Endocrine Tumour
Investigations
1) FNAC - Investigation of choice
- Cost effective
- High accuracy (> 90 %)
- low false positive and false negative rates (<2%)
   
2) Ultrasound Neck  
  - To distinguish a true solitary from a multinodular goitre.
- To differentiate between cystic and solid nodules
- To target FNAC in cystic nodule with solid components or in small nodules
- For objective assessment of nodule size and in follow up in those not offered surgery
- To help identify malignant nodules based on characteristic features (Ref.incidentalomas below)
   
3) Thyroid function tests (T3, T4, TSH)
  - If clinically indicated
- If patient to be considered for Thyroxin suppression therapy
   

Risk criteria for malignancy in STN

• Size > 4cm
• Extremes of age (<15yr or >45yr)
• Males
• Recent onset
• Rapid growth
• Prior history of radio therapy
• Family history of thyroid cancer
• Associated features s/o malignancy (neck nodes, adjacent structure involvement, cord fixity)

Role of FNAC
• Sensitivity 80-93.5%, specificity- 56-94%
• Conventional Papillary carcinoma of thyroid diagnosed on FNAC preoperatively in almost 90% of cases.
• The diagnosis of Differentiated follicular & hurthle cell carcinoma is largely dependant on demonstration of true capsular &/or vascular invasion on histological examination. The diagnosis of the lesions labeled as “Follicular neoplasm” on FNAC are likely to differ on final histopathologic examination

 

 
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