scholarly journals Multinodular Goiter: A Study of Malignancy Risk in Nondominant Nodules

2017 ◽  
Vol 96 (8) ◽  
pp. 336-340
Author(s):  
Jenica Su-ern Yong ◽  
Kwok Seng Loh ◽  
Bengt Fredrik Petersson ◽  
Mark Thong
Keyword(s):  
Lower Risk ◽  
Multinodular Goiter ◽  
Thyroid Nodules ◽  
Recent Literature ◽  
Asian Population ◽  
Neck Surgery ◽  
Histologic Type ◽  
Risk Of Malignancy ◽  
Study Population ◽  
Sizable Proportion

The long-standing belief that multinodular goiters are associated with a lower risk of developing into carcinoma has been challenged by the results of some recent studies. In addition, we have noticed in our practice that a sizable proportion of cancers have been arising from nondominant nodules. We performed a retrospective study of 223 cases to determine (1) the incidence of carcinoma in multinodular goiters that required surgical management in our local, predominantly Asian population and (2) the incidence of carcinoma arising from nondominant nodules. We reviewed the records of all patients with a multinodular goiter who had undergone a thyroidectomy over a period of more than 10 years in our Department of Otolaryngology–Head and Neck Surgery. We examined the histopathology reports for (1) the presence of carcinoma, (2) whether the carcinoma was isolated/unifocal or multifocal, (3) the histologic type of cancer, and (4) whether the isolated/unifocal cancers arose from the dominant or nondominant nodule. Our study population was made up of 47 males and 176 females, aged 15 to 90 years (mean: 53). We found that the incidence of malignancy in surgically treated multinodular goiters was 14.3% (32 of 223 patients). Of the 32 malignancies, 18 (56.3%) were isolated/unifocal and 14 (43.8%) were multifocal. In the isolated/unifocal group, 9 malignancies (50.0%) arose from nondominant nodules and 8 (44.4%) from dominant nodules; in the remaining case, the nodule of origin could not be determined. Our findings corroborate those in the recent literature in that the risk of malignancy associated with multinodular goiters is comparable to that of single thyroid nodules. We recommend that physicians be equally vigilant when monitoring dominant and nondominant nodules.

Improving Malignancy Prediction in AUS/FLUS Pediatric Thyroid Nodules with the Aid of Ultrasound

2020 ◽  
Vol 93 (4) ◽  
pp. 239-244
Author(s):  
Shruthi Arora ◽  
Jane Khoury ◽  
Andrew T. Trout ◽  
Janet Chuang
Keyword(s):  
Predictive Value ◽  
Lower Risk ◽  
Thyroid Nodules ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Needle Aspiration ◽  
Risk Category ◽  
American Thyroid Association ◽  
Risk Of Malignancy

<b><i>Introduction:</i></b> The standard workup of thyroid nodules concerning for malignancy includes fine-needle aspiration (FNA). In 2015, the American Thyroid Association (ATA) guidelines for the management of pediatric thyroid nodules recommended that all nodules with a Bethesda III cytology undergo surgical resection. <b><i>Objectives:</i></b> To correlate a Bethesda III cytology with histologic and clinical outcomes to determine the relevance of the ATA recommendations, and to evaluate whether Thyroid Imaging Reporting and Data System (TI-RADS) scoring could identify Bethesda III nodules at a lower risk of malignancy. <b><i>Methods:</i></b> A retrospective chart review of patients who had undergone thyroid nodule FNA from 2008 to 2018 was performed. Malignancy rates were determined for each Bethesda category. The reference standard was histopathology or 2-year follow-up of imaging outcomes for nonoperative cases. Ultrasound exams of Bethesda III nodules were reviewed and TI-RADS scores assigned. <b><i>Results:</i></b> A total of 143 FNA samples from 128 patients were identified. The mean age was 14.9 years (range 7–22). Twenty-two (15%) of the FNA samples were Bethesda III; the malignancy rate was 38%. A TI-RADS score was assigned in 20 of the 22 Bethesda III nodules. ROC analysis found an optimal cut-off for malignancy prediction of ≥7 points (risk category TR5). The negative predictive value was 85.7% (95% CI 35.9–99.6) and the positive predictive value was 83.3% (95% CI 57.2–98.2). <b><i>Conclusion:</i></b> Although, at baseline, thyroid nodules with a Bethesda III classification carry a moderate risk of malignancy in the pediatric population, TI-RADS scoring can identify nodules with a lower risk within this group. If validated by larger studies, this can inform decision making and reduce unneeded surgery.

scholarly journals MULTINODULAR GOITER;

2013 ◽  
Vol 20 (06) ◽  
pp. 1035-1041
Author(s):  
ZULFIQAR ALI BHATTI, ◽  
JAVED AHMED PHULPOTO, ◽  
NOOR AHMED SHAIKH,
Keyword(s):  
Multinodular Goiter ◽  
Prospective Observational Study ◽  
Thyroid Nodules ◽  
Significant Risk ◽  
Nodular Goiter ◽  
University Hospital ◽  
Risk Of Malignancy ◽  
The Common ◽  
Thyroid Profile ◽  
Surgical Unit

Objective: The object of this study was to determine the frequency and type of thyroid carcinoma in Multi nodular goiter(MNG) after surgical resection on histopathological basis. Introduction: Multi nodular goiter (MNG) is one of the common presentationsof various thyroid diseases. Thyroid nodules have been reported to be found in 4% to 7% of the population on neck palpation. Although incomparison to solitary nodule, the risk of malignancy in MNG is low but certain studies are showing significant risk. Material andmethods: This prospective, observational study was carried out in the surgical unit I of Ghulam Mohammad Mahar Medical collegehospital sukkur from 2007 to 2012. 94 cases with clinical diagnosis of MNG were analyzed during this period. All the patients wereadmitted through opd with routine investigations plus investigations specific to thyroid including thyroid profile, thyroid scan, FNAC ofdominant nodule before being subjected to surgery. All FNACs were carried out at agha khan university hospital Karachi. Histopathologyof operated specimen was the main criteria for malignancy. Results: Among the 94 cases which were included in this study, 9 (9.5%)cases containing foci of malignancy. Incidence of malignancy commonly occurs in females, papillary carcinoma is being the commonestentity. Conclusions: The incidence of malignancy in MNG in this study is 9.5% that is quite high. So people should be educated andencouraged to attend the thyroid clinics for proper evaluation and early diagnosis of Malignancy.

scholarly journals Résultats De 5ans De Thyroïdectomie Au Service D’orl Et Chirurgie Cervico-Faciale De l’Hôpital National De Niamey (Niger)

2017 ◽  
Vol 13 (21) ◽  
pp. 44
Author(s):  
Illé S. ◽  
James Didier L. ◽  
Saidou A. ◽  
Timi N. ◽  
Sani R.
Keyword(s):  
Multinodular Goiter ◽  
Thyroid Nodules ◽  
Neck Surgery ◽  
Descriptive Study ◽  
Postoperative Hemorrhage ◽  
Recurrent Nerve ◽  
National Hospital ◽  
Operative Indications ◽  
The Mean ◽  
Transient Hypoparathyroidism

Purpose: To evaluate the results of thyroidectomy in the Oto-RhinoLaryngology and Neck Surgery office of the National Hospital of Niamey in Niger. Materials and methods: we analyzed the epidemiological aspects, the indications, the technics and the evolution of thyroidectomy through a retrospective and descriptive study conducted from January 2010 to December 2015. Results: Thyroidectomy represents 8, 51% (n = 236/2773) of the ENT operative activities and an average of 47.2 cases per year for 5 years. Among the patients, there were 15 men and 221 women, a sex ratio of 0.17. The mean age was 37.25 years (extreme 22 and 61 years). The operative indications are dominated by multinodular goiter euthyroid (43.22%), thyroid nodules (39.40%), hyperthyroidism (goiter and Basedow) and substernal goiters, respectively, representing 8.90% and 6.35%. The gestures performed were subtotal thyroidectomy in 56 cases (23.73%), complete thyroidectomy in 85 cases (36.02%) and lobo-isthmectomy in 95 cases (40.25%). The recurrent nerve was searched in 235 cases (99%) and found in 215 cases (91, 10%). It was found 1 case (0.42%) of splitting of the left nerve recurrent. 2 cases (0.84%) of immediate postoperative hemorrhage was recorded. Morbidity was 0.29% with 4 cases of definitive unilateral recurrent paralysis and 3 cases of transient hypoparathyroidism. No mortality was encountered. Conclusion: The thyroidectomy is a frequent intervention in the ENT and Neck Surgery office of the National Hospital of Niamey. Multinodular goiter remains the first surgical indication. Recurrent and hypoparathyroid morbidity was very low.

Risk of malignancy and neoplasia predicted by three molecular testing platforms in indeterminate thyroid nodules on fine-needle aspiration

2019 ◽  
Vol 47 (9) ◽  
pp. 853-862 ◽  
Author(s):  
Kristen L. Partyka ◽  
Karen Trevino ◽  
Melissa L. Randolph ◽  
Harvey Cramer ◽  
Howard H. Wu
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Molecular Testing ◽  
Fine Needle ◽  
Risk Of Malignancy

Contemporary Management of Thyroid Nodules

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Kristen Kobaly ◽  
Caroline S. Kim ◽  
Susan J. Mandel
Keyword(s):  
Thyroid Nodules ◽  
Cervical Lymphadenopathy ◽  
Standard Technique ◽  
Clinical History ◽  
Needle Aspiration ◽  
Annual Review ◽  
Publication Date ◽  
Molecular Testing ◽  
Risk Of Malignancy ◽  
Indeterminate Cytology

Thyroid nodules are common in the general population, with higher prevalence in women and with advancing age. Approximately 5% of thyroid nodules are malignant; the majority of this subset represents papillary thyroid cancer. Ultrasonography is the standard technique to assess the underlying thyroid parenchyma, characterize the features of thyroid nodules, and evaluate for abnormal cervical lymphadenopathy. Various risk stratification systems exist to categorize the risk of malignancy based on the ultrasound appearance of a thyroid nodule. Nodules are selected for fine-needle aspiration biopsy on the basis of ultrasound features, size, and high-risk clinical history. Cytology results are classified by the Bethesda system into six categories ranging from benign to malignant. When cytology is indeterminate, molecular testing can further risk-stratify patients for observation or surgery. Surveillance is indicated for nodules with benign cytology, indeterminate cytology with reassuring molecular testing, or non-biopsied nodules without a benign sonographic appearance. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals Risk of Malignancy in Thyroid Nodules Using the American College of Radiology Thyroid Imaging Reporting and Data System in the NIFTP Era

2018 ◽  
Vol 50 (10) ◽  
pp. 735-737 ◽  
Author(s):  
Pedro Rosario ◽  
Alexandre da Silva ◽  
Maurício Nunes ◽  
Michelle Borges
Keyword(s):  
Thyroid Nodules ◽  
Data System ◽  
Thyroid Neoplasm ◽  
Malignant Tumours ◽  
Thyroid Imaging ◽  
Risk Of Malignancy ◽  
Nuclear Features

AbstractRecently, the American College of Radiology (ACR) proposed a Thyroid Imaging Reporting and Data System (TI-RADS) for thyroid nodules based on ultrasonographic features. It is important to validate this classification in different centres. The present study evaluated the risk of malignancy in solid nodules>1 cm using ACR TI-RADS. The risk of malignancy was defined including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and after its exclusion from malignant tumours. For the present study, the original images were revised, and each nodule was assigned to one of the TI-RADS levels proposed for solid nodules: TR3, TR4, or TR5. This risk of malignancy was significantly different for the three levels: 1.7%, 11.2%, and 60.6% for TR3, TR4, and TR5, respectively, when NIFTP was included, and 0.6%, 7.9%, and 60.2% for TR3, TR4, and TR5, respectively, when NIFTP was excluded from malignant tumours. The nodules corresponding to NIFTP were classified according to ACR as TR3 in 28.5% of cases, TR4 in 67.8%, and TR5 in only 3.5%. The nodules corresponding to cancer were classified according to ACR as TR3 in only 2.3% of cases, TR4 in 27%, and TR5 in 70.5%. In conclusion, this study shows the validity of the ACR TI-RADS for solid thyroid nodules, even after the exclusion of NIFTP from malignant tumours.

scholarly journals ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Thayse Lozovoy Madsen Barbosa ◽  
Cleo Otaviano Mesa Junior ◽  
Hans Graf ◽  
Teresa Cavalvanti ◽  
Marcus Adriano Trippia ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Needle Aspiration ◽  
Molecular Testing ◽  
American Thyroid Association ◽  
Institutional Review ◽  
The Us ◽  
Risk Of Malignancy ◽  
Indeterminate Cytology

Abstract Background Cytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. The main aim of our study was to determine whether the classifications, American College of Radiology (ACR) TI-RADS and 2015 American Thyroid Association (ATA) guidelines, in association with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), could be used to stratify the malignancy risk of indeterminate thyroid nodules and guide their clinical management. Methods The institutional review board approved this retrospective study of a cohort of 140 thyroid nodules in 139 patients who were referred to ultrasound-guided fine-needle aspiration cytology (FNAC) from January 2012 to June 2016 with indeterminate cytological results (44 Bethesda III, 52 Bethesda IV and 44 Bethesda V) and in whom pre-FNAC thyroid US images and histological results after surgery were available. Each included nodule was classified by one radiologist blinded to the cytological and histological diagnoses according to the ACR TIRADS scores and the US patterns as recommended in the 2015 ATA guidelines. The risk of malignancy was estimated for Bethesda, TI-RADS scores, ATA US patterns and their combination. Results Of the 140 indeterminate thyroid nodules examined, 74 (52.9%) were histologically benign. A different rate of malignancy (p < 0.001) among Bethesda III, IV and V was observed. The rate of malignancy increased according to the US suspicion categories (p < 0.001) in both US classifications (TI-RADS and ATA). Thyroid nodules classified as Bethesda III and the lowest risk US categories (very low, low and intermediate suspicion by ATA and 2, 3 and 4a by TI-RADS) displayed a sensitivity of 95.3% for both classifications and a negative predictive value of 94.3 and 94.1%, respectively. The highest risk US categories (high suspicion by ATA and 4b,4c and 5 by TI-RADS) were significantly associated with cancer (odds ratios [ORs] 14.7 and 9.8, respectively). Conclusions Ultrasound classifications, ACR TI-RADS and ATA guidelines, may help guide the management of indeterminate thyroid nodules, suggesting a conservative approach to nodules with low-risk US suspicion and Bethesda III, while molecular testing and surgery should be considered for nodules with high-risk US suspicion and Bethesda IV or V.

scholarly journals Surgical Outcome of Thyroid Nodules with Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Fine Needle Aspiration Biopsy

2017 ◽  
Vol 9 (3) ◽  
pp. 100-103
Author(s):  
Saad Alqahtani ◽  
Saif Alsobhi ◽  
Riyadh I Alsalloum ◽  
Saleh N Najjar ◽  
Hindi N Al-Hindi
Keyword(s):  
Fine Needle Aspiration ◽  
Surgical Outcome ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Fine Needle ◽  
Risk Of Malignancy ◽  
Needle Aspiration Biopsy ◽  
Undetermined Significance

ABSTRACT Aim To correlate selected clinical and ultrasonographic (US) characteristics with the final histopathological diagnosis in patients with atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS), and whether this information can be used in planning the surgical approach. Materials and methods It is a retrospective study including the operated cases of AUS/FLUS from 2011 to 2014 treated at one center. Results This cohort included 87 women and 28 men. To test for independence between categorical variables, the chi-square test was used. There was no significant correlation between age or US variables and final pathological diagnosis. However, final diagnosis of malignancy was higher in men compared with women (64.3 and 41.4% respectively; p = 0.035). Furthermore, a significant association between the diagnosis of repeated fine needle aspiration biopsy (FNAB) and the final pathological diagnosis was noted (benign vs malignant, p = 0.005). Conclusion The FNAB has a significant role in the assessment of thyroid nodules. Our results showed no correlation between age, US variables, and the risk of malignancy. Male gender is associated with higher risk of malignancy. Clinical significance Determining the risk of malignancy and prediction of surgical outcome may help triaging cases for repeat FNA or proceeding to surgery. How to cite this article Alqahtani S, Alsobhi S, Alsalloum RI, Najjar SN, Al-Hindi HN. Surgical Outcome of Thyroid Nodules with Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Fine Needle Aspiration Biopsy. World J Endoc Surg 2017;9(3):100-103.

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