Indications for Surgery

The overall assessment of clinical risk factors coupled with the findings of FNAC constitute the fundamental basis of selection for surgery. Although cytology is an invaluable aid to diagnosis, clinical assessment remains the fundamental basis for selection for surgery and may lead the surgeon to operate irrespective of cytologic findings. In an endemic goitrous area, patients are selected for surgery because of coincidental pressure symptoms (e.g., dyspnea, dysphagia, or choking sensation) associated with a progressive expansion in nodular disease. Assessment with flow-loop respiratory function tests and CT or MRI of the neck can be helpful in such cases. In a consecutive series of 100 patients undergoing surgery for histologically proven benign solitary nodules at the University Hospital of Wales, Cardiff, 50% had significant pressure symptoms warranting surgery.

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