Solitary thyroid nodule in Khartoum.

Ninety four patients with solitary and significantly dominant thyroid nodules were studied. Inadequate sampling was reported in 5 patients (5.9%). In the remaining 89 patients, 64 had simple goitre (72%), 12 follicular adenoma (13.5%), 12 were malignant nodules (6 follicular, 5 papillary and one anaplastic) (13.5%) and one patient had Hashimoto's thyroiditis. The incidence of malignancy in the clinically solitary nodules was 14% (10/70) compared to 10% (2/19) for the dominant nodules which increased to 16% (8/49) versus 10% (4/40) respectively after ultrasonography and histopathological confirmation of the nature of the gland. There is a low positive predictive value for follicular neoplasm with fine needle aspiration cytology (FNAC) (44%). This is due to the fact that reports of suspicious follicular pattern is agreed not to imply definite malignancy, however total lobectomy was done for those patients whereas terms like "not suspicious" and "highly suspicious" are considered to mean, benign and malignant respectively and in those latter groups the prediction was 100%. The study stresses the importance of FNAC techniques in reducing the surgical load with minimal false negative results, increasing the yield of carcinoma and projecting the importance of a significantly dominant nodule in endemic areas.