Fine-needle aspiration biopsy of the thyroid: comparison between thyroid palpation and ultrasonography.

OBJECTIVE: To describe our experience with fine-needle aspiration biopsy (FNAB) of the thyroid and compare our results with direct palpation versus ultrasound scanning (USS) in an area of endemic goiter in Italy. METHODS: We considered all patients submitted to ultrasound-guided FNAB of thyroid nodules during a 10-month period at our outpatient clinic and analyzed the following: (1) clinical data (number of nodules and identification of the nodule for FNAB); (2) USS data (number of nodules and identification of the nodule for FNAB on the basis of hypoechoic pattern + blurred perinodal halo + microcalcifications or intranodal color Doppler signal indicative of blood flow); (3) cytologic specimens, categorized as suspicious, malignant, negative, or nondiagnostic; and (4) histologic final report of the cytologically positive nodules. RESULTS: The study group consisted of 348 female and 72 male patients who underwent FNAB of the thyroid at our institution. Among the 140 patients with no palpable thyroid nodules, USS showed that 106 had a single nodule and 34 had multinodular goiters. Among the 182 patients with a single palpable thyroid nodule, USS revealed that 138 had a single nodule, 42 had a multinodular goiter, and 2 had lobe enlargement without detectable nodules. All 98 patients with multinodular palpable goiter had a similar pattern on USS. Of the 420 cytologic specimens, 46(11.0%) were positive for thyroid cancer, 313 (74.5%)were negative, and 61 (14.5%) were nondiagnostic. Histologic malignant growth was confirmed in 27 cytologically positive nodules. Of these histologically malignant nodules, 12 (45%) were nonpalpable, 9 (33%) were single palpable nodules, and 6 (22%) were from a nodule with a suspicious ultrasound pattern within a multinodular goiter. CONCLUSION: Manually guided FNAB is not feasible in nonpalpable nodules and not accurate in a multinodular goiter. Both situations are clinical challenges, and USS should be performed for accurate FNAB under these circumstances. Because 52% of histologically malignant nodules in our study were found only with the aid of ultrasound-guided FNAB, this procedure should be used where multinodular goiter is endemic. Our overall rate of nondiagnostic specimens was comparable to that reported in the literature.

Intraoperative localisation and management of renal calculi during nephrolithotomy by real-time ultrasonography.

OBJECTIVE: To evaluate the role of ultrasound as a sole procedure for intraoperative localisation and management of complex renal calculi. MATERIAL AND METHODS: Between September 1997 and November 2001, 16 patients underwent complex surgery for multiple, large or recurrent renal stones using the ultrasound image as a the sole intraoperative diagnostic procedure. A 8.5 MHz sector transducer with a pulse Doppler signal was used to identify the avascular area, the shortest distance between the renal surface and the stone. RESULTS: Complete stone removal was achieved in all patients without complications. CONCLUSION: Intraoperative sonography for localisation of the intrarenal arteries combined with B scan sonography for intraoperative localisation of stones allows complete removal via radial nephrotomies without peduncle clamping and cooling procedure. The advantage is the exact and quick localisation of stones avoiding X-ray.