Selection of patients with solitary thyroid nodules for operation.

Objective: To improve the preoperative selection for operation of patients with solitary thyroid nodules.
Design: Prospective cohort study.
Setting: University hospital, France.
Patients: 155 consecutive patients who presented with solitary thyroid nodules and were operated on.
Interventions: Clinical examination, ultrasound examination, fine needle aspiration biopsy, followed by total thyroid lobectomy with frozen section and final histological examination.
Main Outcome Measure: Correct prediction of thyroid carcinoma or benign adenoma.
Results: A logistic regression analysis indicated that absence of rim (p < 0.002), solid and hypoechoic feature (p < 0.003) and malignant or suspicious fine needle aspiration biopsy results (p < 0.0001) were significantly associated with malignancy. Selection for operation by the logistic model would save 40 of 73 patients from operation and 40 of 59 from unnecessarily radical operation. It would detect a similar number of cancers as a strategy based solely on fine needle aspiration cytology.
Conclusions: A combination of the available diagnostic methods provides substantial benefit in the preoperative selection of patients with an isolated thyroid nodule.