Importance of FNAC in the detection of tumours within multinodular goitre of the thyroid.

The primary challenge in the management of a multinodular thyroid gland is to rule out malignancy. The present study was undertaken to assess the value of preoperative ultrasound-guided fine needle aspiration cytology (FNAC) in diagnosing tumours of the thyroid gland. Of the 80 patients operated for multinodular lesions, malignant tumours were found in 29 and benign tumours in 36 patients (81%) and non-tumorous lesions in 15 (19%) patients. Compared with the histopathological postoperative diagnosis, the overall sensitivity of FNAC was 85% and specificity 88%. Current morphological diagnosis of the nodules in multinodular goitre requires thorough preoperative examination, including ultrasound-guided FNAC in order to establish the appropriate management.

Ultrasonic evaluation of benign and malignant nodules in echographically multinodular thyroids.

In 165 patients with ultrasound findings of multinodular thyroids in whom thyroid resection was performed, sonographic features and pathohistologic findings of removed nodules were analyzed. Of 426 nodules removed, 70 were carcinomas and 356 benign. Carcinomas are more often hypoechogenic (p < 0.01) and contain nodular calcifications (p < 0.01), while benign nodules are more often iso-hyperechogenic (p < 0.01), showing intranodular cystic degenerative changes (p < 0.01) and perinodular hypoechogenic rim (p < 0.01). Mean diameter of carcinomatous nodules is lower than in benign nodules (p = 0.022). The relative proportion of malignant nodules is highest in the upper halves of thyroid lobes (p < 0.01). Although certain sonographic signs increase the likelihood of a given lesion being malignant or benign, the lack of absolute specificity in the ultrasound evaluation of thyroid nodules was confirmed.

Parathyroid sonography in secondary hyperparathyroidism: correlation with clinical findings.

We present the results of ultrasonic neck examination in 72 patients (47 males, 25 females) on chronic haemodialysis, with clinical and biochemical signs of increased function of the parathyroid glands. The findings of the ultrasonic examination performed using linear transducers of 5 and 7.5 MHz for the surface tissue are compared with the duration of haemodialysis treatment, biochemical parameters (calcium, phosphate, parathormone, alkaline phosphatase) and skeleton X-ray findings. In 18 patients parathyroid glands were not visible, in 30 patients there were one or two enlarged (i.e. abnormal) parathyroid glands, and in the remaining 24 patients three or four of the glands were enlarged. Abnormal parathyroid glands were more often found in patients who had been dialysed for a longer period of time, as well as in those with a higher parathormone level in the blood. It is concluded that ultrasonic examination of the neck is very useful in the diagnosis of enlarged parathyroid glands, and helpful in the management of patients on chronic haemodialysis.