New this month in Scientific American™ Surgery:

  • Neck Mass
  • Lower Gastrointestinal Endoscopy


Head and Neck

Neck Mass

GERARD M. DOHERTY, MD
Utley Professor and Chair of Surgery, Boston University, Boston Medical Center, Boston, MA

The current recommendations for fine-needle aspiration (FNA) are based on the clinical history, size of the nodule, and imaging characteristics. FNA is not routinely recommended for nodules smaller than 1 cm; however, in patients with a higher risk of malignancy, including those with a family history of thyroid cancer or a history of radiation exposure in childhood or adolescence, FNA of a smaller nodule may be indicated. Ultrasound-guided FNA is especially useful for nodules that are predominantly cystic, located posteriorly in the thyroid lobe, or nonpalpable. FNA is useful in the evaluation of thyroid nodules in children.


Gastrointestinal Tract and Abdomen

Lower Gastrointestinal Endoscopy

PARAKKAL DEEPAK, MBBS
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN
DAVID H. BRUINING, MD
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN

The U.S. Preventive Services Task Force lists colonoscopy, flexible sigmoidoscopy (alone or in combination with FIT), CTC, gFOBT, FIT, and FIT-DNA as acceptable methods for screening average-risk individuals for both adenomatous polyps and CRC. Screening should commence at 50 years of age. There are several FDA-approved bowel preparations, along with validated scoring systems for determining quality, including the Aronchick Scale, Boston Bowel Preparation Scale, and Ottawa Bowel Preparation Scale. Newer methods of colonoscopy use water exchange, water immersion, and chromoendoscopy techniques. In cases of incomplete colonoscopy, balloon-assisted colonoscopy is indicated.

 

 


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