N. A. Matheson

Management of isolated thyroid swellings: a prospective six year study of fine needle aspiration cytology in diagnosis.

OBJECTIVE--To audit the accuracy and impact on the frequency of operation of fine needle aspiration cytology of isolated thyroid swellings. DESIGN--Prospective analysis over six years of cytological predictions compared with histological findings. SETTING--Thyroid clinic serving the Grampian region. PATIENTS--395 Consecutive patients presenting with an isolated thyroid swelling, 307 of whom underwent surgical excision. Analysis was confined to a subgroup of 283 patients with satisfactory aspirates who were operated on. RESULTS--The positive predictive value of aspiration cytology for detecting malignant disease was 100% and the sensitivity 83%. The sensitivity for the detection of neoplasia (frank malignancy together with follicular adenomas) was 76%. The specificity was 58% and the overall accuracy 69%. Recalculation of data in previous papers with strict criteria showed the accuracy of aspiration cytology to be variable and lower than is widely accepted. Since the introduction of aspiration cytology 21% fewer operations for isolated thyroid swellings have been performed. CONCLUSIONS--As a basis of selection for surgical excision of isolated thyroid swellings according to prediction of neoplasia fine needle aspiration cytology is less reliable than is widely accepted. It is an adjunct to management rather than a definitive test, and negative cytological results do not exclude neoplastic disease. Further study should take account of the implications of repeated clinic attendances for review and aspiration as these may culminate in delayed surgical treatment.

Fine needle aspiration cytology in isolated thyroid swellings: a prospective two year evaluation

During 1 September 1981 to August 1982 aspiration cytology was carried out in all isolated thyroid swellings referred to the Aberdeen Thyroid Clinic: cytological findings were not disclosed, did not influence management, and were compared retrospectively with the histological diagnosis. In a total of 70 swellings sensitivity for the detection of neoplasia was 86% and overall accuracy 92%; the positive predictive value was 80% and negative predictive value 96%. During the second year (1 September 1982 to 31 August 1983), when cytological findings were used to influence management, the frequency of operation for isolated thyroid swellings decreased by 25% and the proportion of operations for neoplasia increased from 31% to 50%. In terms of bed occupancy the potentially avoidable surgical workload for benign disease was reduced by 34%. Aspiration cytology, carried out at the first clinic attendance, makes a sound basis for selective surgery and leads to economy in the management of isolated thyroid swellings.

Infection after abdominal surgery: five year prospective study.

A total of 1504 consecutive abdominal operations were studied prospectively over a five year period. The incidence of wound (2.8%) and intraperitoneal (0.8%) infections was low compared with contemporary reports. It is difficult to justify modifying existing practice on the basis of small controlled clinical trials when information from accurate audit discloses results superior to those of experimental studies.

Risk of neoplasia and malignancy in "dominant" thyroid swellings.

OBJECTIVE--To determine the risk of neoplasia and malignancy in dominant thyroid swellings. DESIGN--Prospective analysis during six years. SETTING--Thyroid clinic serving the Grampian region. PATIENTS--574 consecutive patients presenting with a discrete thyroid swelling, of whom 179 (31%) were classified clinically as having a dominant area of enlargement within a multinodular gland. RESULTS--After clinical and cytological assessment 77 dominant swellings were excised. Of the excised swellings, 45 were non-neoplastic and 32 neoplastic, including 11 malignant lesions. The minimum incidence of neoplasia and malignancy in all 179 dominant swellings was therefore 18% and 6% respectively. CONCLUSION--Dominant thyroid swellings should be regarded with greater clinical suspicion than has been traditional.