Patients’ Preferences’ Impact on Decision Making for Clinical Solitary Thyroid Nodule in a Global Healthcare Setting: A Clinical Study

2021 ◽  
Vol 3 (2) ◽  
pp. 48-58
Author(s):  
Abdalla Y Bashir ◽  
Keyword(s):  
Decision Making ◽  
Thyroid Nodule ◽  
Thyroid Surgery ◽  
Frozen Section ◽  
Management Strategies ◽  
Healthcare Setting ◽  
Objective Evaluation ◽  
Needle Aspiration ◽  
Solitary Thyroid Nodule ◽  
Risk Of Malignancy

Objective: Evaluation of patients’ preferences (PP) impact on decision-making for solitary thyroid nodule management. Study Design: A retrospective review of prospectively collected data in patients with clinical solitary nodules admitted for thyroid surgery. PP survey in various management strategies included determinants of surgery, fine-needle aspiration cytology (FNAC), frozen section (FS), and PP for total thyroidectomy (TT) or total lobectomy (TL) compared to guidelines concordance. Results: Thyroid surgery was performed for 558 patients, 75.8% were females and 43.7% were international. FNAC was done in 79.8% and refused by 20.2% due to the misperception that it spreads cancer. The risk of malignancy was the reason for choosing surgery in 35.1%. FS was preferred by 87% of the patients for decision-making (TT vs TL) in our setting with available pathology resources and low FS cost. FS based decisions were more guideline-concordant (79%) with TT performed in 41% patients compared to 74.4% in PP based decisions alone (P < 0.001). 57.9% of the patients preferred surgeon authorization for decision-making when FS was unavailable. Papillary thyroid carcinoma (PTC) occurred in 85.3%. FS diagnosed PTC in 79% of the patients with malignant nodules in inconclusive FNACs (Bethesda I, III, IV, and V). Conclusion: Decisions (TT vs TL) based on PP and beliefs compared to FS based decisions were less guideline-concordant (21% vs 79%) with more TT performed (74.4% vs 41%) (P < 0.001). Advancing patients’ knowledge on their disease, guidelines, and equipoise awareness is needed for better-shared decision-making.

Use of fine-needle aspiration biopsy and frozen section in the management of the solitary thyroid nodule

Surgery ◽  
1997 ◽  
Vol 122 (6) ◽  
pp. 1021-1027 ◽  
Author(s):  
Michael S Sabel ◽  
Edgar D Staren ◽  
Louis M Gianakakis ◽  
Suri Dwarakanathan ◽  
Richard A Prinz
Keyword(s):  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Biopsy ◽  
Frozen Section ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Fine Needle ◽  
Solitary Thyroid Nodule ◽  
Needle Aspiration Biopsy

scholarly journals Predictors of Malignancy in Patients With Thyroid Nodule(s)

2017 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Islam Alatiar ◽  
Hassam Elfol ◽  
Tarek Rageh
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Surgery ◽  
Large Scale ◽  
Thyroid Nodules ◽  
Nodular Goiter ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
University Hospital ◽  
Fine Needle ◽  
Risk Of Malignancy

Purpose: To detect the predictors of malignancy in patients with thyroid nodule(s). Background: Thyroid nodules are common surgical problem with 5-10% risk of malignancy. Thyroid surgery is a major operation with many complications. So, it is important to search for the predictors of malignancy in thyroid nodules to spare more benign lesions from surgery. Patients and methods: This prospective study includes 150 patients with thyroid nodule(s), all were admitted for thyroidectomy at Menoufia University Hospital. Demographic and clinical data, ultrasound, fine needle aspiration reports and final histopathology were recorded and analyzed. Patients with previous thyroid surgery or previous neck biopsy were excluded. Results: About 20% of the studied population proved to have malignant nodules on final histopathology reports. Out of 150 cases, there were 83 with multi-nodular goiter and 67 with solitary thyroid nodules. There were higher incidence of malignancy in male patients. The incidence also was higher in solitary nodules than in multinodular goiter. There were statistically significant ultrasound features differences such as; micro-calcifications, ill-defined edges, solid consistency, hypo-echoic pattern, intra-nodular vascularity and size below 2cm. Regarding fine needle biopsy, there were a significant increase in incidence of malignancy from Bethesda(II) – Bethesda(VI) with highest incidence in Bethesda(VI). Conclusion: Predictors of malignancy detected were; male gender, solitary nodules, micro-calcifications, hypo-echoic pattern, ill-defined edges, intra-nodular vascularity, solid nodules, size below 2 cm and Bethesda VI. Large scale multi center studies are needed for more solid statistical result.

Management of the single thyroid nodule

2011 ◽  
pp. 595-600
Author(s):  
Laszlo Hegedüs ◽  
Finn N. Bennedbæk
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Surgery ◽  
Main Concern ◽  
Thyroid Malignancy ◽  
Normal Gland ◽  
Solitary Thyroid Nodule ◽  
Euthyroid Patient ◽  
Surgery Management

The main concern of patients and physicians alike, when dealing with the solitary thyroid nodule, is to diagnose the few cancers (approximately 5%) as rapidly and cost-effectively as possible, and to reduce superfluous thyroid surgery. Management has changed in recent years, but differences prevail as shown by an investigation among European thyroidologists (1). This chapter focuses on the palpably discrete swelling within an otherwise normal gland in the clinically and biochemically euthyroid patient (2, 3). The toxic nodule is dealt with in Chapter 3.3.11, and thyroid malignancy in Chapters 3.5.4–3.5.7.

Operative Decision-Making for Follicular Thyroid Lesions: A Community Hospital System Experience

2011 ◽  
Vol 77 (4) ◽  
pp. 443-446 ◽  
Author(s):  
Kevin Grannan ◽  
Jonathan Snyder ◽  
Sarah Mcdonough ◽  
Amy Engel ◽  
James Farnum
Keyword(s):  
Decision Making ◽  
Community Hospital ◽  
Frozen Section ◽  
Needle Aspiration ◽  
Frozen Sections ◽  
Indication For Surgery ◽  
Hospital System ◽  
Reoperative Surgery ◽  
Intraoperative Frozen Section ◽  
Initial Surgery

Follicular neoplasms of the thyroid are a frequent indication for surgery of the thyroid gland. We evaluated the use of frozen sections on intraoperative decision-making, possible avoidance of reoperative surgery, and histologic findings in a retrospective cohort. A database was created of all thyroid operations from 2001 to 2007. Data collected included age, gender, preoperative cytology, indication for surgery, surgeon, intraoperative decision-making, and histologic findings. Of the 723 thyroidectomies, 203 were performed for follicular neoplasms diagnosed by fine needle aspiration. Of these, 135 had cytology reports available within our electronic medical record; 44 per cent (59 of 135) of these patients had an intraoperative frozen section. Only two of 59 (3.4%) were positive for carcinoma, both of which were papillary carcinomas. One was interpreted as “suspicious” for carcinoma by the pathologist. In these three cases, the surgeon proceeded with total thyroidectomy at the time of initial surgery. The results of frozen section altered the operation in only three of 59 cases (5.1%). Intraoperative frozen section rarely impacts the conduct of thyroidectomy for follicular neoplasms.

scholarly journals Frozen section and fine needle aspiration biopsy in thyroid surgery — needles and sections

2007 ◽  
Vol 69 (4) ◽  
pp. 140-144 ◽  
Author(s):  
Oktay Irkorucu ◽  
Oge Tascilar ◽  
Guldeniz Karadeniz Cakmak ◽  
Ali Ugur Emre ◽  
Hamdi Bulent Ucan ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Surgery ◽  
Fine Needle Aspiration Biopsy ◽  
Frozen Section ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Fine Needle ◽  
Needle Aspiration Biopsy

scholarly journals Diagnostic Accuracy of the Bethesda System of Reporting Thyroid Cytopathology in the Evaluation of Thyroid Nodule in a Tertiary Care Hospital of Kolkata

2021 ◽  
Vol 8 (05) ◽  
pp. 241-245
Author(s):  
Sweta Verma ◽  
Mita Saha Dutta Chowdhury ◽  
Souradeep Ray ◽  
Ruma Guha
Keyword(s):  
Diagnostic Accuracy ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Care Hospital ◽  
Risk Of Malignancy ◽  
Needle Aspiration Cytology ◽  
Thyroid Cytopathology ◽  
The Bethesda System

BACKGROUND Thyroid cancer has the most rapidly increasing incidence of all major cancers in India. The overall prevalence of thyroid malignancy is approximately 1 - 5 % of all cancers in women and less than 2 % in men. Thyroid nodules are a common clinical finding and have a reported prevalence of 4 – 7 % in the general population. The vast majority of these nodules are non-neoplastic or benign and the risk of malignancy varies from 5 to 10 %. Fine needle aspiration cytology (FNAC) is an efficient and reliable means for the evaluation of thyroid nodules. A key challenge for clinicians is to choose which thyroid nodule is to be investigated further and treated. Early detection and treatment of malignant thyroid nodules is associated with excellent outcomes. The aim of our study is to compare and correlate between fine needle aspiration cytology and histopathology of resected specimen and to determine the diagnostic accuracy of TBSRTC (The Bethesda System for Reporting Thyroid Cytopathology) in thyroid nodule. METHODS This is a cross sectional validation study conducted in a tertiary care hospital (R.G. Kar Medical College) of Kolkata to find the sensitivity, specificity and diagnostic accuracy of TBSRTC in evaluation of thyroid nodule. RESULTS We have observed that TBSRTC is highly sensitive and specific in stratifying the malignancy risk of thyroid nodule. CONCLUSIONS It aids the clinician to choose the thyroid nodules which require further evaluation and intervention. It also guides the clinician to decide the operability of thyroid nodule. TBSRTC is highly accurate and is highly specific in stratifying the risk of malignancy of thyroid nodule. KEYWORDS TBSRTC, FNAC, Thyroid Nodules, Thyroid Cancer

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