The relationship of thyroid cancer with dominant nodule in patients with nodular goiter who underwent total thyroidectomy and had thyroid carcinoma

Abstract

Purpose: To query the sufficiency of fine needle aspiration biopsy for dominant nodule in terms of planning the surgical treatment and diagnosis of thyroid cancer. Materials and Methods: Medical records of 161 patients who underwent total thyroidectomy and had thyroid cancer on pathological examination in the period of 1998-2010, were retrospectively examined. We reviewed the pathological findings of 142 patients with fine needle aspiration directed to the nodule with a diameter greater than 1 cm which was palpable or ultrasonographically detected and termed as the dominant nodule. Numbers, and diameters of malignant foci, localization in the dominant nodule and/or out of it, and histological types were recorded. Results: 65.5% of the 208 cancerous areas were single, and 34.5% were multicentric, and the histological type of all multicentric cases was papillary carcinoma. Additionally, 57.7%, and 34.5% of the cancerous areas were observed outside the dominant nodule, and in the contralateral lobe of the dominant nodule, respectively. Conclusion: Our findings indicate that, if fine needle aspiration is carried out only in the dominant nodule, more than half of the thyroid cancer foci could be missed, and lobectomy for the lobe with the dominant nodule might be overlooked in one third of thyroid cancer foci. It was concluded that fine needle aspiration should be carried out also in at least one nodule other than the dominant nodule, especially in the contralateral lobe if there are suspicious nodules, and in the presence of the papillary cancer suspicion, and, because of possible multicentricity, total thyroidectomy should be considered.