Endocrine Abstracts (2003) 6 S18

The case against

JH Lazarus

Department of Medicine, University of Wales College of Medicine, Cardiff, UK.

There is no doubt that the use of a syringe and needle has led to an important cost effective strategy for the investigation of thyroid nodules by fine needle aspiration biopsy (FNAB) with cytological examination of the aspirate. A recent European Thyroid Association survey found that 99% of respondents used FNAB (Bennedbaek et al 1999). However, there are limitations of FNAB including false negatives, false positives, inadequate specimens and reporting, accessibility of nodule or nodules and patient anxiety despite negative FNAB. FNAB should therefore be supplemented by appropriate imaging modalities such as ultrasound, CT (or MRI) in the minority of patients where anatomic detail is required. Functional airway status may be evaluated by plain radiography + flow volume studies. Specific groups of patients should have other concurrent investigations e.g. those with positive family history of medullary carcinoma, previous history of irradiation and probably prepubertal children.

While the role of thyroid scintigraphy as a first line evaluation for nodules has now been superseded it may give useful results in patients with a 'hot' nodule and in the assessment of functioning thyroid tissue. Certainly this investigation is used significantly less in North America than in Europe (Bennedbaek and Hegedus 2000).

This house is too sophisticated to accept that a syringe and needle is the be all and end all to the investigation of thyroid nodules.


Bennedbaek FN, et al. Clin Endocr 1999 50:357-63.

Bennedbaek FN and Hegedus L. J Clin Endorinol Metab 2000 85:2493-8.

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