The role of fine needle aspiration biopsy cytology in the evaluation of the clinically solitary thyroid nodule.

The imputation that a clinically solitary nodule is a suspicious sign of carcinoma has been the cause of too many surgical procedures as well as the subject of much controversy. This study evaluated the effectiveness of fine needle aspiration (FNA) biopsy cytology in diagnosing the uninodular goiters in 286 patients who presented with clinically solitary nodules. The final diagnoses in these cases included carcinoma (4.7%), adenoma (6.3%), autonomous nodule (11.0%), colloid goiter (45.8%), colloid cyst (17.4%) and chronic thyroiditis (13.4%). The proportion of patients with cancer in this group was the same as in patients with multinodular and diffuse goiters. These findings call attention to (1) the fact that any thyroid disease may appear as a uninodular goiter and (2) the frequency with which lymphocytic thyroiditis was cytologically diagnosed, even in cases with negative antibody titers. The cytologic diagnosis of benign disease has contributed to a reduction in the number of unnecessary surgical procedures; only 24.1% of our patients with uninodular goiters underwent surgery.

Diagnosis of bronchogenic carcinoma through the cytologic examination of sputum, with special reference to tumor typing.

The results obtained in the cytologic study of sputa from 630 patients are presented. There were 251 cases of bronchogenic carcinoma; diagnosis through sputum examination was possible in 57.4 per cent of the patients. Abnormal cells were detected in an additional 24.3 per cent. Sputum examination has proven to be a valuable complement by establishing the correct diagnosis when other methods failed. Cancer cells were unequivocally identified in 45.8 per cent of the cases with normal bronchoscopic examination and in 52.4 per cent of the cases in which bronchial biopsy did not include malignant tissue. The same proportion of cases with the various tumor types was obtained by cytologic and by histologic study. However, one of the methods often showed a higher degree of cellular differentiation than the other. The number of cases with undifferentiated cancer or unclassified tumors was markedly reduced when the information concerning cell differentiation available through both methods was used. In this manner, excluding the oat cell carcinomas, only 7.6 per cent of the cases of bronchogenic carcinoma did not show any cellular differentiation. The authors recommend wider use of the information provided by simultaneous evaluation of both cytologic smears and tissue sections in order to achieve a more accurate appraisal of tumor type.