scholarly journals Surgical Outcome and Malignant Risk Factors in Patients With Thyroid Nodule Classified as Bethesda Category III

2021 ◽  
Vol 12 ◽  
Author(s):  
Jianhao Huang ◽  
Hongyan Shi ◽  
Muye Song ◽  
Jinan Liang ◽  
Zhiyuan Zhang ◽  
...  

BackgroundThyroid nodules are a very common finding in the general population. Fine-needle aspiration (FNA) has been recommended as the initial test for the evaluation of thyroid nodules. The trend on reporting as atypia of undetermined significance (AUS) has been significantly increased, but the malignant risk is still controversial among different studies. The aim of this study is to investigate the malignancy risk of thyroid nodules reported as Bethesda category III (AUS/FLUS) on initial FNA.MethodWe reviewed 272 papillary thyroid cancer (PTC) patients with suspicious thyroid nodules who underwent fine-needle aspiration and received surgical treatment during 2019 to 2020.ResultsOne hundred ten (40.4%) patients were diagnosed with PTC. Multivariate analysis showed that microcalcification (p = 0.037, OR = 2.260, 95% CI: 1.051–4.860), shape (p = 0.003, OR = 4.367, 95% CI: 1.629–11.705), diameters (p = 0.002, OR = 0.278, 95% CI: 0.123–0.631), anti-thyroglobulin antibodies (TGAb) (p = 0.002, OR = 0.150, 95% CI: 0.046–0.494), anti-thyroid peroxidase antibody (A-TPO) (p = 0.009, OR = 4.784, 95% CI: 1.486–15.401), and nodule goiter (p < 0.001, OR = 0.100, 95% CI: 0.046–0.217) were independent malignant risk factors in patients with thyroid nodule classified as Bethesda category III.ConclusionIn this study, malignant risk factors in patients with thyroid nodule classified as Bethesda category III were significantly associated with preoperative serum TGAb, A-TPO, microcalcification, irregular shape, and nodule diameters. Nodules with malignant factors should be carefully elevated; surgery may be the better option for those patients.

2020 ◽  
Vol 26 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Ngan Betty Lai ◽  
Dave Garg ◽  
Anthony P. Heaney ◽  
Marvin Bergsneider ◽  
Angela M. Leung

Objective: Acromegaly results from the excessive production of growth hormone and insulin-like growth factor-1. While there is up to a 2-fold increased prevalence of thyroid nodules in patients with acromegaly, the incidence of thyroid cancer in this population varies from 1.6 to 10.6% in several European studies. The goal of our study was to determine the prevalence of thyroid nodules and thyroid cancer among patients with acromegaly at a large urban academic medical center in the United States (U.S.). Methods: A retrospective chart review was performed of all patients with acromegaly between 2006–2015 within the University of California, Los Angeles health system. Data were collected regarding patient demographics, thyroid ultrasounds, thyroid nodule fine needle aspiration (FNA) biopsy cytology, and thyroid surgical pathology. Results: In this cohort (n = 221, 49.3% women, mean age 53.8 ± 15.2 [SD] years, 55.2% Caucasian), 102 patients (46.2%) underwent a thyroid ultrasound, from which 71 patients (52.1% women, mean age 52.9 ± 15.2 [SD] years, 56.3% Caucasian) were found to have a thyroid nodule. Seventeen patients underwent a thyroid nodule FNA biopsy and the results revealed 12 benign biopsies, 1 follicular neoplasm, 3 suspicious for malignancy, and 1 papillary thyroid cancer (PTC), from which 6 underwent thyroidectomy; PTC was confirmed by surgical pathology for all cases (8.5% of all nodules observed). Conclusion: In this sample, the prevalence of thyroid cancer in patients with acromegaly and coexisting thyroid nodules is similar to that reported in the general U.S. population with thyroid nodules (7 to 15%). These findings suggest that there is no benefit of dedicated thyroid nodule screening in patients newly diagnosed with acromegaly. Abbreviations: AACE = American Association of Clinical Endocrinologists; ATA = American Thyroid Association; DTC = differentiated thyroid cancer; FNA = fine needle aspiration; GH = growth hormone; IGF-1 = insulin-like growth factor-1; PTC = papillary thyroid cancer; U.S. = United States


2020 ◽  
Vol 17 (2) ◽  
Author(s):  
Alireza Aziz Ahari ◽  
Mohammad Ali Mohammadi Vajari ◽  
Navid Khatibi Moghadam ◽  
Hassan Hashemi ◽  
Mahmoud Parvin ◽  
...  

Background: Thyroid fine needle aspiration (FNA) is currently the most acceptable method for evaluating thyroid nodules. Non-satisfactory sample is the main limitation of FNA. It has been shown that spinal needles can reduce the number of non-diagnostic samples. Objectives: In this study, we decided to compare the results obtained using spinal (stylet) needle and simple needle in thyroid nodule FNA according to the agreement between them and with the pathology results as the gold standard. Patients and Methods: Sampling of thyroid nodules of 156 patients was performed by a simple non-stylet 23 gauge needle (A) and a spinal 22 gauge needle with stylet (B). The samples were provided to the pathologist for blind examination. All samples were obtained by an expert radiologist and the pathology examination was also performed by a pathologist expert in thyroid gland diseases. Blind analysis was done using SPSS Statistics for Windows, version 16 (SPSS Inc., Chicago, Ill., USA). Results: The results of FNA with needles A and B were reported unsatisfactory in 11.51 (18 subjects) and 3.84 (six subjects), respectively (P = 0.01). The result in 63.46% (99 subjects) of the participants, in whom FNA was obtained by needle B was introduced as a better sample by the pathologist in comparison with 36.44% (57 subjects) (P < 0.001). Cancer was diagnosed in 9.56 and 7.66 of the samples yielded by needles B and A, respectively, which was not statistically significant (P = 0.54). There was also a significant relationship between thyroid imaging reporting and data system (TI-RADS) score and FNA result. Conclusion: A significant relationship between the adequate sampling results, the qualitative examination result, TI-RADS score and the needle type indicates the importance of needle type on the results of thyroid FNA. Using spinal (stylet) needles may reduce the number of non-diagnostic samples in fine needle aspiration of thyroid nodules and therefore, can have a better effect on the results of this method.


2020 ◽  
Vol 26 (11) ◽  
pp. 1286-1290
Author(s):  
Edy Kornelius ◽  
Shih-Chang Lo ◽  
Chien-Ning Huang ◽  
Yi-Sun Yang

Objective: There are conflicting data on the risk of thyroid cancer in thyroid nodules 3 cm or larger, and few such studies on this issue have been conducted in Asia. This study aimed to examine the risk of thyroid cancer in patients with thyroid nodules 3 cm or larger. Methods: This was a 7-year retrospective study conducted in a tertiary referral hospital in Taiwan. All patients with a thyroid nodule measuring ≥3 cm who underwent thyroid operation with or without fine-needle aspiration biopsy (FNAB) were included. The prevalence rate of thyroid cancer, as well as the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and false-negative rate of FNAB for thyroid nodule ≥3 cm were also examined. Results: A total of 132 patients were included in this study. Thyroid cancer was detected in 19 of 132 (14.4%) thyroid nodules measuring ≥3 cm. The performance of FNAB for detecting cancer in nodules 3 cm or larger without considering other ultrasonography parameters was relatively poor with a sensitivity of 50%, but the specificity (100%), PPV (100 %), and NPV (93.4 %) were excellent. Conclusion: The risk of thyroid cancer for thyroid nodules ≥3 cm in this study was low. The PPV and NPV of FNAB were high for the detection of cancer in large nodules. The decision to perform thyroidectomy should not be solely based on nodule size and should include other factors, such as ultrasound characteristics and surgical risk. Abbreviations: ATA = American Thyroid Association; FNAB = fine-needle aspiration biopsy; mPTC = micropapillary thyroid carcinoma; NPV = negative predictive value; PPV = positive predictive value; PTC = papillary thyroid carcinoma


1994 ◽  
Vol 131 (5) ◽  
pp. 474-479 ◽  
Author(s):  
Catherine De Micco ◽  
Patricia Zoro ◽  
Stéphane Garcia ◽  
Lambert Skoog ◽  
Edneia M Tani ◽  
...  

De Micco C, Zoro P, Garcia S, Skoog L, Tani EM, Carayon P, Henry J-F. Thyroid peroxidase immunodetection as a tool to assist diagnosis of thyroid nodules on fine-need aspiration biopsy. Eur J Endocrinol 1994;131:474–9. ISSN 0804–4643 In a previous work we have reported the presence in 96.9% of malignant and 4.2% of benign thyroid tumors of an immunological abnormality of the enzyme thyroid peroxidase, impeding the fixation of the anti-thyroid peroxidase monoclonal antibody termed "MoAb47". The present study has been designed to establish the ability of thyroid peroxidase immunodetection to assist the diagnosis of malignancy in fine-needle aspiration of thyroid nodules. The fixation of anti-thyroid peroxidase monoclonal antibody was investigated by immunohistochemistry on fine-needle aspirates of 150 surgically removed thyroid nodules (20 papillary carcinomas, five follicular carcinomas, 90 colloid adenomas, nine fetal adenoma, 13 atypical adenomas, five oncocytic adenomas, six Hashimoto's thyroiditis and two Graves' disease). The percentage of positive cells has been compared to the final histological diagnosis. In samples from 113/125 benign nodules 80–100% cells presented a positive immunoreaction, whereas all samples from malignant tumors yielded less than 80% positive cells. Benign nodules exhibiting less than 80% positive cells corresponded to three degenerative colloid nodules, five atypical follicular adenomas, two oncocytomas and two thyroiditis. According to results obtained in this series, with the value of 80% as the limit for discrimination between benign and highrisk nodules, the sensitivity of thyroid peroxidase staining for diagnosis of malignancy would be 100%, its specificity 90% and its overall accuracy 92%. Thyroid peroxidase staining with monoclonal antibody MoAb47 on fine-needle aspirates is a useful adjunct to conventional cytology for the investigation of patients with thyroid nodules. Catherine De Micco, Laboratoire d'Anatomie Pathologique, Faculté de Médecine Nord, Bd Pierre Dramard, 13916 Marseille Cedex 20, France


2019 ◽  
Vol 35 (4) ◽  
Author(s):  
Muhammad Ayoob Jat

Objective: To assess the Solitary thyroid nodules by surgeon-performed ultrasound-guided FNAC and evaluate with the histopathological findings. Methods: This study includes 100 Consecutive patients of a solitary thyroid nodule which were presented to the Outpatients Department of Surgery during the period of two years from September 2016 to August 2018. Exclusion criteria were patients with extra-thyroid swelling, diffuse goiter and multinodular goiter. All patients with a solitary thyroid nodule underwent Surgeon –performed ultrasound-guided FNAC in the department of Radiology. After thyroid surgery, thyroid specimens were sent for histopathology and evaluate with FNAC findings. Results: The study included hundred patients with solitary thyroid nodule, 75(75%) female and 25 (25%) male with a ratio of F 3:1M. The age of the patients ranged from 15-75 years with a mean age of 35 years. The result of 100 cases of Surgeon –performed Ultrasound –guide FNAC of a solitary thyroid nodule were inconclusive in 10 cases (10%), Non-neoplastic in 60 cases (60%) and Neoplastic lesions in 30 cases (30%). After evaluation of findings from FNAC and histopathology, four cases with benign FNAC (adenomatous/colloid Goiter) turnout as neoplastic (papillary carcinoma) on histopathology and six cases with neoplastic FNAC (papillary carcinoma), just two cases turnout as benign (nodular colloid goiter with cystic degeneration) on histopathology. In present study Surgeon – performed Us FNAC has found to be 87.5% sensitive, 95.3% specific and 92.0% diagnostic accuracy. Conclusion: Surgeon – performed Ultrasound-guided FNAC is a safe, simple and accurate technique in the diagnosis of solitary thyroid nodule. doi: https://doi.org/10.12669/pjms.35.4.537 How to cite this:Jat MA. Comparison of surgeon-performed ultrasound-guided fine needle aspiration cytology with histopathological diagnosis of thyroid nodules. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.537 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


2020 ◽  
Vol 102 (1) ◽  
pp. 43-48
Author(s):  
M Jinih ◽  
F Faisal ◽  
K Abdalla ◽  
M Majeed ◽  
AA Achakzai ◽  
...  

Introduction The diagnostic performance of ultrasound-fine needle aspiration to identify thyroid nodules harbouring malignancy remains variable. The aim of this study was to determine thyroid nodule size and cytological classification as predictors of malignancy risk. Materials and methods We conducted a retrospective cohort analysis at an academic hospital involving 499 consecutive patients who underwent thyroid surgery between 2004 and 2015. Results A total of 503 thyroid nodules (499 patients, 84% female; mean age 50.8 years, standard deviation, SD, 15.4 years) were analysed. Of these, 19.5% were malignant. The mean (± SD) nodule size was 3.28 ± 1.63 cm and 3.27 ± 1.54 cm for benign and malignant nodules, respectively. The odds of malignancy for thyroid nodules less than 3.0 cm was similar to those for nodules of 3.0 cm or greater (0.26 compared with 0.29; p=0.77). Overall, the sensitivity and specificity of fine-needle aspiration in this cohort were 71.4% and 100%, respectively. The overall false negative rate was 5.4%. When the cut-off of 3.0 cm was used, the false negative rate in thyroid nodules less than 3.0 cm was 0% compared with 7.0% in nodules of 3.0 cm or greater. Thus, class (p<0.01) but not nodule size (p=0.49), was associated with higher malignancy risk. Conclusions Our results suggest that thyroid nodule size did not accurately predict the risk of thyroid malignancy irrespective of fine-needle aspiration cytology. Routine diagnostic thyroid lobectomy solely owing to thyroid nodule size of 3.0 cm or greater is currently not justified.


2008 ◽  
Vol 93 (11) ◽  
pp. 4175-4182 ◽  
Author(s):  
Erik K. Alexander

Background: Fine-needle aspiration remains the primary diagnostic intervention for the evaluation of most thyroid nodules larger than 1–1.5 cm. Although most aspirates provide diagnostic cytology, approximately 15–25% will be classified indeterminate (often referred to as follicular neoplasm, suspicious for carcinoma, or atypical). In such cases, abnormal cellular findings preclude interpretation of benignity, although only a minority will prove cancerous upon final histopathology. Nonetheless, patients with indeterminate aspirates are commonly referred for consideration of hemi- or near-total thyroidectomy. Recently, improved understanding and novel investigation of clinical, radiological, cytological, and molecular factors has allowed improved stratification of cancer risk. Conclusion: Although surgery continues to be commonly recommended, strategies for such patients should increasingly seek to define treatment based on the estimation of an individual’s thyroid cancer risk in comparison with associated operative risk and morbidity. In doing so, the rate of unnecessary surgical procedures and associated complications can be reduced.


Author(s):  
Sanjeev Mohanty ◽  
Sreenivas . ◽  
Vinay Raj T. ◽  
Devipriya . ◽  
Vinoth M.

<p class="abstract" style="display: inline !important;"><strong>Background:</strong> Thyromegaly is a common cause of physician consultation. Solitary thyroid nodules are conventionally viewed with suspicion. Clinical examination cannot reliably distinguish between a solitary thyroid nodule and a dominant nodule in multinodular goiter. Ultrasonographical examination has its own pitfalls. Technetium 99 is a commonly used modality for the functional assessment of solitary thyroid nodule detection. It has the advantage of low cost with lower radiation dose to the exposed patients. On literature search, studies on technetium 99 scintigraphy for thyroid in context to the Indian scenario do not yield much information and very few studies are notable. This study was conducted to correlate and qualify thyroid cold nodule as detected by Technetium 99 pertechnetate thyroid scan. <span lang="EN-IN">This study was conducted to correlate, qualify and compare the predictive value of Technetium 99 pertechnetate scintigraphy on solitary thyroid nodule via fine needle aspiration cytology and to countercheck with histopathological examination. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A prospective cohort study in a NABH, NAAC and JCI accredited tertiary care teaching university hospital was conducted over a period of 36 months. All the subjects underwent clinical assessment of the neck included standard examination techniques to segregate solitary thyroid nodules. They were then subjected to Technetium 99 pertechnate scintigraphy using the standard protocol. All the patients with solitary cold nodule underwent FNAC followed by nodule excision or hemi-thyroidectomy under general anaesthesia. All the specimens underwent histo-pathological examination by an experienced histopathologist. The results were statistically analysed using pearson chi-square test.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Cold nodules as detected by Technetium 99 pertechnetate thyroid scan is a reasonable indicator of probable malignancy via fine needle aspiration cytology. Occurrence of cold nodules is highest in 3<sup>rd</sup> to 5<sup>th</sup> decade of life (21-50 year age group). Occurrence of cold nodules is higher in females (83%) whereas occurrence of malignancy in cold nodules is higher in males (85%). Occurrence of malignancy in cold nodules is higher in subjects less than 21 and above 50 years. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Technetium 99m pertechnetate thyroid scintigraphy is an important preoperative tool in management of thyroid nodules and its routine use in all such patients is recommended especially to rule out cold nodules.</span></p>


2021 ◽  
pp. 1-9
Author(s):  
Li Li ◽  
Xiao Chen ◽  
Peipei Li ◽  
Yibo Liu ◽  
Xiaoli Ma ◽  
...  

<b><i>Introduction:</i></b> There are few studies on the role of puncture feeling in thyroid nodules during ultrasound-guided fine-needle aspiration cytology (US-FNAC), although it is expected to become a new predictive technique. We aimed to analyze the importance of puncture feeling in combination with US-FNAC and investigate whether it can be used as an indicator to predict the nature of thyroid nodules. <b><i>Materials and Methods:</i></b> From January 1, 2018, to October 31, 2020, a total of 623 thyroid nodules were included. Puncture feeling was classified as “soft,” “hard,” or “hard with grittiness.” The correlation between puncture feeling and postoperative pathology and the diagnostic value of FNAC combined with puncture feeling were analyzed, and the influence of thyroid nodule size on puncture feeling, FNAC, and FNAC combined with puncture feeling was studied. We further explored the correlation between puncture feeling and histopathology in Bethesda III and IV thyroid nodules. <b><i>Results:</i></b> There was a significant correlation between puncture feeling and postoperative pathology (<i>p</i> &#x3c; 0.001). The sensitivity, negative predictive value, and total coincidence rate of US-FNAC combined with puncture feeling for the diagnosis of thyroid nodules were higher than those of US-FNAC alone (96.1, 83.6, and 94.7% vs. 89.0, 65.5, and 89.7%, respectively). Thyroid nodule size was the influencing factor for puncture feeling, FNAC, and FNAC combined with puncture feeling (<i>p</i> &#x3c; 0.05 for all). The area under the curve for puncture feeling, FNAC, and FNAC combined with puncture feeling for thyroid nodules of size ≤1 cm was greater than for modules of size &#x3e;1 cm. Puncture feeling was of great value in diagnosing Bethesda III thyroid nodules (<i>p</i> &#x3c; 0.001), and all Bethesda IV thyroid nodules had puncture feeling of soft. <b><i>Conclusion:</i></b> Puncture feeling is of great value during US-FNAC. “Hard” and “hard with grittiness” were indicators for malignancy, while “soft” indicated that the thyroid nodule was likely to be benign. The diagnostic value of US-FNAC combined with puncture feeling for thyroid nodules is higher than US-FNAC alone, especially when nodule size is ≤1 cm. Puncture feeling is of great value in predicting the nature of Bethesda III thyroid nodules.


2015 ◽  
Vol 173 (5) ◽  
pp. 677-681 ◽  
Author(s):  
Tamira K Klooker ◽  
Anne Huibers ◽  
Klaas in 't Hof ◽  
Els J M Nieveen van Dijkum ◽  
Saffire S Phoa ◽  
...  

BackgroundFine needle aspiration (FNA) cytology is the method of choice to exclude malignancy in thyroid nodules. A major limitation of thyroid FNA is the relatively high rate (13–17%) of non-diagnostic samples. The aim of this study is to determine the diagnostic yield of a screw needle compared to the conventional FNA.MethodsWe retrospectively analysed thyroid nodule cytology of all patients that underwent thyroid nodule fine needle or screw needle aspiration between July 2007 and July 2012 in a single academic medical centre. Cytology results were categorized according to the Bethesda classification system.ResultsIn total, 644 punctures of thyroid nodules from 459 patients were available for analysis. The screw needle was used 531 times, and the conventional fine needle 113 times. The percentage of non-diagnostic cytology was significantly lower in the screw needle samples than in the fine needle samples (3% vs 17%, P<0.001).ConclusionThis study shows a significantly better diagnostic performance of the screw needle compared to the conventional fine needle in cytology of thyroid nodules.


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