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Thyroid Cysts: Does Cancer at Pathology Mean Clinical Cancer?

Tim J. O'Leary, MD; Peter Walker, MD
Arch Intern Med. 1991;151(6):1228. doi:10.1001/archinte.1991.00400060138027.
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To the Editor. —  In the July issue of the ARCHIVES, De los Santos et al1 clearly demonstrate that a significant portion of cystic thyroid nodules are due to an underlying papillary carcinoma. Furthermore, two of 12 of these papillary carcinomas were not identified on needle-biopsy cytology leading the authors and the accompanying editorial2 to advise resection of all cystic thyroid nodules that do not have clearly benign cytology and disappear with repeated aspiration. While this advice may be prudent, it is important to acknowledge our very limited understanding about the biological behavior of papillary carcinoma.In practice, our approach to various thyroid lesions is largely based on the clinical lesion rather than the probability of finding a malignancy at surgery. Occult thyroid carcinoma (smaller than 1.5 cm) is found in 6% to 13% of all thyroids at autopsy,310% of multinodular goiters,4 and, in the


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