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PubMed2002

Effect of low- and high-dose levothyroxine on thyroid nodule volume: a crossover placebo-controlled trial.

OBJECTIVE: The efficacy and the effective dose of levothyroxine suppressive therapy in the treatment of benign thyroid nodules are controversial. In this study, we aimed to determine the response of solitary thyroid nodules to low- or high-level TSH suppression in a placebo-controlled, randomized crossover trial. DESIGN: Forty-nine patients with solitary thyroid nodules on palpation were randomized to high-level and low-level TSH suppression groups. In each group, patients were further randomized to placebo and active levothyroxine subgroups. Patients in each subgroup were crossed over to placebo or active levothyroxine at the end of the first year and were then followed up for an additional year. METHODS: TSH levels were suppressed to 0.4-0.6 mIU/ml and < or = 0.01 mIU/ml in the low-level and high-level TSH suppression groups, respectively. Nodule volumes were measured at baseline and every 6 months after the desired level of TSH was reached if the patients were in the active levothyroxine treatment group or every 6 months if they were in the placebo group. RESULTS: In high-level TSH suppression groups, nodule volume decreased significantly at the end of the active treatment periods (4.99 +/- 2.02 ml vs. 3.20 +/- 1.50 ml, P < 0.01, in Group 1; and 3.72 +/- 1.79 ml to 2.05 +/- 0.64 ml, P < 0.001, in Group 2). In the low-level TSH suppression groups, nodule volume also decreased significantly at the end of the active treatment periods (4.43 +/- 1.76 ml vs. 3.04 +/- 1.32, P < 0.05, in Group 3; and 3.59 +/- 0.89 ml to 2.22 +/- 0.59 ml, P < 0.01, in Group 4). Nodule volumes regained their original volumes during the placebo treatment periods. The percentage decline in clinically relevant nodule volume reduction (> or = 50%) was similar in the low-level and high-level TSH suppression groups. CONCLUSION: Low- and high-level TSH suppression were equally effective in reducing nodule volume and thus, considering the complications of high-level TSH suppression, low-level TSH suppression should be used if one considers levothyroxine suppressive therapy to reduce thyroid nodule size.

Adult↗

PubMed1996

Endofinger for tactile localization of pulmonary nodules during thoracoscopic resection.

To localize a deeply situated small pulmonary nodule during thoracoscopic resection, we developed as instrument a so-called "endofinger" for tactile localization of the nodule, and examined its usefulness. An attempt was made in 26 patients, using endofinger palpation under thoracoscopy, to localize twenty-six pulmonary nodules, each of which was less than 20 mm in diameter (mean 12.2 mm) and situated apart from the pleural surface. An endofinger comprises an extended "finger' section connected with a sleeve section. The sleeve section fits with a large contract area over the surgeon's forefinger, effectively lengthening it. The surgeon uses an endofinger in each hand and palpates a pulmonary nodule with the endofinger from two directions simultaneously. Surgeons could feel the hardness of nodules with a high degree of sensitivity. The sense of touch of the endofinger is much better than that of a simple bar, due to the large contact area of the sleeve section with the real finger. With the endofinger palpation 22 of 26 nodules were localized and their margins confirmed. All of 19 nodules larger than 10 mm in size had their locality confirmed by endofinger palpation. Four of 7 nodules smaller than 10 mm in size could not be localized, however. The endofinger is a useful instrument for tactile localization of pulmonary nodules under thoracoscopic surgery, especially for nodules larger than 10 mm. The method is simple, low-cost, time-saving, and has no complications.

Adult↗

PubMed2004

Ultrasound-guided fine-needle capillary biopsy of thyroid nodules, coupled with on-site cytologic review, improves results.

Fine-needle aspiration biopsy represents the most reliable test for cytologic evaluation of thyroid nodules. However, inadequate samples may occur leading to a repetition of the procedure with the consequence of patients' discomfort and poor compliance. In this paper, we present results from biopsy of thyroid nodules obtained by combining: (1) ultrasound (US) guidance, (2) no-aspiration technique, and (3) on-site review of specimens. A total of 465 nodules were biopsied in 307 patients. Solitary nodules and multinodular goiter were present in 36.8% and 63.1% of patients, respectively. After collection, each sample was smeared in duplicates, one of which was stained with hematoxylin and checked on-site by a cytopathologist. In cases of inadequate smears, biopsies were immediately repeated. All slides were then processed for final cytologic results, which were reported as benign in 427 nodules (91.8%), malignant in 12 nodules (2.5%), with follicular proliferation or suspicious for malignancy in 23 nodules (4.9%). Inadequate final cytology was reported in 3 nodules (0.6%). No statistically significant relationship was found between nodule size and adequacy of specimens. We conclude that the combination of US guidance, capillary collection with no-aspiration technique, and on-site review of slides, characterizes an advantageous method for thyroid nodule fine-needle biopsy.

Biopsy, Fine-Needle↗

PubMed2007

Pulmonary rheumatoid nodules demonstrating features usually associated with rheumatoid synovial membrane.

OBJECTIVES: To describe the unusual immunohistological characteristics of two pulmonary rheumatoid nodules showing ectopic lymphoid follicles and the features normally associated with rheumatoid synovial membrane, and to discuss the implications of this novel observation. METHODS: Two formalin-fixed wax-embedded pulmonary rheumatoid nodules were processed for immunohistology. RESULTS: The central structure of the pulmonary nodules was typical of that uniformly expected in a rheumatoid nodule with central necrosis surrounded by a palisade of macrophages. However, a feature not previously observed in nodules was the presence of lymphoid aggregates containing B lymphocytes and, in some cases, showing characteristic features of lymphoid follicles. CONCLUSIONS: The presence of B lymphocytes and the development of ectopic lymphoid follicles in rheumatoid nodules have not been described previously. It is similar to synovial membrane, and contrasts with the expected structure of subcutaneous nodules where B cells and lymphoid follicles are normally absent. These observations establish that the morphology of rheumatoid nodules can vary in different tissues. They further suggest that the inflammatory process in the nodule and synovial membrane are likely to be similar, and that the characteristics of different tissues may be an important determinant of apparent differences between inflammatory lesions in synovial membrane and extra-articular nodules in rheumatoid arthritis.

B-Lymphocytes↗

PubMedDate not supplied

Posterior subpleural nodules in patients with underlying malignancies: value of prone computed tomography.

PURPOSE: The aim of this study was to investigate the value of prone computed tomography (CT) in patients with underlying malignancies and posterior subpleural nodule(s) on a supine CT scan. METHOD: A prospective study was performed on 26 patients who had an underlying malignancy and posterior subpleural nodule(s) on a chest CT scan. Helical CT scanning with a 3-mm collimation was done in both the supine and prone positions at an interval of 1-50 days (mean, 9 days). The size, shape, and location of the nodule(s) as well as the associated dependent ground-glass opacity on an initial CT scan and the change in the nodule(s) on follow-up supine and prone CT scans were analyzed. RESULTS: The nodules were single in 10 patients and multiple in 16. In 25 of 26 patients, the nodules were located in the lower lobes. Most had an oval shape, forming an obtuse angle with the adjacent pleura. The size ranged from 5 mm x 2 mm to 12 mm x 4 mm (mean, 7 mm x 3 mm). An associated dependent ground-glass opacity was found in 11 patients. At the follow-up examinations, the posterior subpleural nodules had disappeared in 10 patients on the supine scan and in 21 patients on the prone scan. The persistent nodules on the prone CT scan were granulomas in 2 patients and metastases in 3 patients. CONCLUSION: Posterior subpleural nodules may be reversible, and the nodular atelectasis can be differentiated from true nodules without using invasive procedures by employing prone CT scanning.

Adult↗

PubMed1993

Variables affecting pulmonary nodule detection with computed tomography: evaluation with three-dimensional computer simulation.

To meaningfully evaluate factors determining the overall accuracy of computed tomography (CT) for identifying pulmonary nodules, computer-generated nodules were superimposed on normal CT scans and interpreted independently by three experienced chest radiologists. Variables evaluated included nodule size, shape, number, density, location, edge characteristics, and relationship to adjacent vessels, as well as technical factors, including slice thickness and electronic windowing. The overall sensitivity in identifying nodules was 62% and the specificity was 80%. On average, the observers identified 56, 67, and 63% of nodules on 1.5-, 5-, and 10-mm-thick sections, respectively (p = 0.037). Nodules were more difficult to identify on 1.5-mm-thick sections. On average, observers identified 1, 48, 82, and 91% of nodules < 1.5, < 3, < 4.5, and < 7 mm in diameter, respectively (p < 0.001). Other factors that made a significant contribution (p < 0.01) in identifying nodules, as determined by linear discriminant function analysis, included nodule location, angiocentricity, and density. We concluded that computer-generated nodules can be used to assess a large number of imaging variables. We anticipate that this approach will be of considerable utility in assessing the accuracy of interpretation of a wide range of pathologic entities as well as in optimizing three-dimensional scan protocols within the thorax.

Humans↗

PubMed2004

Peripheral lung nodules: fluoroscopically guided video-assisted thoracoscopic resection after computed tomography-guided localization using platinum microcoils.

OBJECTIVES: We sought to test the safety and efficacy of fluoroscopically guided, video-assisted, thoracoscopic resection after computed tomography (CT)-guided localization using platinum microcoils. SUMMARY BACKGROUND DATA: Video-assisted thoracoscopic (VATS) resection of small pulmonary nodules >5 mm deep to the visceral pleura fails to locate the nodule and requires conversion to open thoracotomy in two thirds of cases. Therefore, we developed a new technique for intraoperative localization of these nodules using CT-guided placement of platinum microcoils. This study tests the safety and efficacy of this technique in a Phase I human study. METHODS: Twelve patients with undiagnosed growing pulmonary nodules <20 mm were marked preoperatively using percutaneously placed CT-guided platinum microcoils. The coil was deployed adjacent to the nodule with the distal end of the coil placed deep to the nodule and the superficial end coiled on the pleural surface. The nodule and coil were excised using endostaplers guided by VATS and fluoroscopy. Histopathologic diagnosis was performed immediately after resection. RESULTS: CT-guided microcoil localization was successful in all patients. A small hemothorax and a pneumothorax requiring a chest tube occurred in 2 patients. Mean distance from visceral pleura to the deep edge of the nodule was 30.9 +/- 15.4 mm. VATS resection of the nodules (size = 11.8 +/- 3.2 mm) was successful in all patients. Mean microcoil localization, fluoroscopy, and operative times were 42 +/- 14, 3.1 +/- 2.0, and 67 +/- 27 minutes. A diagnosis of primary nonsmall cell bronchogenic carcinoma was made in 6 patients who then received a completion lobectomy. Six patients (hamartoma: 2, reactive lymph node: 1, bronchoalveolar cell carcinoma: 2, metastatic sarcoma: 1) did not receive further resections. CONCLUSIONS: Preoperative localization of pulmonary nodules using percutaneous CT-guided platinum microcoil insertion combined with operative fluoroscopic visualization is a safe, effective technique that increases the success rate of VATS excision.

Female↗

PubMed1994

Ultrasound guided percutaneous ethanol injection in the treatment of cystic thyroid nodules.

OBJECTIVE: The management of cystic lesions in the thyroid remains controversial. We examined the efficacy and safety of ultrasound guided percutaneous ethanol injection for the treatment of benign cystic thyroid nodules in euthyroid patients. STUDY DESIGN: (A) Preliminary randomized trial: 20 patients with predominantly cystic thyroid nodules were randomized in two groups and followed up for 1 month. Group 1 underwent fine needle aspiration of the fluid component of the nodules; Group 2 underwent percutaneous ethanol injection at the end of fine needle aspiration of the cyst fluid. (B) Prospective study: 32 patients with the same clinical characteristics (Group 3) were treated by fine needle aspiration and percutaneous ethanol injection, and followed up for 12 months. METHODS: Groups 1 and 2: clinical evaluation, thyroid ultrasonography, thyroid scintiscan and serum thyroid hormone profile were performed before treatment and one month later. Group 3: clinical evaluation, thyroid ultrasonography and serum thyroid hormone profile were performed in basal conditions and 1, 3, 6, 9, 12 months after treatment. Thyroid scintiscan was performed before treatment and 3-6 months later. RESULTS: (A) Randomized study: one month after treatment, nodule volume decrease in Group 2 was significantly higher than in Group 1 (Group 2: median 14.75 range 6-29.9 ml; Group 1: median 3.65 range 0.2-18.5 ml; P < 0.01). Nodule volume reduction was greater than 50% versus baseline in 8 (80%) patients in Group 2 and in 3 (30%) patients in Group 1 (P < 0.01). (B) Prospective study (Group 3): a significant nodule volume reduction (P < 0.01 vs pretreatment) was observed 1 and 12 months after percutaneous ethanol injection (pretreatment: median 14.5, range 1.5-65.8 ml; 1 month: median 3.5, range 0.4-38.9 ml; 12 months: median 2.5, range 0.4-34.5 ml). Nodule volume reduction greater than 50% was recorded in 24 (80%) patients. Groups 1-3: recurrence of cyst fluid was demonstrated by ultrasonography in 8 patients of Group 1, in 3 patients of Group 2 and in 1 patient of Group 3. No relevant adverse effects or significant biochemical changes were observed. CONCLUSIONS: Ultrasound guided percutaneous ethanol injection of cystic thyroid nodules is a safe, low-cost and effective therapeutic procedure in patients with benign thyroid cystic nodules. Indeed, nodule volume reduction was significantly greater and more frequent in patients treated by percutaneous ethanol injection than in those patients who underwent fluid aspiration alone. These results were confirmed in a long-term prospective trial and only one fluid recurrence was observed during 12 months of follow-up.

Adolescent↗

PubMed2006

Natural course of benign thyroid nodules in a moderately iodine-deficient area.

OBJECTIVE: Few studies using ultrasonographic evaluation have addressed the natural course of benign thyroid nodules. In this study, we present the long-term analysis of benign, untreated thyroid nodules in a moderately iodine-deficient area. DESIGN: We collected the retrospective data for 531 nodules in 420 patients followed by ultrasonography for a mean time period of 39.7 +/- 27.8 months (range 12-168 months). RESULTS: When we considered significant nodule size decrease criteria as decreases in nodule volume of at least 15% and 30%, we found that 33.1% and 20.7% of thyroid nodules decreased in size, respectively. Using the criteria of a greater than 15% and 30% increase in volume showed that 32% and 24.1% increased in size, respectively. A logistic regression analysis using mixed models to predict thyroid nodule growth (volume change > or = 15%), including age, TSH, sex and time between evaluations, failed to predict nodule growth. Only hypoechoic echo pattern remained as a statistically significant predictor of growth. CONCLUSION: In 40 months' follow-up, we found that benign thyroid nodules exhibited a mostly favourable clinical natural course. One-third of benign thyroid nodules showed continuous growth, one-third remained unchanged, and the other third decreased in size.

Adolescent↗

PubMed1995

The role of colour and duplex Doppler ultrasound in the assessment of thyroid nodules.

The role of colour and duplex Doppler ultrasound in investigating nodular thyroid disease was evaluated. Fifty patients with solitary or dominant nodules were studied. All nodules were examined with colour Doppler with spectral analysis performed on vascular lesions. Pathological correlation was available for all nodules. The majority of thyroid nodules could be accurately categorized by their colour Doppler appearances. This was true for both solitary and dominant nodules. All neoplastic nodules (adenomas, carcinomas) contained intra-nodular flow signals. The majority of the colloid nodules were either avascular or had halo flow signals only. A minority of colloid nodules were vascular. These nodules were large (> 2 cm), had dominant halo vessels and cytological evidence of follicular cell hyperplasia. Although colour Doppler lacks absolute specificity in discriminating neoplastic and non-neoplastic thyroid nodules, the data suggests the modality has considerable use in clinical practice. The spectral analysis data was time-consuming to obtain and had less obvious clinical application.

Adult↗

PubMed2006

Arbuscular mycorrhizal fungi colonize nonfixing root nodules of several legume species.

Many legumes form tripartite symbiotic associations with rhizobia and arbuscular mycorrhizal fungi (AMF). Rhizobia are located in root nodules and provide the plant with fixed atmospheric nitrogen, while AMF colonize plant roots and deliver several essential nutrients to the plant. Recent studies showed that AMF are also associated with root nodules. This might point to interactions between AMF and rhizobia inside root nodules. Here, we test whether AMF colonize root nodules in various plant-AMF combinations. We also test whether nodules that are colonized by AMF fix nitrogen. Using microscopy, we observed that AMF colonized the root nodules of three different legume species. The AMF colonization of the nodules ranged from 5% to 74% and depended on plant species, AMF identity and nutrient availability. However, AMF-colonized nodules were not active, that is, they did not fix nitrogen. The results suggest that AMF colonize old senescent nodules after nitrogen fixation has stopped, although it is also possible that AMF colonization of nodules inhibits nitrogen fixation.

Fabaceae↗

PubMed2003

Computerized scheme for determination of the likelihood measure of malignancy for pulmonary nodules on low-dose CT images.

An automated computerized scheme has been developed for determination of the likelihood measure of malignancy of pulmonary nodules on low-dose helical CT (LDCT) images. Our database consisted of 76 primary lung cancers (147 slices) and 413 benign nodules (576 slices). With this automated computerized scheme, the location of a nodule was first indicated by a radiologist. The outline of the nodule was segmented automatically by use of a dynamic programming technique. Various objective features on the nodules were determined by use of outline analysis and image analysis, and the likelihood measure of malignancy was determined by use of linear discriminant analysis (LDA). The effect of many different combinations of features and the performance of LDA in distinguishing benign nodules from malignant ones were evaluated by means of receiver operating characteristic (ROC) analysis. The Az value (area under the ROC curve) obtained by the computerized scheme in distinguishing benign nodules from malignant ones was 0.828 when a single slice was employed for each of the nodules. However, the Az value was improved to 0.846 when multiple slices were used for determination of the likelihood measure of malignancy. The Az values obtained by the computerized scheme on LDCT images were significantly greater than the Az value of 0.70, which was obtained from our previous observer studies by radiologists in distinguishing benign nodules from malignant ones on LDCT images. The automated computerized scheme for determination of the likelihood measure of malignancy would be useful in assisting radiologists to distinguish between benign and malignant pulmonary nodules on LDCT images.

Algorithms↗

PubMed2004

Segmentation of nodules on chest computed tomography for growth assessment.

Several segmentation methods to evaluate growth of small isolated pulmonary nodules on chest computed tomography (CT) are presented. The segmentation methods are based on adaptively thresholding attenuation levels and use measures of nodule shape. The segmentation methods were first tested on a realistic chest phantom to evaluate their performance with respect to specific nodule characteristics. The segmentation methods were also tested on sequential CT scans of patients. The methods' estimation of nodule growth were compared to the volume change calculated by a chest radiologist. The best method segmented nodules on average 43% smaller or larger than the actual nodule when errors were computed across all nodule variations on the phantom. Some methods achieved smaller errors when examined with respect to certain nodule properties. In particular, on the phantom individual methods segmented solid nodules to within 23% of their actual size and nodules with 60.7 mm3 volumes to within 14%. On the clinical data, none of the methods examined showed a statistically significant difference in growth estimation from the radiologist.

Algorithms↗

PubMed2006

Computer-aided diagnosis of pulmonary nodules on CT scans: segmentation and classification using 3D active contours.

We are developing a computer-aided diagnosis (CAD) system to classify malignant and benign lung nodules found on CT scans. A fully automated system was designed to segment the nodule from its surrounding structured background in a local volume of interest (VOI) and to extract image features for classification. Image segmentation was performed with a three-dimensional (3D) active contour (AC) method. A data set of 96 lung nodules (44 malignant, 52 benign) from 58 patients was used in this study. The 3D AC model is based on two-dimensional AC with the addition of three new energy components to take advantage of 3D information: (1) 3D gradient, which guides the active contour to seek the object surface, (2) 3D curvature, which imposes a smoothness constraint in the z direction, and (3) mask energy, which penalizes contours that grow beyond the pleura or thoracic wall. The search for the best energy weights in the 3D AC model was guided by a simplex optimization method. Morphological and gray-level features were extracted from the segmented nodule. The rubber band straightening transform (RBST) was applied to the shell of voxels surrounding the nodule. Texture features based on run-length statistics were extracted from the RBST image. A linear discriminant analysis classifier with stepwise feature selection was designed using a second simplex optimization to select the most effective features. Leave-one-case-out resampling was used to train and test the CAD system. The system achieved a test area under the receiver operating characteristic curve (A(z)) of 0.83 +/- 0.04. Our preliminary results indicate that use of the 3D AC model and the 3D texture features surrounding the nodule is a promising approach to the segmentation and classification of lung nodules with CAD. The segmentation performance of the 3D AC model trained with our data set was evaluated with 23 nodules available in the Lung Image Database Consortium (LIDC). The lung nodule volumes segmented by the 3D AC model for best classification were generally larger than those outlined by the LIDC radiologists using visual judgment of nodule boundaries.

Biopsy↗

PubMed2002

Benign solitary solid cold thyroid nodules: US-guided interstitial laser photocoagulation--initial experience.

PURPOSE: To evaluate the effects of ultrasonography (US)-guided interstitial laser photocoagulation (ILP) on the volume of benign solitary solid cold thyroid nodules and any nodule-related symptoms. MATERIALS AND METHODS: ILP was performed in 16 patients with normal thyroid function and a solid benign thyroid nodule. None of the patients had uptake on a radionuclide scan. Patients underwent one ILP session. A needle was positioned in the thyroid nodule with US guidance, and the laser fiber was placed in the lumen of the needle. Patients were treated for 287-1,200 seconds with an output power of 1-3 W. ILP was performed with continuous US guidance and terminated when the echogenic changes were stationary. Thyroid nodule volume and thyroid function were evaluated before and 1, 3, and 6 months after treatment. During the same period, 15 untreated patients (control group) were followed up to evaluate the size of the untreated thyroid nodule. RESULTS: In the 16 patients treated with ILP, the mean thyroid nodule volume decreased from 10 to 5.4 mL (P <.001) after 6 months. The median energy given was 761 J. There was no relationship between the dose of thermal energy given and nodule reduction. Pressure symptoms were significantly reduced (P =.0002) after 6 months. The treatment was well-tolerated in all patients. No significant change in thyroid nodule volume was seen in the control group. CONCLUSION: US-guided ILP could become a useful nonsurgical alternative in the treatment of the benign solitary solid cold thyroid nodule in patients who cannot or will not undergo surgery.

Adult↗

PubMed1985

Pulmonary nodules: detection using magnetic resonance and computed tomography.

Detection of pulmonary nodules using spin-echo magnetic resonance (MR) imaging was compared with detection using computed tomography (CT). Of the 25 patients studied independently by two radiologists, no lung nodules were detected in 11 (CT or MR), ten had a single nodule, and four had multiple nodules. The lesions not seen using CT or MR were less than 1.3 cm in diameter. The greater spatial resolution of CT enabled better detection of nodules close to the diaphragm, the pleura, or to each other, whereas the better contrast resolution of MR enabled the detection of several nodules close to blood vessels. With MR, nodules were best seen on images with long repetition times (2.0 sec). Most pulmonary nodules are seen using both CT and MR. CT generally enables the detection of more small nodules than MR does, and some low-density nodules near blood vessels are better displayed using MR.

Adolescent↗

PubMed2000

Lung nodule enhancement at CT: multicenter study.

PURPOSE: To test the hypothesis that absence of statistically significant lung nodule enhancement (< or =15 HU) at computed tomography (CT) is strongly predictive of benignity. MATERIALS AND METHODS: Five hundred fifty lung nodules were studied. Of these, 356 met all entrance criteria and had a diagnosis. On nonenhanced, thin-section CT scans, the nodules were solid, 5-40 mm in diameter, relatively spherical, homogeneous, and without calcification or fat. All patients were examined with 3-mm-collimation CT before and after intravenous injection of contrast material. CT scans through the nodule were obtained at 1, 2, 3, and 4 minutes after the onset of injection. Peak net nodule enhancement and time-attenuation curves were analyzed. Seven centers participated. RESULTS: The prevalence of malignancy was 48% (171 of 356 nodules). Malignant neoplasms enhanced (median, 38.1 HU; range, 14.0-165.3 HU) significantly more than granulomas and benign neoplasms (median, 10.0 HU; range, -20.0 to 96.0 HU; P < .001). With 15 HU as the threshold, the sensitivity was 98% (167 of 171 malignant nodules), the specificity was 58% (107 of 185 benign nodules), and the accuracy was 77% (274 of 356 nodules). CONCLUSION: Absence of significant lung nodule enhancement (< or = 15 HU) at CT is strongly predictive of benignity.

Adult↗

PubMed2006

Evaluation of the thyroid nodule.

BACKGROUND: Thyroid nodules are common, yet treatment modalities range from observation to surgical resection. Because thyroid nodules are frequently found incidentally during routine physical examination or imaging performed for another reason, physicians from a diverse range of specialties encounter thyroid nodules. Clinical decision making depends on proper evaluation of the thyroid nodule. METHODS: The current literature was reviewed and synthesized. RESULTS: Current evidence allows the formulation of recommendations and a general algorithm for evaluating the incidental thyroid nodule. CONCLUSIONS: Only a small percentage of thyroid nodules require surgical management. Diagnosis and treatment selection require a risk stratification by history, physical examination, and ancillary tests. Nodules causing airway compression or those at high risk for carcinoma should prompt evaluation for surgical treatment. In nodules larger than 1 cm, fine-needle aspiration biopsy is central to the evaluation as it is accurate, low risk, and cost effective. Subcentimeter nodules, often found incidentally on imaging obtained for another purpose, can usually be evaluated by ultrasonography. Other laboratory and imaging evaluations have specific and more limited roles. An algorithm for the evaluation of the thyroid nodule is presented.

Biopsy, Fine-Needle↗