Diagnostic work-up of euthyroid nodules: whichnodules should undergo fine-needle aspiration biopsy?

Efficient and rational methods for the differential diagnosisand decision are required to identify those nodules with an increasedcarcinoma risk or those which are hot among the many thyroid nodules. History, ultrasound and TSH- and CT-determination do allow arisk assessment for the further diagnostic work up. Especially ultrasoundcriteria for malignancy lead to a risk stratification and efficientselection of thyroid nodules for Fine needle aspiration biopsy (FNAB).FNAB is the diagnostic method with the best sensitivity and specificityfor the distinction between benign and malignant thyroid nodules.However, the efficiency of the fine needle aspiration biopsy requiressufficient training and experience of both the cytopathologist andthe person performing the fine needle aspiration biopsy. Thyroid nodules with a suspicion for malignancy should be referredto the surgeon. Euthyroid thyroid nodules with lack of clinical,ultrasound or cytologic criteria for malignancy and normal calcitoninshould be followed up.