A retrospective study of ultrasound and FNA cytology investigation of thyroid nodules: working towards combined risk stratification.

The British Thyroid Association recommended in new guidelines on thyroid cancer treatment [Kwak et al. (Korean J Radiol 14:110-117, 2013)] that ultrasound grading of thyroid nodules should be incorporated into MDT management. A retrospective study was carried out to determine that the impact of US grading has had on MDT decision making in practice. The design used in the study is a retrospective review of case notes. The study was carried out in the hub hospital for thyroid cancer in the North west London Cancer network. We included consecutive patients referred to the regional thyroid multidisciplinary meeting between August 2014 and May 2015 for investigation of thyroid nodules. Data were collected on patient demographics, co-morbidity, thy grading, ultrasound grading, surgery, post-operative histology, and radioactive iodine treatment details. Accuracy of cytology and ultrasound in diagnosing malignancy was correlated to definitive histology. 99 patients with thyroid nodules were included in the study. 97% of patients had at least one fine needle aspiration and 75% had ultrasound grading. Thy3f (Bethesda IV) nodules were more likely to be carcinoma if associated with a U4 grade rather than U3 (67 vs 18%, p = 0.028). Ultrasound grading has recently been introduced to the standard practice in investigation of thyroid nodules. Further assessment of the accuracy of ultrasound grading in clinical practice may allow us to risk-stratify thy3a/thy3f (Bethesda III/IV) lesions and personalise treatment.

Inflammatory pseudotumour of the neck with multifocal sites on positron emission tomography scan imaging.

We present a patient with an inflammatory pseudotumour of the neck with multifocal sites in the head and chest responding to steroids. A review of the literature revealed that this is the first case of a pseudotumour with multiple sites in the head and neck as revealed by 2-[18]fluorodeoxyglucose (FDG) PET scan imaging.

Role of tonsillectomy in the search for a squamous cell carcinoma from an unknown primary in the head and neck.

Cervical metastases of an unknown primary lesion accounts for 5%-10% of head and neck cancers. Tonsillar carcinoma is the third most common, with an incidence in the region of 18%-47% of unknown primaries, and the likelihood of synchronous tonsillar tumour of about 5%-10%. Current practice for investigating an unknown primary includes computed tomography (CT) with or without magnetic resonance imaging (MRI), and then, if necessary, 18-fluoro-deoxy-glucose positron emission tomography (FDG-PET). This is followed by panendoscopy with biopsy from the potential primary sites and tonsillectomy. A five-year retrospective review of our database of metastatic squamous cell carcinomas from unknown primary sites identified patients with synchronous tonsillar tumours (n=5). All had clinically normal-looking tonsils; MRI was within normal limit and a PET-CT identified the ipsilateral tonsillar primary in three cases only. Bilateral tonsillectomy rather than a tonsillar biopsy in the search for an unknown primary has been standard practice in our unit. Identification of a second primary dictates planning for the primary site and in the long term, influences patients' survival. We therefore recommend that bilateral tonsillectomy should be standard in the investigation of patients who present with cervical metastases from an unknown primary in the head and neck region.