroid gland is rare.1–9 The number of cases reported in the world literature has been cited at approximately 250.9 Although this is probably an underestimate, it is a general indication of the frequency of this disease. Most of the tumors are histiocytic or lymphocytic lymphomas. Primary involvement of the thyroid gland by Hodgkin’s disease is truly exceedingly rare.10 The diagnoses have almost always been made retrospectively after operations for different presumptive diagnoses.

The impact of needle biopsy on the diagnosis of the thyroid nodule

Management of the patient with a thyroid nodule has been the subject of debate for many years. The essential question for any given nodule is whether the risk of cancer is great enough to justify the risk of surgical treatment. Granted the risks are very small when operations are performed by expert thyroid surgeons in first rate hospitals. Nevertheless, even these small risks must be justified when one is dealing with a problem which is as common as thryoid nodules, especially since most thyroid nodules are benign, most of those which are malignant are not very agressive, and the few highly lethal are almost always incurable by surgical methods.

Is Thyroid Imaging an Overutilized Diagnostic Procedure

The technique for thyroid imaging has improved dramatically over the past 30 years so that modern images are remarkably clear and may provide striking pictures of abnormal thyroid structure. Also the patient radiation burden has been reduced by a factor of 100. However, advanced technology carries a correspondingly advanced price tag. As physicians are being held increasingly accountable for the rising cost of health care it becomes incumbent upon us to consider the cost effectiveness of thyroid imaging in relation to the indications for its use. This issue is particularly pertinent now because of improvement in the sensitivity and reliability of in vitro thyroid function testing. Also, needle biopsy is gaining favor as the procedure of choice for the diagnosis of the thyroid nodule.1

Do All Nodules Appearing in Patients Subsequent to Radiation Therapy to the Head and Neck Areas Require Excision

Since the 1950 report of Duffy and Fitzgerald1 there has been increasing awareness that radiation therapy to the upper body administered to infants, children, and even young adults may induce carcinoma of the thyroid 10 to 30 years later. Between 1950 and 1975 numerous publications provided support for this concept. It was generally appreciated that these malignancies were usually papillary carcinomas, easily cured surgically.