Monday, May 08, 2006

Thyroid Nodules: Why the Radiologist's Criteria is Wrong

Terry Davies, editor of the Thyroid Journal, had a word to say about the recent
Radiology consensus conference result on ultrasound for thyroid nodules. He states that consensus means no one agrees.

First, he makes a definitive statement on who should do thyroid ultrasound. "all thyroid ultrasonography should be done in real time by a thyroidologists, where the clinical history, examination, and be combined into a sensible plan."

The second big time comment by Dr Davies was " One thing to be sure of is the days of planting ones expert fingers on the neck and pronouncing the lack of thyroid nodules to the patient is gone".

Third is the fact that he states the disturbing fact that cancer is just as common in multinodular goiter as single nodule or worse. Also the biggest dominant nodule is not always the cancer.

The radiologist when all was said and done fell back on the size as the criteria for FNA. This goes against all logic as cancer starts small.

Dr. Jack Baskin and Dan Duick, clinical thyroidologists, founding members of the Academy of Clinical Thyroidologists, had an editorial which clearly showed the obvious defects of using size as a major criteria. They went as far to say size was irrelevant. The Ultrasound operator has to be experienced in USG/FNA of small nodules.

Finally, for all that are interested go to for the Academy of Clinical Thyroidologists position paper on US criteria for FNA of thyroid nodules and
suspicious cancer neck lymph nodes. You will find a different answer than the size only by the radiologists.


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