Khosla, Shivun1, Simo, Ricard1, Nixon, Iain1, Tikka, Theofano1, Jeannon, Jean-Pierre1, Ngu, Rose1, Chandra, Ash1, Moonim, Muffadal1, Carroll, Paul1, Tharavaj, Selvam1
1 Head and Neck and Thyroid Oncology Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
Background: Ultrasound-guided fine needle aspiration (USS-FNAC) is now the gold standard tool for evaluating patients with thyroid nodules with a false-negative rate of < 3%. However, the utility of USS-FNAC in the evaluation of Intrathoracic Goitres (ITGs) remains controversial.
Objectives: To determine the value of USS-FNAC in the evaluation of ITG, to determine the incidence of cancer in ITG and establish the clinical implications of this diagnosis.
Methods: A review of 237consecutive patients undergoing surgery for ITG from 2004 to 2016 was undertaken. All patients were evaluated with USS-FNAC and cytology results of Thy3 or above were discussed in the thyroid multidisciplinary oncology meeting before surgery. Data on cytological and histological analysis was collected prospectively and analyzed.
Results: Nineteen patients were diagnosed with thyroid cancer. The rate of malignancy in ITG is 8.01%. Twelve patients had benign pre-operative benign cytology results and resulting in a rate of unexpected occult malignancy of 0.46%. 18 patients had Papillary Thyroid Cancer and 1 patient Medullary Thyroid Cancer. Of the 13 patients undergoing initial hemithyroidectomy, 7 underwent completion surgery due to multicentricity or tumour stage. The USS-FNAC had a sensitivity of 33% and specificity 93.3% to exclude cancer.
Discussion & Conclusion: Surgery for ITG is challenging. It requires accurate evaluation and a multidisciplinary approach by specialised teams. USS-FNAC has poor sensitivity (33%) but high specificity (93.3%) to exclude cancer in ITGs. Patients undergoing initial hemi-thyroidectomy and diagnosed of cancer may need to undergo completion thyroidectomy due to the stage of tumour.