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Bukasa-Kakamba J, Bangolo AI, Wadhwani S, Bayauli P, Wadhwani N, Nagesh VK, Mou MJ, Chahal PS, Mbunga B, Chindam S, Mushfiq T, Thapa A, Rao NL, Kalambayi IK, Rajesh RY, Sarioguz IB, Thoomkuntla VKR, Arefin S, Kaur N, Mutombo MB, Singh S, Muto N, Vamsi S, Mallampalli P, Nkodila AN, Weissman S, M'Buyamba-Kabangu JR. Environmental mineral density and thyroid malignancy: A multicenter cross-sectional study. World J Exp Med 2025; 15:103371. [DOI: 10.5493/wjem.v15.i2.103371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 12/29/2024] [Accepted: 01/07/2025] [Indexed: 04/16/2025] Open
Abstract
BACKGROUND Several trace minerals have been shown to be associated with thyroid cancer. Democratic Republic of Congo (DRC) is deemed the most mineral-rich country globally. Data on the characteristics of thyroid nodules in various mineral-rich regions of the DRC is scarce.
AIM To analyze the differential spectrum of thyroid nodules based on locoregional variance in mineral density.
METHODS We conducted a cross-sectional study on 529 patients with thyroid nodules residing in Katanga, South Kivu and Kinshasa between 2005 and 2019. Of these three provinces, Katanga and South Kivu have the highest mineral density with the DRC.
RESULTS Mean patient age was 44.2 years ± 14.6 years with a female predominance, with a female to male ratio of 5.4. The 66.5% of patients had a family history of thyroid disease. Total 74 patients had simple nodules, and the remaining 455 patients had multiple nodules. The 87.7% of patients were euthyroid. The nodules exhibited varying characteristics namely hypoechogenicity (84.5%), solid echostructure (72.2%), macronodular appearance (59.8%), calcifications (14.4%) and associated lymphadenopathy (15.5%). The 22.3% of the nodules were malignant. Factors independently associated with malignancy were older age (≥ 60 years) [adjusted odds ratio (aOR) = 2.81], Katanga province (aOR = 8.19), solid echostructure (aOR = 7.69), hypoechogenicity (aOR = 14.19), macronodular appearance (aOR = 9.13), calcifications (aOR = 2.6) and presence of lymphadenopathy (aOR = 6.94).
CONCLUSION Thyroid nodules emanating from the mineral-laden province of Katanga were more likely to be malignant. Early and accurate risk-stratification of patients with thyroid nodules residing in high-risk areas could be instrumental in optimizing survival in these patients.
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Affiliation(s)
- John Bukasa-Kakamba
- Department of Endocrinology and Metabolic Diseases, University of Kinshasa, Kinshasa 999069, Congo
- Department of Endocrinology, Liege University Hospital Center, Liège 4000, Belgium
| | - Ayrton I Bangolo
- Department of Hematology and Oncology, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ 07601, United States
| | - Shruti Wadhwani
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Pascal Bayauli
- Department of Endocrinology and Metabolic Diseases, University of Kinshasa, Kinshasa 999069, Congo
| | - Nikita Wadhwani
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Vignesh K Nagesh
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Maria J Mou
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Princejeet S Chahal
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Branly Mbunga
- Department of School of Public Health, University of Kinshasa, Kinshasa 999069, Congo
| | - Sindhuja Chindam
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Taieba Mushfiq
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Abhishek Thapa
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Nidhi L Rao
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | | | - Rahul Y Rajesh
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ipek B Sarioguz
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Vishal KR Thoomkuntla
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Shamsul Arefin
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Navneet Kaur
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Manasse Bukasa Mutombo
- Department of Endocrinology and Metabolic Diseases, University of Kinshasa, Kinshasa 999069, Congo
| | - Satyajeet Singh
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Natalia Muto
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Surya Vamsi
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Pujita Mallampalli
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Aliocha Natuhoyila Nkodila
- Department of Family Medicine and Primary Health Care, Protestant University of Congo, Kinshasa 999069, Congo
| | - Simcha Weissman
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
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Fallahi MM, Koulaian S, Mardani P, Malekhosseini SA, Shahriarirad R. The diagnostic role of FNA based on clinicopathological features in thyroid malignancy. BMC Endocr Disord 2025; 25:119. [PMID: 40289083 PMCID: PMC12034144 DOI: 10.1186/s12902-025-01945-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Accepted: 04/22/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND Thyroid nodules are mostly benign lesions within the thyroid, with a small percentage being malignant. The decision for surgery is mainly based on the fine needle aspiration (FNA) cytology report, which is categorized into six categories from non-diagnostic to malignant. The accuracy of FNA is of utmost importance to minimize the complications due to misdiagnosis. METHODS In a retrospective study, we analyzed 310 patients who underwent thyroidectomy due to suspicious thyroid nodules with both FNA and histopathological results. We reviewed patient files, extracting demographic data, FNA results, and final histopathology reports and grouped them based on the size of the nodules. Sensitivity, specificity, and predictive values were calculated. RESULTS The average age of the patients was 42.9 ± 13.2 years, and the average size of the largest nodule diameter was 2.1 ± 1.89 cm. Histopathological evaluation of specimens obtained during surgery showed that 184 (59.4%) samples were malignant and 126 (40.6%) were non-malignant. The overall specificity was 96.8%, and the sensitivity was 89.6%, and the accuracy of FNA in diagnosing malignancy was 92.2%. Logistic regression analysis revealed that Bethesda classification (OR: 2.34; 95%CI: 1.73-3.16; P < 0.001), and also tumor size (OR: 2.02; 95%CI: 1.32-3.10; P = 0.001) exhibited a significant direct correlation with the capability of FNA in accurately diagnosing malignancy. The highest FNA accuracy of malignancy detection was among nodules above 3 cm (97.1%) while in nodules smaller than 1 cm the accuracy was 73.2%. CONCLUSION FNA is a suitable diagnostic tool for detecting malignant nodules, while diagnostic capability varies with approaches to indeterminate FNA results. False positive and negative rates are crucial, with challenges in diagnosing malignancy in the context of multinodular goiter cases and smaller nodules.
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Affiliation(s)
- Mohammad Mehdi Fallahi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- School of Medicine, Jahrom University of Medical Sciences, Shiraz, Iran
| | - Sepehr Koulaian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parviz Mardani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
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Liu Y, Liu H, Zhan J, Chai Q, Zhu J, Ding S, Chen L. Contrast-Enhanced Ultrasound for Diagnosing Thyroid Nodules With Indeterminate Cytology: A Retrospective Study. Clin Endocrinol (Oxf) 2025; 102:223-231. [PMID: 39502003 DOI: 10.1111/cen.15160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 10/21/2024] [Accepted: 10/24/2024] [Indexed: 01/03/2025]
Abstract
BACKGROUND A small number of thyroid nodules cannot be clearly diagnosed using ultrasound-guided fine needle aspiration biopsy. Contrast-enhanced ultrasound (CEUS) has high diagnostic performance for thyroid nodules. We explored the value of CEUS for diagnosing thyroid nodules with indeterminate cytology. METHODS Between September 2019 and July 2022, 27,646 patients with thyroid nodule(s) underwent conventional ultrasound (CUS) in our hospital. From these patients, 597 nodules were subjected to CEUS and ultrasound-guided fine needle aspiration biopsy and 116 thyroid nodules with indeterminate cytology diagnose were enrolled in this study. The independent risk factors for predicting malignancy were determined using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were drawn for CUS, CEUS, and CEUS combined with CUS. The area under the curve (AUC) was calculated and compared. RESULTS Of the 116 thyroid nodules, 40 (34.5%) were benign and 76 (65.5%) were malignant. Univariate analysis showed that the shape, echogenicity, margin, microcalcification, enhancement intensity, enhancement homogeneity, wash in, and wash out were significantly different between benign and malignant thyroid nodules (all p < 0.05). Multivariate logistic regression analysis showed that taller-than-wide, irregular margin, microcalcification, hypo-enhancement, heterogeneity enhancement, synchronous/slower wash in, and synchronous/slower wash out were independent risk factors for malignancy (all p < 0.05). ROC curve analysis showed that the AUC of CUS and CEUS were 0.769 and 0.848, respectively. No significant difference was observed in the AUC between the two modalities (p > 0.05). However, the AUC (0.934) of the CUS combined with CEUS was significantly higher than that of CEUS or CUS alone (both p < 0.05). CONCLUSIONS CEUS is helpful in diagnosing thyroid nodules with indeterminate cytology. CUS combined with CEUS is highly valuable for predicting malignancy.
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Affiliation(s)
- Yingchun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Hui Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Department of Ultrasound, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Qiliang Chai
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Jun Zhu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Shengnan Ding
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
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Li W, Du Y, Wei Y, Feng R, Wang Y, Yang X, Wang H, Li J. Diagnostic performance of adult-based thyroid imaging reporting and data systems in pediatric thyroid carcinoma: a retrospective study. BMC Med Imaging 2024; 24:311. [PMID: 39548449 PMCID: PMC11568523 DOI: 10.1186/s12880-024-01496-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/07/2024] [Indexed: 11/18/2024] Open
Abstract
BACKGROUND Thyroid nodules diagnosed in children pose a greater risk of malignancy compared to those in adults. However, there is no ultrasound thyroid nodule evaluation system aimed at children. The objective of this research is to assess the diagnostic performance of the adult-based American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) in pediatric thyroid carcinoma. METHODS The preoperative ultrasound images of 177 thyroid lesions in 136 pediatric patients aged 18 or younger who underwent thyroid surgery or fine needle aspiration (FNA) at our center from July 2017 to July 2022 were reviewed. The sonographic characteristics of pediatric thyroid carcinoma were compared and analyzed in contrast to benign nodules. All the nodules were evaluated by the ACR-TIRADS and the C-TIRADS respectively. RESULTS Ultrasound features such as solid composition (94.8%), hypoechogenicity or marked hypoechogenicity (94.8-95.7%) and microcalcification (78.3-84.3%) were more common in pediatric malignant nodules (P-values < 0.05). The areas under receiver operating characteristic curves (AUC) of the ACR-TIRADS and the C-TIRADS in diagnosing pediatric thyroid carcinoma were 0.903-0.906, 0.907-0.909 (P-value > 0.05). The interobserver agreement of both the ACR-TIRADS and the C-TIRADS was strong (weighted Kappa > 0.90). CONCLUSIONS Both the C-TIRADS and the ACR-TIRADS owned great diagnostic performance and strong interobserver agreement in diagnosing pediatric thyroid carcinoma. However, a more complete and specific ultrasound evaluation system for pediatric thyroid nodules is still needed.
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Affiliation(s)
- Wanying Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiyan Du
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Ultrasound, Wuxi branch of Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Jiangsu, China
| | - Yao Wei
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruie Feng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Yang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongyan Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jianchu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Cheng J, Han B, Chen Y, Li Q, Xia W, Wang N, Lu Y. Clinical risk factors and cancer risk of thyroid imaging reporting and data system category 4 A thyroid nodules. J Cancer Res Clin Oncol 2024; 150:327. [PMID: 38914743 PMCID: PMC11196368 DOI: 10.1007/s00432-024-05847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Beyond the Thyroid Imaging Reporting and Data System (TIRADS) classification of thyroid nodules, additional factors must be weighed in the decision to perform fine needle aspiration (FNA). In this study, we aimed to identify risk factors for malignancy in patients with ultrasound-classified Chinese-TIRADS (C-TIRADS) 4 A nodules. METHODS Patients who underwent thyroid FNA at our institution between May 2021 and September 2022 were enrolled. We collected demographic data, including age, sex, previous radiation exposure, and family history. An in-person questionnaire was used to collect lifestyle data, such as smoking habits and alcohol consumption. Body mass index (BMI) was calculated. The serum levels of thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TGAb) were measured. Prior to FNA, ultrasonic inspection reports were reviewed. The cytologic diagnoses for FNA of thyroid nodules followed the Bethesda System for Reporting Thyroid Cytopathology (2017). RESULTS Among the 252 C-TIRADS 4 A nodules, 103 were malignant. Compared to those in the benign group, the patients in the malignant group had a younger age (42.2 ± 13.6 vs. 51.5 ± 14.0 years, P < 0.001). Logistic regression showed that advanced age was associated with a lower risk of malignancy in C-TIRADS 4 A nodules (OR = 0.95, 95% CI 0.93 ~ 0.97, P < 0.001). We demonstrated a decreased risk of malignancy in patients with 48.5 years or older. CONCLUSION Advanced age was associated with a decreased risk of malignancy in patients with C-TIRADS 4 A nodules. This study indicated that in addition to sonographic characteristics, patient age should be considered when assessing the risk of malignancy.
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Affiliation(s)
- Jing Cheng
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Bing Han
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Yingchao Chen
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Qin Li
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Wenwen Xia
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Ningjian Wang
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Yingli Lu
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China.
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Yuan X, Wen H, Huang M, Xie X, Yi Z, Li S. A Clinical Retrospective Study on the Qualitative Value of Multimodal Ultrasonography for ACR-TIRADS 4 Thyroid Nodules Ranging from 1 cm to 1.5 cm. Technol Cancer Res Treat 2024; 23:15330338241297599. [PMID: 39540218 PMCID: PMC11561986 DOI: 10.1177/15330338241297599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 10/03/2024] [Accepted: 10/09/2024] [Indexed: 11/16/2024] Open
Abstract
INTRODUCTION This study explored the clinical value and application of ultrasound contrast imaging technology in the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) TR4 benign and malignant thyroid nodules. METHODS We retrospectively analyzed data from the medical records of 40 patients who met the inclusion criteria between January 2020 and December 2023. Each patient was evaluated using the ACR TI-RADS classification and contrast-enhanced ultrasound (CEUS). The agreement between pathological outcomes and ultrasound indicators and the diagnostic value and significance of each parameter were assessed. RESULTS The diameters did not differ between benign and malignant nodules (P = 0.324). Ring enhancement was closely associated with benign thyroid nodules, with a negative predictive value of 100%. Homogeneous enhancement and enhancement intensity showed good diagnostic value for pathological results, with an area under the curve (AUC) > 0.8. This parameter showed a high diagnostic value for serial and parallel combinations of homogeneous enhancement and enhancement intensity, with a sensitivity of 77.8% and specificity of 85.7% for the serial combination and 100% and 71.4%, respectively. for the parallel combination. CONCLUSION Among ACR TI-RADS TR4 nodules, diameter 1.0-1.5 cm was not significantly correlated with a benign or malignant nature. Nodules featuring ring enhancement with ring-enhancing features should be considered benign. Similarly, nodules showing no, homogeneous, or high enhancement with clear borders on CEUS imaging may be benign. However, nodules with uneven low enhancement or unclear borders may be malignant. Therefore, uneven and low enhancement on CEUS imaging may have a high diagnostic value for malignant nodules. Moreover, the combination of these features may have even higher specificity.
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Affiliation(s)
- Xiaodan Yuan
- Department of Ultrasonic, Huizhou Central People's Hospital, Huizhou, Guangdong, China
| | - Hong Wen
- Department of Ultrasonic, Huizhou Central People's Hospital, Huizhou, Guangdong, China
| | - Mei Huang
- College of Foreign Languages, Chongqing Medical University, Chongqing, China
| | - Xumin Xie
- Department of Ultrasonic, Huizhou Central People's Hospital, Huizhou, Guangdong, China
| | - Zhijun Yi
- Department of Ultrasonic, Huizhou Central People's Hospital, Huizhou, Guangdong, China
| | - Shengkai Li
- Department of Ultrasonic, Huizhou Central People's Hospital, Huizhou, Guangdong, China
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Kim MK, Shin JH, Hahn SY, Kim H. Delayed Cancer Diagnosis in Thyroid Nodules Initially Treated as Benign With Radiofrequency Ablation: Ultrasound Characteristics and Predictors for Cancer. Korean J Radiol 2023; 24:903-911. [PMID: 37634644 PMCID: PMC10462893 DOI: 10.3348/kjr.2023.0386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE Regrowth after radiofrequency ablation (RFA) of symptomatic large thyroid nodules, initially treated as benign, sometimes turns out to be malignancies. This study aimed to assess the ultrasound (US) characteristics of thyroid nodules initially treated as benign with RFA and later diagnosed as cancers, predictive factors for cancers masquerading as benign, and methods to avoid RFA in these cancers. MATERIALS AND METHODS We reviewed the medical records of 134 consecutive patients with 148 nodules who underwent RFA between February 2008 and November 2016 for the debulking of symptomatic thyroid nodules diagnosed as benign using US-guided biopsy. We investigated the pre-RFA characteristics of the thyroid nodules, changes at follow-up after RFA, and the final surgical pathology. RESULTS Nodule regrowth after RFA was observed in 36 (24.3%) of the 148 benign nodules. Twenty-two of the 36 nodules were surgically removed, and malignancies were confirmed in seven (19.4% of 36). Of the 22 nodules removed surgically, pre-RFA median volume (range) was significantly larger for malignant nodules than for benign nodules: 22.4 (13.9-84.5) vs. 13.4 (7.3-16.8) mL (P = 0.04). There was no significant difference in the regrowth interval between benign and malignant nodules (P = 0.49). The median volume reduction rate (range) at 12 months was significantly lower for malignant nodules than for benign nodules (51.4% [0-57.8] vs. 83.8% [47.9-89.6]) (P = 0.01). The pre-RFA benignity of all seven malignant nodules was confirmed using two US-guided fine-needle aspirations (FNAs), except for one nodule, which was confirmed using US-guided core-needle biopsy (CNB). Regrown malignant nodules were diagnosed as suspicious follicular neoplasms by CNB. Histological examination of the malignant nodules revealed follicular thyroid carcinomas, except for one follicular variant, a papillary thyroid carcinoma. CONCLUSION Symptomatic large benign thyroid nodules showing regrowth or suboptimal reduction after RFA may have malignant potential. The confirmation of these nodules is better with CNB than with FNA.
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Affiliation(s)
- Myoung Kyoung Kim
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Haejung Kim
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Barcelos RN, Camacho CP, da Conceição de O C Mamone M, Ikejiri ES, Vanderlei FAB, Yang JH, Padovani RP, Martins LAL, Biscolla RPM, Macellaro D, Lindsey SC, Maciel RMB, Martins JRM. Risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy in thyroid nodules with diameters greater than 4 centimeters. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e000644. [PMID: 37364146 PMCID: PMC10661008 DOI: 10.20945/2359-3997000000644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/04/2023] [Indexed: 06/28/2023]
Abstract
Objective The risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy (FNAB) of thyroid nodules (TN) with diameters ≥ 3-4 cm remains controversial. However, some groups have indicated surgical treatment in these patients regardless of the FNAB results. We aimed to evaluate the diagnostic accuracy of the FNAB in systematically resected ≥4 cm TN and if the risk of malignancy is higher in these patients. Subjects and methods We retrospectively evaluated 138 patients (142 nodules) with TN with diameters ≥4 cm who underwent thyroidectomy. Results The FNAB results were nondiagnostic/unsatisfactory (ND/UNS) in 2.1% of the cases and benign in 51.4%. They indicated atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 23.9% of cases, follicular neoplasia/suspicious for a follicular neoplasm (FN/SFN) in 9.2%, suspicion of malignancy (SUS) in 8.5%, and malignant in 4.9%. The histopathological analysis after thyroidectomy revealed a thyroid cancer rate of 100% in the FNABs classified as malignant, 33.3% in SUS cases, 7.7% in FN/SFN, 17.6% in AUS/FLUS, and 4.1% in benign FNABs. None of the ND/UNS FNABs were malignant. The global malignancy diagnosis was 14.8% (n = 21). However, the rate of false negatives for FNAB was low (4.1%). Conclusion We showed that the risk of malignancy in nodules with diameters ≥4 cm was higher compared to the risk of thyroid cancer in TN in general. However, we found a low rate of false-negative cytological results; therefore, our data do not justify the orientation of routine resection for these larger nodules.
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Affiliation(s)
- Rafaela N Barcelos
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Cléber P Camacho
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Laboratório de Inovação Molecular e Biotecnologia, Programa de Pós-graduação em Medicina, Universidade Nove de Julho (Uninove), São Paulo, SP, Brasil
| | - Maria da Conceição de O C Mamone
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Elza S Ikejiri
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Felipe A B Vanderlei
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Ji H Yang
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rosália P Padovani
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Leandro A L Martins
- Laboratório de Anatomia Clínica e Patológica, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Rosa Paula M Biscolla
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Danielle Macellaro
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Susan C Lindsey
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rui M B Maciel
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - João Roberto M Martins
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil,
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9
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Scorziello C, Durante C, Biffoni M, Borcea MC, Consorti F, Laca A, Melcarne R, Ventrone L, Giacomelli L. The Size of a Thyroid Nodule with ACR TI-RADS Does Not Provide a Better Prediction of the Nature of the Nodule: A Single-Center Retrospective Real-Life Observational Study. Healthcare (Basel) 2023; 11:1673. [PMID: 37372791 DOI: 10.3390/healthcare11121673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
We investigated if thyroid nodule size has a predictive value of malignancy on a par with composition, echogenicity, shape, margin, and echogenic foci, and what would be the consequence of observing the rule of the American College of Radiology (ACR) to perform a fine-needle aspiration biopsy (FNAB). We conducted a retrospective real-life observational study on 86 patients who underwent surgery after a standardized diagnostic protocol. We divided the TR3, TR4, and TR5 classes into sub-classes according to the size threshold indicating FNAB (a: up to the threshold for no FNAB; b: over the threshold for FNAB suggested). We computed sensitivity, specificity, and positive (PPV) and negative predictive value (NPV) for the different sub-classes and Youden's index (Y) for the different possible cutoffs. Each sub-class showed the following PPV (0.67, 0.68, 0.70, 0.78, 0.72), NPV (0.56, 0.54, 0.51, 0.52, 0.59), and Y (0.20, 0.20, 0.22, 0.31, 0.30). In this real-life series, we did not find a significant difference in prediction of malignancy between the sub-categories according to the size threshold. All nodules have a pre-evaluation likelihood of being malignant, and the impact and utility of size thresholds may be less clear than suggested by the ACR TIRADS guidelines in patients undergoing standardized thyroid work up.
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Affiliation(s)
- Chiara Scorziello
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Maria Carola Borcea
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Fabrizio Consorti
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Angelo Laca
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Rossella Melcarne
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Luca Ventrone
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Laura Giacomelli
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
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10
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Guha R, Jana S, Biswas A, De KS, Das P. Trends in Thyroid Nodules and Malignancy: A Two-Year Retrospective Study in a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg 2023; 75:713-719. [PMID: 37275012 PMCID: PMC10235349 DOI: 10.1007/s12070-022-03463-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/30/2022] [Indexed: 01/08/2023] Open
Abstract
Thyroid nodules are one of the most common presentations faced by ENT clinicians, and the prevalence of differentiated thyroid cancer is increasing worldwide. We found no other study showing a clear occurence of cancer in thyroid nodules in the state of West Bengal. Hence, we undertook this study to determine the occurence of thyroid cancer among people with thyroid nodules. A retrospective review was performed for 96 patients with thyroid nodules who underwent USG and Fine Needle Aspiration Cytology (FNAC) and thyroid surgery at a tertiary hospital in Kolkata over a 2-year period from January 2020 to December 2021. The occurence of thyroid cancer in patients with thyroid nodules; association with age, sex, duration of thyroid swelling and thyroid stimulating hormone (TSH) levels of the patients; the sonographic findings (nodule size and number) and Bethesda classification on FNAC were reviewed. A total of 96 cases were reviewed. The highest malignancies were seen in swellings of 3-5 years duration (50%), and in patients with increased TSH levels (60%). Patients with single vs. multinodular goitre had comparable rates (23.07 vs 22.22%). The highest risk was seen in nodules 1-2 cm in size. A TIRADS score of 2 had a negative predictive value of 86.95% and a score of 5 had a positive predictive value of 100%. BETHESDA II lesions had a 3.44% rate of malignancy, while BETHESDA V and VI had rates of 100% and 75% respectively. While most of the thyroid swellings were benign, 22.91% were malignant, the most common being papillary carcinomas.
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Affiliation(s)
- Ruma Guha
- Department of ENT and Head and Neck Surgery, Calcutta National Medical College and Hospital, 32, Gorachand Road, Kolkata, 700014 India
- West Bengal University of Health Sciences, Kolkata, India
| | - Sonali Jana
- Department of ENT and Head and Neck Surgery, Calcutta National Medical College and Hospital, 32, Gorachand Road, Kolkata, 700014 India
- West Bengal University of Health Sciences, Kolkata, India
| | - Arpan Biswas
- Department of ENT and Head and Neck Surgery, Calcutta National Medical College and Hospital, 32, Gorachand Road, Kolkata, 700014 India
- West Bengal University of Health Sciences, Kolkata, India
| | - Kumar Shankar De
- Department of ENT and Head and Neck Surgery, Calcutta National Medical College and Hospital, 32, Gorachand Road, Kolkata, 700014 India
- West Bengal University of Health Sciences, Kolkata, India
| | - Prithvi Das
- Department of ENT and Head and Neck Surgery, Calcutta National Medical College and Hospital, 32, Gorachand Road, Kolkata, 700014 India
- West Bengal University of Health Sciences, Kolkata, India
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11
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Muacevic A, Adler JR, Aldosari AA, Amer KA, Al Qannass AM. Association of Ultrasonography With Final Histopathology in Diagnosing Thyroid Malignancy: A Single-Institute Retrospective Study. Cureus 2022; 14:e31677. [PMID: 36545178 PMCID: PMC9762525 DOI: 10.7759/cureus.31677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background Thyroid nodules are well-defined regions of aberrant echogenicity within the thyroid parenchyma that are radiologically distinct from the normal thyroid gland. The most common incidental finding in imaging scans that include the neck is a thyroid nodule. Rarely are thyroid nodules cancerous, as the majority are benign. Aim The current study aims to assess the concordance between ultrasound (US) of thyroid nodules and final histopathology results to identify the different types of detected thyroid lesions. Methodology A retrospective study reviewed the medical files of all patients presenting to the Armed Forces Hospital, Southern Region, with suspected thyroid nodules from April 2018 to January 2020. Data were extracted using pre-structured proforma to avoid inconsistency. Data extracted included patient demographic, swelling laterality, size, and US and histopathological findings. Results In the present study, 47 samples had a mean age of 44.27 (SD = ±13.5) years, 85.1% were of the female gender, the majority (85.1%) had multiple nodules, 38.3% were with Thyroid Imaging Reporting and Data System (TI-RADS) TR4 US score, and the median size of the nodule on US was 3 cm with a range of 0.6 to 14 cm. The study showed that 10% of TR1 samples were lymphocytic in histopathology, 66.7% of TR3 samples were benign multinodular goiter in histopathology, and 55.6% of samples of TR4 were malignant in histopathology. Conclusions The current study showed that the malignancy rate of the examined nodules was not uncommon both by US and histopathology, where papillary carcinoma was the most detected malignancy. The study showed a satisfactory agreement rate between TI-RADS classification by US sonography and histopathological reporting, where TR4 and TR5 by the US were mainly categorized as pre-malignant/malignant lesions by histopathology.
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12
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Lu W, Zhang D, Zhang Y, Qian X, Qian C, Wei Y, Xia Z, Ding W, Ni X. Ultrasound Radiomics Nomogram to Diagnose Sub-Centimeter Thyroid Nodules Based on ACR TI-RADS. Cancers (Basel) 2022; 14:cancers14194826. [PMID: 36230749 PMCID: PMC9562658 DOI: 10.3390/cancers14194826] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/23/2022] [Accepted: 09/27/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of the present study was to develop a radiomics nomogram to assess whether thyroid nodules (TNs) < 1 cm are benign or malignant. From March 2021 to March 2022, 156 patients were admitted to the Affiliated Hospital of Nantong University, and from September 2017 to March 2022, 116 patients were retrospectively collected from the Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine. These patients were divided into a training group and an external test group. A radiomics nomogram was established using multivariate logistics regression analysis using the radiomics score and clinical data, including the ultrasound feature scoring terms from the thyroid imaging reporting and data system (TI-RADS). The radiomics nomogram incorporated the correlated predictors, and compared with the clinical model (training set AUC: 0.795; test set AUC: 0.783) and radiomics model (training set AUC: 0.774; test set AUC: 0.740), had better discrimination performance and correction effects in both the training set (AUC: 0.866) and the test set (AUC: 0.866). Both the decision curve analysis and clinical impact curve showed that the nomogram had a high clinical application value. The nomogram constructed based on TI-RADS and radiomics features had good results in predicting and distinguishing benign and malignant TNs < 1 cm.
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Affiliation(s)
- Wenwu Lu
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Di Zhang
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Yuzhi Zhang
- Affiliated Hospital of Integration Chinese and Western Medicine with Nanjing University of Traditional Chinese Medicine, Nanjing 210023, China
| | - Xiaoqin Qian
- Department of Ultrasound, Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212050, China
| | - Cheng Qian
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Yan Wei
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Zicong Xia
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Wenbo Ding
- Affiliated Hospital of Integration Chinese and Western Medicine with Nanjing University of Traditional Chinese Medicine, Nanjing 210023, China
- Correspondence: (W.D.); (X.N.)
| | - Xuejun Ni
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
- Correspondence: (W.D.); (X.N.)
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13
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Paik C, Osterbauer B, Sahyouni G, Park S, Gomez G, Kwon D, Austin J. Thyroid tumor ratio: Improving the assessment of the impact of size in pediatric thyroid cancer. Head Neck 2022; 44:1342-1348. [PMID: 35322489 DOI: 10.1002/hed.27029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The impact of thyroid nodule size is less useful in children who have smaller thyroid volumes than in adults. We investigate using a novel thyroid tumor ratio measurement in children with thyroid cancer. METHODS Patient and pathologic characteristics were investigated via Student's t-test in a univariate analysis for any correlation with the log-transformed tumor ratio, followed by a multivariate linear regression. RESULTS Of 75 patients with malignancy and tumor ratio information, mean ratio decreased with increasing age (p = 0.04). Out of several clinical factors, patients with lymph node metastases and those treated with postoperative radioactive iodine had significantly higher mean tumor ratios on multivariate analysis (p = 0.04 for both factors). CONCLUSIONS Our study is the first to describe thyroid tumor volume in pediatric thyroid cancer and shows that increased tumor ratio was associated with indicators of more advanced disease such as lymph node metastases and use of radioactive iodine.
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Affiliation(s)
- Connie Paik
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Beth Osterbauer
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Grace Sahyouni
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Soyun Park
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Gabriel Gomez
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA.,Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of University of Southern California, Los Angeles, California, USA
| | - Daniel Kwon
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA.,Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of University of Southern California, Los Angeles, California, USA
| | - Juliana Austin
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
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14
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Hurtado-Lopez LM, Carrillo-Muñoz A, Zaldivar-Ramirez FR, Basurto-Kuba EOP, Monroy-Lozano BE. Assessment of diagnostic capacity and decision-making based on the 2015 American Thyroid Association ultrasound classification system. World J Methodol 2022; 12:148-163. [PMID: 35721246 PMCID: PMC9157633 DOI: 10.5662/wjm.v12.i3.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/27/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study evaluates the American Thyroid Association (ATA) ultrasound (US) classification system for the initial assessment of thyroid nodules to determine if it indeed facilitates clinical decision-making.
AIM To perform a systematic review and meta-analysis of the diagnostic value of the ATA US classification system for the initial assessment of thyroid nodules.
METHODS In accordance with the PRISMA statement for diagnostic test accuracy, we selected articles that evaluated the 2015 ATA US pattern guidelines using a diagnostic gold standard. We analyzed these cases using traditional diagnostic parameters, as well as the threshold approach to clinical decision-making and decision curve analysis.
RESULTS We reviewed 13 articles with 8445 thyroid nodules, which were classified according to 2015 ATA patterns. Of these, 46.62% were malignant. No cancer was found in any of the ATA benign pattern nodules. The Bayesian analysis post-test probability for cancer in each classification was: (1) Very-low suspicion, 0.85%; (2) Low, 2.6%; (3) Intermediate, 6.7%; and (4) High, 40.9%. The net benefit (NB), expressed as avoided interventions, indicated that the highest capacity to avoid unnecessary fine needle aspiration biopsy (FNAB) in the patterns that we studied was 42, 31, 35, and 43 of every 100 FNABs. The NB calculation for a probability threshold of 11% for each of the ATA suspicion patterns studied is less than that of performing FNAB on all nodules.
CONCLUSION These three types of analysis have shown that only the ATA high-suspicion diagnostic pattern is clinically useful, in which case, FNAB should be performed. However, the curve decision analysis has demonstrated that using the ATA US risk patterns to decide which patients need FNAB does not provide a greater benefit than performing FNAB on all thyroid nodules. Therefore, it is likely that a better way to approach the assessment of thyroid nodules would be to perform FNAB on all non-cystic nodules, as the present analysis has shown the ATA risk patterns do not provide an adequate clinical decision-making framework.
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Affiliation(s)
| | - Alfredo Carrillo-Muñoz
- Thyroid Clinic, General Surgery Service, Hospital General de Mexico, Mexico 06726, Mexico
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15
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Sakajiri RK, Rahal A, Francisco MJ, Queiroz MRGD, Garcia RG, Martins LAL, Malerbi DAC. Ultrasound classification of thyroid nodules: does size matter? EINSTEIN-SAO PAULO 2022; 20:eAO6747. [PMID: 35584446 PMCID: PMC9094606 DOI: 10.31744/einstein_journal/2022ao6747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/05/2021] [Indexed: 12/04/2022] Open
Abstract
Objective To determine whether the size of thyroid nodules in ACR-TIRADS ultrasound categories 3 and 4 is correlated with the Bethesda cytopathology classification. Methods Thyroid nodules (566) subclassified as ACR-TIRADS 3 or 4 were divided into three size categories according to American Thyroid Association guidelines. The frequency of different Bethesda categories in each size range within ACR-TIRADS 3 and 4 classifications was analyzed. Results Most nodules in both ACR-TIRADS classifications fell in the Bethesda 2 category, regardless of size (90.8% and 68.6%, ACR-TIRADS 3 and 4 respectively). The prevalence of Bethesda 6 nodules in the ACR-TIRADS 4 group was 14 times higher than in the ACR-TIRADS 3 group. There were no significant differences between nodule size and fine needle aspiration biopsy classification in any of the ACR-TIRADS categories. Conclusion Size does not appear to be an important criterion for indication of fine needle aspiration biopsy in thyroid nodules with a high suspicion of malignancy on ultrasound examination.
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16
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Zia-Ul-Hussnain HM, Kgosidialwa O, Kennedy C, Quinn M, Dolan E, Deignan P, Sherlock M, Thompson CJ, Smith D, O'Neill JP, Hill A, Leader M, Barrett H, Ryan C, Keeling F, Morrin MM, Agha A. Is repeat fine needle aspiration required in thyroid nodules with initial benign cytology? Results from a large Irish series. BMC Endocr Disord 2022; 22:102. [PMID: 35428234 PMCID: PMC9013082 DOI: 10.1186/s12902-022-01014-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND : Fine needle aspiration (FNA) cytology is the preferred method for assessing thyroid nodules for malignancy. Concern remains about the rate of false negative results. The primary aim of this study is to investigate the malignancy rate of thyroid nodules initially classified as benign (Thy 2). METHODS We retrospectively examined 658 nodules in 653 (429 female) patients between January 2013 to December 2017. All FNA biopsies (FNABs) were performed under ultrasound (US) guidance by a radiologist with expertise in thyroid pathology. Nodules were cytologically classified according to the UK Royal College of Pathologists guidelines. Decisions about further management were made at a regular thyroid multidisciplinary meeting. Follow up of the Thy 2 nodules was determined based on clinical and radiological criteria. RESULTS The mean age (± SD) was 53.2 (14.6) years. Five hundred out of 658 (76.0%) nodules were classified as Thy 2 (benign) after the first FNAB. Of these thyroid nodules initially classified as benign, 208 (41.6%) underwent repeat FNAB and 9 (1.8%) were surgically removed without repeat FNAB. The remainder were followed up clinically and/or radiologically. Seven (1.4%) of nodules initially classified as Thy 2 were later shown to be or to harbor malignancy after a follow-up of 74.5 (± 19.7) months. Papillary thyroid microcarcinomas were found co-incidentally in two thyroid glands of benign nodules, giving a true prevalence of 5/500 (1.0%). CONCLUSIONS With a well targeted FNAB, the false negative rate of an initial benign thyroid FNA is very low thus routine second FNAB is not required in patients with a thyroid nodule initially deemed benign. Multidisciplinary input is imperative in informing decision making.
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Affiliation(s)
| | | | - Carmel Kennedy
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Mark Quinn
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Emma Dolan
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Paul Deignan
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Mark Sherlock
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Chris J Thompson
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Diarmuid Smith
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | | | - Arnold Hill
- Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Mary Leader
- Department of Histopathology, Beaumont Hospital, Dublin, Ireland
| | - Helen Barrett
- Department of Histopathology, Beaumont Hospital, Dublin, Ireland
| | - Cliona Ryan
- Department of Histopathology, Beaumont Hospital, Dublin, Ireland
| | - Frank Keeling
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | | | - Amar Agha
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland.
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17
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Substantial interreader agreement for biopsy with reduction in biopsy rate: A multireader diagnostic performance study of ACR TI-RADS. Clin Imaging 2022; 84:93-97. [DOI: 10.1016/j.clinimag.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 12/26/2022]
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18
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The relationship between ultrasound-based TIRADS and BETHESDA categories in patients undergoing thyroid biopsy. Clin Exp Med 2022; 22:661-666. [PMID: 35022917 DOI: 10.1007/s10238-021-00779-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/28/2021] [Indexed: 11/03/2022]
Abstract
The TIRADS is a scoring system used for the selection of nodules for FNA and classification of the risk of malignancy based on ultrasound characteristics. The BETHESDA is a standard reporting system used for the classification of FNA results based on six criteria with risks for malignancy. The objective of this study was to evaluate the relationship between TIRADS and BSRTC classifications in patients undergoing thyroid biopsy. A total of 350 consecutive patients were retrospectively evaluated using TIRADS and BETHESDA reporting systems for determining preoperative diagnosis of thyroid nodules. Patients' demographics, size, echogenicity and contour status of the nodules, TIRADS and BETHESDA scores were recorded and analyzed. Data obtained in this study were expressed as mean, standard deviation, frequency and percentage descriptive statistics. The mean age of the patients was 49.03 ± 17.58 years. The mean nodule size was measured as 20.56 ± 10.47 mm. TIRADS TR3 category was found in 165 (47.14%), TR4 in 154 (44%) and TR5 in 31 (8.86%) patients, while BETHESDA II category was found in 288 (82.28%), BETHESDA III category in 1 (0.29%), BETHESDA IV category in 19 (5.43%), BETHESDA V in 37 (10.57%) and BETHESDA VI in 5 (1.43%) patients. There was a general concordance between BETHESDA and TRIADS categories. The most significant concordance was found between BETHESDA IV and TR4 categories (84.21%). Combined use of TRIADS and BETHESDA can be efficiently used to provide the most accurate results for making preoperative diagnosis of thyroid nodules and to determine the risk of malignancy.
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Lee H, Chung YS, Lee JH, Lee KY, Hwang KH. Characterization of focal hypermetabolic thyroid incidentaloma: An analysis with F-18 fluorodeoxyglucose positron emission tomography/computed tomography parameters. World J Clin Cases 2022; 10:155-165. [PMID: 35071515 PMCID: PMC8727242 DOI: 10.12998/wjcc.v10.i1.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/09/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Incidentally found thyroid tumor (thyroid incidentaloma, TI) on F-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is reported in 2.5%-5% of patients being investigated for non-thyroid purposes. Up to 50% of these cases have been diagnosed to be malignant by cytological/histological results. Ultrasonography (US) and fine-needle aspiration cytology are recommended for thyroid nodules with high FDG uptake (hypermetabolism) that are 1 cm or greater in size. It is important to accurately determine whether a suspicious hypermetabolic TI is malignant or benign. AIM To distinguish malignant hypermetabolic TIs from benign disease by analyzing F-18 FDG PET-CT parameters and to identify a cut-off value. METHODS Totally, 12761 images of patients who underwent F-18 FDG PET-CT for non-thyroid purposes at our hospital between January 2016 and December 2020 were retrospectively reviewed, and 339 patients [185 men (mean age: 68 ± 11.2) and 154 women (mean age: 63 ± 15.0)] were found to have abnormal, either focal or diffuse, thyroid FDG uptake. After a thorough review of their medical records, US, and cytological/histological reports, 46 eligible patients with focal hypermetabolic TI were included in this study. The TIs were categorized as malignant and benign according to the cytological/histological reports, and four PET parameters [standardized uptake value (SUV)max, SUVpeak, SUVmean, and metabolic tumor volume (MTV)] were measured on FDG PET-CT. Total lesion glycolysis (TLG) was calculated by multiplying the SUVmean by MTV. Both parametric and non-parametric methods were used to compare the five parameters between malignant and benign lesions. Receiver operating characteristic (ROC) curve analysis was performed to identify a cut-off value. RESULTS Each of the 46 patients [12 men (26.1%; mean age: 62 ± 13.1 years) and 34 women (73.9%; mean age: 60 ± 12.0 years)] with focal hypermetabolic TIs had one focal hypermetabolic TI. Among them, 26 (56.5%) were malignant and 20 (43.5%) were benign. SUVmax, SUVpeak, SUVmean, and TLG were all higher in malignant lesions than benign ones, but the difference was statistically significant (P = 0.012) only for SUVmax. There was a positive linear correlation (r = 0.339) between SUVmax and the diagnosis of malignancy. ROC curve analysis for SUVmax revealed an area under the curve of 0.702 (P < 0.05, 95% confidence interval: 0.550-0.855) and SUVmax cut-off of 8.5 with a sensitivity of 0.615 and a specificity of 0.789. CONCLUSION More than half of focal hypermetabolic TIs on F-18 FDG PET-CT were revealed as malignant lesions, and SUVmax was the best parameter for discriminating between malignant and benign disease. Unexpected focal hypermetabolic TIs with the SUVmax above the cut-off value of 8.5 may have a greater than 70% chance of malignancy; therefore, further active assessment is required.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Yoo Seung Chung
- Department of Endocrine Surgery, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Joon-Hyop Lee
- Department of Endocrine Surgery, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Ki-Young Lee
- Department of Endocrinology and Metabolism, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Kyung-Hoon Hwang
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
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20
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Steinmetz-Wood SN, Kennedy AG, Tompkins BJ, Gilbert MP. Navigating the Debate on Managing Large (≥4 cm) Thyroid Nodules. Int J Endocrinol 2022; 2022:6246150. [PMID: 35469125 PMCID: PMC9034904 DOI: 10.1155/2022/6246150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Discordant practice guidelines for managing large thyroid nodules may result in unnecessary surgeries and costs. Recent data suggest similar false-negative rates in fine needle aspiration (FNA) biopsies between small (<4 cm) and large (≥4 cm) nodules, indicating that monitoring rather than surgery may be appropriate for large biopsy-negative nodules. We investigated the management of thyroid nodules ≥4 cm to determine the proportion of surgeries not necessary for diagnostic purposes and examined for potential predictors. METHODS This was a retrospective cohort study of patients who received a FNA of nodule(s) ≥4 cm between 11/1/2014 and 10/31/2019 at the University of Vermont Medical Center. A surgery was considered unnecessary if the FNA result was benign in the absence of any of the following: compressive symptoms, family history of thyroid cancer in a first degree relative, history of neck irradiation, toxic nodule or toxic multinodular goiter, or substernal extension. Data were analyzed with Wilcoxon rank sum tests, chi square, or Fisher's exact tests. RESULTS 177 patients had a ≥4 cm nodule during the timeframe and half (54.2%) had surgery. Patients who underwent surgery were significantly younger (51.5 years vs. 62 years; P < 0.001), more likely to report obstructive symptoms (34.4% vs. 12.1%; P < 0.001) and had a larger nodule size (5.0 cm vs. 4.7 cm; P=0.26). Forty-one patients with benign (Bethesda II) FNA results had surgery, all with negative surgical pathology. Thirteen percentage (23/177) of surgeries were potentially not necessary for diagnostic purposes. CONCLUSION Approximately half of our patients with ≥4 cm nodules had surgery, with 13% having surgery not necessary for diagnostic purposes revealing opportunities for improving care and costs.
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Affiliation(s)
| | - Amanda G. Kennedy
- Department of Medicine Quality Program, The Larner College of Medicine at The University of Vermont, Burlington, VT, USA
| | - Bradley J. Tompkins
- Department of Medicine Quality Program, The Larner College of Medicine at The University of Vermont, Burlington, VT, USA
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21
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Yang GE, Na DG. Impact of the ultrasonography assessment method on the malignancy risk and diagnostic performance of five risk stratification systems in thyroid nodules. Endocrine 2022; 75:137-148. [PMID: 34533767 DOI: 10.1007/s12020-021-02795-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/07/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE Ultrasonographic (US) assessment methods may affect the estimated malignancy risk of thyroid nodules. This study aimed to investigate the impact of retrospective and prospective US assessments on the estimated malignancy risk of US features, classified categories, and diagnostic performance of five risk stratification systems (RSSs) in thyroid nodules. METHODS A total of 3685 consecutive thyroid nodules (≥1 cm) with final diagnoses (retrospective dataset, n = 2180; prospective dataset, n = 1505) were included in this study. We compared the estimated malignancy risk of US features, classified categories, and diagnostic performances of the five common RSSs between retrospective (static US images without cine clips) and prospective datasets of real-time US assessment. RESULTS There was no significant difference in the prevalence and histological type of malignant tumours between the two datasets (p ≥ 0.216). The malignancy risk of solid composition and nonparallel orientation was higher and that of microcalcification was lower in the prospective dataset than in the retrospective dataset (p < 0.001, p = 0.018, p = 0.007, respectively). The retrospective US assessment showed slightly higher malignancy risk of intermediate- or high-risk nodules according to the RSSs. Prospective US assessment showed lower specificities and higher unnecessary biopsy rates by all RSSs compared to the retrospective US assessment (p ≤ 0.006, p ≤ 0.045, respectively). CONCLUSIONS The retrospective US assessment showed higher malignancy risk of microcalcification and some classified categories by RSSs, and overestimated the specificities and underestimated the unnecessary biopsy rates by all RSSs compared to prospective US assessment.
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Affiliation(s)
- Go Eun Yang
- Department of Radiology, School of medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
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22
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Nabahati M, Mehraeen R, Moazezi Z, Ghaemian N. Can sonographic features of microcalcification predict thyroid nodule malignancy? a prospective observational study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00498-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Abstract
Background
The aim of this study was to investigate the diagnostic accuracy of microcalcification, as well as its associated sonographic features, for prediction of thyroid nodule malignancy.
We prospectively assessed the patients with thyroid nodule, who underwent ultrasound-guided fine-needle aspiration during 2017–2020 in Babol, northern Iran. The ultrasonographic characteristics of the nodules, as well as their cytological results, were recorded. We used regression analysis to evaluate the relation between sonographic findings and nodule malignancy. A receiver operator characteristics (ROC) analysis was also used to estimate the ability of ultrasound to predict the characteristic features of malignancy, as estimated by the area under the curve (AUC).
Results
Overall, 1129 thyroid nodules were finally included in the study, of which 452 (40%) had microcalcification. A significant positive association was found between nodule malignancy and microcalcification in both univariate (OR=3.626, 95% CI 2.258–5.822) and multivariable regression analyses (OR=1.878, 95% CI 1.095–3.219). In the nodules with microcalcification, significant positive relations were seen between malignancy and hypoechogenicity (OR=3.833, 95% CI 1.032–14.238), >5 microcalcification number (OR=3.045, 95% CI 1.328–6.982), irregular margin (OR=3.341, 95% CI 1.078–10.352), and lobulated margin (OR=5.727, 95% CI 1.934–16.959). The ROC analysis indicated that AUC for hypoechogenicity, >5 microcalcification number, irregular margin, and lobulated margin were 60%, 62%, 55%, and 60%, respectively, in predicting malignant thyroid nodules.
Conclusion
The findings indicated that microcalcification can be a potential predictor of thyroid nodule malignancy. Also, the presence of irregular or lobulated margins, multiple intranodular microcalcification (>5 microcalcifications), and/or hypoechogenicity can improve the ability of microcalcification in distinguishing malignant from benign nodules.
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23
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Large thyroid nodules: should size alone matter? Eur Arch Otorhinolaryngol 2021; 279:3139-3146. [PMID: 34739578 DOI: 10.1007/s00405-021-07151-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The management of thyroid nodules ≥ 4 cm is controversial due to conflicting evidence on the prevalence of malignancy and diagnostic accuracy of fine-needle aspiration cytology (FNAC). Some literature recommends routine excision of large thyroid nodules due to high cytology false negative rates (FNR). We aim to investigate the diagnostic accuracy of FNAC, prevalence of malignancy in large (≥ 4 cm) thyroid nodules compared to nodules < 4 cm, and the clinical and ultrasound characteristics of those large nodules with false negative cytology. METHODS This was a retrospective case-log review in a tertiary referral hospital. All thyroid nodules subjected to Ultrasound (US)-guided FNAC by the Interventional Radiology department between December 2011 and November 2017 were included. Data on patient demographics, thyroid US features, cytology findings, and surgical histology were collected and analyzed. Sensitivity, specificity, and FNR were calculated based on FNAC results and final post-operative histology. Factors associated with a false negative result were analyzed using univariate and multivariate analyses. RESULTS A total of 4982 nodules were studied, including 4419 < 4 cm and 563 ≥ 4 cm. Malignancy rates were similar in both groups. For nodules ≥ 4 cm, FNAC sensitivity was 40%, specificity 100%, and FNR 6.6% compared to 4.2% in nodules < 4 cm. Within malignant nodules, there was a significantly higher proportion of follicular and Hurthle cell carcinomas in nodules ≥ 4 cm. Amongst nodules ≥ 4 cm, multivariate analysis revealed male gender to be an independent predictor of FNR (OR 3.32; 95% CI 1.29-8.59). CONCLUSION Larger nodules ≥ 4 cm have a similar malignancy rate as nodules < 4 cm, and FNAC FNR is low at 6.6%. Management of large thyroid nodules should be individualized based on their clinical, sonographic and cytological features rather than routine surgery. LEVEL OF EVIDENCE 3.
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24
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Ha EJ, Chung SR, Na DG, Ahn HS, Chung J, Lee JY, Park JS, Yoo RE, Baek JH, Baek SM, Cho SW, Choi YJ, Hahn SY, Jung SL, Kim JH, Kim SK, Kim SJ, Lee CY, Lee HK, Lee JH, Lee YH, Lim HK, Shin JH, Sim JS, Sung JY, Yoon JH, Choi M. 2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol 2021; 22:2094-2123. [PMID: 34719893 PMCID: PMC8628155 DOI: 10.3348/kjr.2021.0713] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1-2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.
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Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Chung
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea
| | - Seong Whi Cho
- Department of Radiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seul Kee Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Soo Jin Kim
- Department of Radiology, New Korea Hospital, Gimpo, Korea
| | - Chang Yoon Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Ho Kyu Lee
- Department of Radiology, Jeju National University, Jeju, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
| | - Jin Young Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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25
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Gündüz N, Söylemez UPO. A practical approach for the management of small thyroid nodules referred for biopsy. Int J Clin Pract 2021; 75:e14757. [PMID: 34453376 DOI: 10.1111/ijcp.14757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Current guidelines recommend against routine ultrasound (US) guided fine-needle aspiration biopsy (FNAB) of small (<1 cm) thyroid nodules and suggest follow-up of ≥5 mm small nodules only if they are TI-RADS-5. This study aims to determine the best suspicious ultrasound features related to cytology results in patients referred for FNAB of small thyroid nodules and construct an algorithm for declining unnecessary biopsies and selection of patients to be followed up. METHODS This prospective observational study enrolled patients referred for US-guided biopsy of ≤1 cm thyroid nodules. Ultrasound features including composition, echogenicity, shape, margin, echogenic focus, hypoechoic rim, vascularity were assessed. The cytology results were dichotomised as either benign or malignant/high risk. The features with excellent interobserver reliability and more than 90% sensitivity were selected. RESULTS Overall, 95 patients [82 (86.3%) females, mean age 48.5 ± 11.9 years] with 95 small (≤1 cm) thyroid nodules were biopsied. Cytology revealed 15 (15.8%) malignant nodules. Pure solid composition, hypoechogenicity, taller than wide shape and irregular margin of the nodules were significantly associated with malignancy. Hypoechogenicity (100%) and pure solid composition (93%) had very high sensitivity and excellent interobserver agreement (Cohen's Kappa 0.83, P = .003 for both) for predicting high risk/malignant nodule. In the absence of these two features, 48 (50.5%) nodules either would not require FNAB or follow-up. CONCLUSION The presence of cyst or iso/hyperechogenicity within a small thyroid nodule in patients already referred for invasive sampling safely allows for declining a decision of FNAB or follow-up without the concern of missing malignancy.
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Affiliation(s)
- Nesrin Gündüz
- Faculty of Medicine, Department of Radiology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul Medeniyet University, İstanbul, Turkey
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26
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Xin Y, Liu F, Shi Y, Yan X, Liu L, Zhu J. A Scoring System for Assessing the Risk of Malignant Partially Cystic Thyroid Nodules Based on Ultrasound Features. Front Oncol 2021; 11:731779. [PMID: 34692506 PMCID: PMC8526936 DOI: 10.3389/fonc.2021.731779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/20/2021] [Indexed: 01/10/2023] Open
Abstract
Objective To assess the ultrasound (US) features of partially cystic thyroid nodules (PCTNs) and to establish a scoring system to further improve the diagnostic accuracy. Methods A total of 262 consecutive nodules from September 2017 to March 2020 were included in a primary cohort to construct a scoring system. Moreover, 83 consecutive nodules were enrolled as an validation cohort from May 2018 to August 2020. All nodules were determined to be benign or malignant according to the pathological results after surgery or ultrasound-guided fine-needle aspiration (US-FNA). The US images and demographic characteristics of the patients were analyzed. The ultrasound features of PCTNs were extracted from primary cohort by two experienced radiologists. The features extracted were used to develop a scoring system using logistic regression analysis. Receiver operating characteristic (ROC) curves were applied to evaluate the diagnostic efficacy of the scoring system in both the primary cohort and validation cohort. In addition, the radiologists evaluated the benign and malignant PCTNs of the validation cohort according to the ACR TI-RADS guidelines and clinical experience, and the accuracy of their diagnosis were compared with that of the scoring system. Results Based on the eight features of PCTNs, the scoring system showed good differentiation and reproducibility in both cohorts. The scoring system was based on eight features of PCTNs and showed good performance. The area under the curve (AUC) was 0.876 (95% CI, 0.830 - 0.913) in the primary cohort and 0.829(95% CI, 0.730 - 0.903) in the validation cohort. The optimal cutoff value of the scoring system for the diagnosis of malignant PCTNs was 4 points, with a good sensitivity of 71.05% and specificity of 87.63%. The scoring system (AUC=0.829) was superior to radiologists (AUC= 0.736) in diagnosing PCTNs and is a promising method for clinical application. Conclusions The scoring system described herein is a convenient and clinically valuable method that can diagnose PCTNs with relatively high accuracy. The use of this method to diagnose PCTNs, which have been previously underestimated, will allow PCTNs to receive reasonable attention, and assist radiologist to confidently diagnose the benignity or malignancy.
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Affiliation(s)
- Yuwei Xin
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Feifei Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Yan Shi
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, China
| | - Xiaohui Yan
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Liping Liu
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
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27
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Hamour AF, Yang W, Lee JJW, Wu V, Ziai H, Singh P, Eskander A, Sahovaler A, Higgins K, Witterick IJ, Vescan A, Freeman J, de Almeida JR, Goldstein D, Gilbert R, Chepeha D, Irish J, Enepekides D, Monteiro E. Association of the Implementation of a Standardized Thyroid Ultrasonography Reporting Program With Documentation of Nodule Characteristics. JAMA Otolaryngol Head Neck Surg 2021; 147:343-349. [PMID: 33570552 DOI: 10.1001/jamaoto.2020.5233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Although most thyroid nodules are benign, the potential for malignant neoplasms is associated with unnecessary workup in the form of imaging, fine-needle aspiration, and diagnostic surgery. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is commonly used to assess the malignant neoplasm risk potential of thyroid nodules imaged by ultrasonography. However, standardized reporting of ACR TI-RADS descriptors is inconsistent. Objective To increase the documentation rate of ACR TI-RADS thyroid nodule characteristics to 80% in 18 months. Design, Setting, and Participants This prospective interrupted time series quality improvement study was conducted from December 1, 2018, to March 31, 2020, at a tertiary outpatient head and neck clinic among 229 patients who had at least 1 documented thyroid nodule identified on bedside clinic ultrasonography. Data analysis was performed throughout the entire study period because this was a quality improvement study with iterative small cycle changes; final analysis of the data was performed in April 2020. Main Outcomes and Measures The primary outcome was the documentation rates of 6 ACR TI-RADS ultrasonographic descriptors. Secondary outcomes included nodule fine-needle aspiration biopsy rate and physician-reported clinic flow efficiency. Results A total of 229 patients had at least 1 documented thyroid nodule and were included in the analysis. Size was the most frequently documented nodule characteristic (72 of 74 [97.3%]) at baseline, followed by echogenic foci (31 of 74 [41.9%]), composition (23 of 74 [31.1%]), echogenicity (17 of 74 [23.0%]), margin (6 of 74 [8.1%]), and shape (1 of 74 [1.4%]). After 3 Plan, Do, Study, Act (PDSA) cycles, the final intervention consisted of a standardized ultrasonography reporting form and educational initiatives for surgical trainees. After the third PDSA cycle (n = 36), reporting of nodule size, echogenic foci, and composition increased to 100%. Similarly, reporting of echogenicity (34 of 36 [94.4%]), shape (28 of 36 [77.8%]), and margin (25 of 36 [69.4%]) all increased. This represented a cumulative 90.3% documentation rate (195 of 216), a 56.5% increase from baseline (95% CI, 50.0%-61.9%). The standardized reporting form was used in 83.3% of eligible thyroid ultrasonography cases (30 of 36) after PDSA cycle 3, demonstrating good fidelity of implementation. There were no unintended consequences associated with clinic workflow, as a balancing measure, reported by staff surgeons. Conclusions and Relevance This study suggests that implementation of an ACR TI-RADS-based reporting form in conjunction with educational initiatives improved documentation of ultrasonographic thyroid nodule characteristics, potentially allowing for improved bedside risk stratification and communication among clinicians.
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Affiliation(s)
- Amr F Hamour
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John J W Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Praby Singh
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Scarborough Hospital, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Allan Vescan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - David Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Douglas Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
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CENGİZ H, DEMİRCİ T, AYDIN A, VARIM C. Does fine needle aspiration from a different nodule other than the dominant nodule provide additional benefit in thyroid diseases with nodules? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.950773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Elbalka SS, Metwally IH, Shetiwy M, Awny S, Hamdy O, Kotb SZ, Shoman AM, Shahda E, Elzahaby IA. Prevalence and predictors of thyroid cancer among thyroid nodules: a retrospective cohort study of 1,000 patients. Ann R Coll Surg Engl 2021; 103:683-689. [PMID: 34448415 DOI: 10.1308/rcsann.2021.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Thyroid cancer is increasing in incidence globally due either to early detection (overestimation) or true increment. A recent debate concerns multinodular goitre (MNG) or toxic goitres which have classically been considered at a lower risk for cancer. METHODS In this study, we enrolled retrospectively all patients with nodular goitre treated at our tertiary hospital and analysed their data with the aim of detecting the rate of cancer among different types of nodular goitre. We also studied predictors of incidental malignancy among thyroidectomies. RESULTS A predilection for solitary thyroid nodules (STNs) was found in women of younger age, with STNs tending to be larger in comparison with MNG in the same age group. However, both types of nodules were at equal risk of harbouring malignancy. Thyroid Imaging Reporting and Data System (TI-RADS) and Bethesda scores were the only dependent predictors of malignancy within thyroid nodules. CONCLUSION The authors recommend management of both STNs and MNG using the same algorithm.
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Affiliation(s)
- S S Elbalka
- Oncology Center Mansoura University, Mansoura, Egypt
| | - I H Metwally
- Oncology Center Mansoura University, Mansoura, Egypt
| | - M Shetiwy
- Oncology Center Mansoura University, Mansoura, Egypt
| | - S Awny
- Oncology Center Mansoura University, Mansoura, Egypt
| | - O Hamdy
- Oncology Center Mansoura University, Mansoura, Egypt
| | - S Z Kotb
- Oncology Center Mansoura University, Mansoura, Egypt
| | - A M Shoman
- Mansoura University Hospitals, Mansoura, Egypt
| | - E Shahda
- Mansoura University Hospitals, Mansoura, Egypt
| | - I A Elzahaby
- Oncology Center Mansoura University, Mansoura, Egypt
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Wang M, Sun P, Zhao X, Sun Y. Ultrasound Parameters of Thyroid Nodules and the Risk of Malignancy: A Retrospective Analysis. Cancer Control 2021; 27:1073274820945976. [PMID: 33035078 PMCID: PMC7791455 DOI: 10.1177/1073274820945976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Ultrasonography-guided fine-needle aspiration biopsy is the common choice for
diagnosis of the suspected thyroid nodule. An algorithm(s) that finds the
malignant potential of a nodule preoperatively, to overcome unnecessary
diagnostic methods, does not exist. The objective of the study was to correlate
thyroid nodule sizes measured by ultrasonography and risk of malignancy assessed
by cytologic and histologic examinations. Data regarding fine-needle aspiration
cytology and the results of histologic examinations of surgical specimens of 260
nodules were collected and analyzed. The macro or multiple calcifications, the
complex echo pattern, and posterior region homogeneity were considered
suspicious in ultrasonography. Bethesda system for classification of thyroid
nodules was used for cytopathology. Histopathology performed as per the 2004
World Health Organization classification system. The benefit score analysis was
performed for determination of clinical usefulness. Twenty-eight of 49 malignant
nodules and 46 of 68 malignant nodules detected through ultrasound following
fine-needle aspiration cytopathology and histopathology were <2 cm in size. A
correlation was found for malignancy rate detected by ultrasonography-guided
fine-needle aspiration cytology and those of the surgical specimen
(r = 0.945, P = .015, R2 = 0.894). Ultrasonography-guided fine-needle aspiration cytology
had 0.994 sensitivities, 0.721 accuracies, and 0.08 to 0.945 diagnostic
confidence for the detection of malignant nodules. Nodule size less than 2 mm
(P = .011) was associated with the malignancy potential of
thyroid nodules. Ultrasonography-guided fine-needle aspiration cytology had 19
(7%) results as a false negative and 1 (1%) results were false positive.
Ultrasound-guided fine-needle aspiration cytopathology reported oversize of
thyroid nodule than original but can predict the risk of malignancy. Level of
Evidence: III.
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Affiliation(s)
- Minxin Wang
- Department of Ultrasound, Weihai Central Hospital, Weihai, Shandong, China
| | - Ping Sun
- Department of Ultrasound, Weihai Central Hospital, Weihai, Shandong, China
| | - Xiaodong Zhao
- Department of Gastroenterology, Weihai Central Hospital, Weihai, Shandong, China
| | - Yongmei Sun
- Department of Ultrasound, 12593The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Linhares SM, Handelsman R, Picado O, Farrá JC, Lew JI. Fine needle aspiration and the Bethesda system: Correlation with histopathology in 1,228 surgical patients. Surgery 2021; 170:1364-1368. [PMID: 34134896 DOI: 10.1016/j.surg.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fine-needle aspiration combined with the Bethesda System for Reporting Thyroid Cytopathology is indispensable in the diagnostic evaluation of thyroid nodules. Their increased detection over the last few decades mandates the determination of which thyroid nodules require surgical management for malignancy. This study examines the correlation of fine-needle aspiration to final histopathology of dominant thyroid nodules in a large series of surgical patients undergoing thyroidectomy at a single academic institution. METHODS A retrospective review of prospectively collected data of 1,228 patients who underwent fine-needle aspiration for a dominant thyroid nodule and thyroidectomy from a single institution between 2010 and 2019 was performed. The cases were stratified into all 6 Bethesda categories. Fine-needle aspiration results were compared to index thyroid nodule malignancy on final histopathology. RESULTS Of 1,228 patients who underwent thyroidectomy, the overall malignancy rate was 53%. When fine-needle aspiration was stratified by the Bethesda System for Reporting Thyroid Cytopathology, malignancy rate was 29% for nondiagnostic; 11% for benign; 51% for atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS); 47% for follicular neoplasm/suspicious for follicular neoplasm (FN/SFN); 84% for suspicious for malignancy (SFM); and 98% for malignant results on final histopathology. There was a false positive rate of 1% and false negative rate ranging from 7 to 11%. CONCLUSION Fine-needle aspiration of a dominant thyroid nodule in patients who underwent thyroidectomy had an overall malignancy rate of 53%. False negative and false positive rates are within the reported range in surgical patient populations. The majority of patients with AUS/FLUS, FN/SFN and SFM results with underlying malignancy received the appropriate surgical resection.
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Affiliation(s)
- Samantha M Linhares
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL.
| | - Rachel Handelsman
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - Omar Picado
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - Josefina C Farrá
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
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Fiorentino V, Dell’ Aquila M, Musarra T, Martini M, Capodimonti S, Fadda G, Curatolo M, Traini E, Raffaelli M, Lombardi CP, Pontecorvi A, Larocca LM, Pantanowitz L, Rossi ED. The Role of Cytology in the Diagnosis of Subcentimeter Thyroid Lesions. Diagnostics (Basel) 2021; 11:diagnostics11061043. [PMID: 34204172 PMCID: PMC8230300 DOI: 10.3390/diagnostics11061043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Thyroid nodules are common and typically detected by palpation and/or ultrasound (US). Guidelines have defined the management of large nodules, but controversy exists regarding nodules ≤ 1 cm. We evaluated a cohort of patients with subcentimeter nodules to determine their rate of malignancy (ROM). A total of 475 thyroid FNAs of lesions ≤ 1 cm with available follow-up were identified from January 2015–December 2019. For comparative analysis, we added a control series of 606 thyroid lesions larger than 1 cm from the same reference period. All aspirates were processed with liquid-based cytology and classified according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Subcentimeter nodules were stratified as 35 category I—non-diagnostic cases (ND; 7.3%), 144 category II—benign lesions (BL; 30.3%), 12 category III—atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; 2.5%), 12 category IV—follicular neoplasm/suspicious for follicular neoplasm (FN/SFN; 2.5%), 124 category V—suspicious for malignancy (SM; 26.1%), and 148 category VI—positive for malignancy (PM; 31.1%). A total of 307 cases (64.6%) underwent subsequent surgery. Only one ND and three BLs had a malignant outcome. ROM for indeterminate lesions (III + IV) was 3.2%; with 1.6% for category III and 3.2% for category IV. ROM for the malignant categories (V + VI) was 88.2%. The control cohort of lesions demonstrated a higher number of benign histological diagnoses (67.3%). We documented that 57.2% of suspected subcentimeter lesions were malignant, with a minor proportion that belonged in indeterminate categories. There were very few ND samples, suggesting that aspirates of subcentimeter lesions yield satisfactory results. Suspected US features in subcentimeter lesions should be evaluated and followed by an interdisciplinary team for appropriate patient management.
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Affiliation(s)
- Vincenzo Fiorentino
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Marco Dell’ Aquila
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Teresa Musarra
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Mariangela Curatolo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Emanuela Traini
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (E.T.); (M.R.); (C.P.L.)
| | - Marco Raffaelli
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (E.T.); (M.R.); (C.P.L.)
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (E.T.); (M.R.); (C.P.L.)
| | - Alfredo Pontecorvi
- Division of Endocrinology-Fondazione, Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy;
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Liron Pantanowitz
- Department of Pathology & Clinical Labs, University of Michigan, Ann Arbor, MI 48103, USA;
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
- Correspondence: ; Tel.: +39-06-3015-4433
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Dong S, Pan J, Shen YB, Zhu LX, Xia Q, Xie XJ, Wu YJ. Factors Associated with Malignancy in Patients with Maximal Thyroid Nodules ≥2 Cm. Cancer Manag Res 2021; 13:4473-4482. [PMID: 34113173 PMCID: PMC8186937 DOI: 10.2147/cmar.s303715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/15/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The relationship between large thyroid nodules and the risk of malignancy is controversial. This study aimed to examine the relationship between thyroid nodule size and the risk of malignancy of maximal thyroid nodules ≥2 cm and the risk of accompanied by occult thyroid carcinoma. Methods This was a retrospective study of patients who underwent near-total or total thyroidectomy for thyroid nodules from January 2016 to January 2019 at the First Affiliated Hospital,Zhejiang University School of Medicine. Clinical, biochemical, and pathological characteristics were examined for association with malignancy using univariable, multivariable, and receiver operating characteristic curve analyses. Results Finally, 367 patients (277 females (75.5%) and 90 males (24.5%)) with a mean age of 49.0±13.5 years were included. Multivariable logistic regression analysis showed that age (OR=0.959, 95% CI: 0.939–0.979, P<0.001), Hashimoto’s thyroiditis (OR=2.437, 95% CI: 1.162–5.112, P=0.018), the diameter of maximal nodule (small) (OR=0.706, 95% CI: 0.541–0.919, P=0.010), and punctate echogenic foci (OR=2.837, 95% CI: 1.598–5.286, P<0.001) were independently associated with malignancy. Of 223 patients who had non-suspicious malignant nodules (TI-RADS <4), 12.7% (n=29) patients showed malignancy at postoperative pathology. Only age was associated with occult PTC in the univariable analyses (OR=0.962, 95% CI: 0.934–0.991, P=0.011). When TPOAb was used as a continuous variable for statistical analysis, it showed a significant difference in the ROC curve, and the results showed TPOAb >31.4 mIU/L was more associated with occult PTC (P=0.006). A predictive model including four independent risk factors of malignancy showed an optimal discriminatory accuracy (area under the curve, AUC) of 0.783 (95% CI=0.732–0.833). Conclusion Relatively young age (<54.5 years), Hashimoto’s thyroiditis, the diameter of the maximal nodule, and punctate echogenic foci were independently associated with thyroid malignancy in patients with maximal thyroid nodules ≥2 cm. Young age (<54.5 years) and TPOAb >31.4 mIU/L were associated with occult PTC.
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Affiliation(s)
- Shuai Dong
- Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China
| | - Jun Pan
- Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China
| | - Yi-Bin Shen
- Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China
| | - Li-Xian Zhu
- Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China
| | - Qing Xia
- Department of Endocrinology, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, People's Republic of China
| | - Xiao-Jun Xie
- Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China
| | - Yi-Jun Wu
- Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China
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Chen Z, Mosha SS, Zhang T, Xu M, Li Y, Hu Z, Liang W, Deng X, Ou T, Li L, Li W. Incidence of microcarcinoma and non-microcarcinoma in ultrasound-found thyroid nodules. BMC Endocr Disord 2021; 21:38. [PMID: 33663475 PMCID: PMC7934238 DOI: 10.1186/s12902-021-00700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/16/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUNDS The incidence of thyroid nodules is increasing year by year around the world. However, ultrasound is not recommended as a screening test for the general population or patients with a normal thyroid on palpation by the American Association of Clinical Endocrinologists (AACE). In practice, some individuals with normal thyroid palpation have nodules that can just be found out by ultrasound. No studies have directly described the risk of nodules found by ultrasound or by palpation up to now. More evidence is needed to carry out for helping us balance the over diagnosis and missed diagnosis of malignant lesions. Therefore, we carried out a retrospective study to investigate the incidence of malignant lesions in ultrasound-found nodules in a large cohort. METHODS We conducted a retrospective analysis involving 2957 patients who underwent thyroid ultrasound evaluation and fine-needle aspiration (FNA) between Jan 2013 and Dec 2019. The cytologic examinations were analyzed based on the Bethesda system. For nodules suspected to be follicular neoplasm or other malignant tumors by cytological tests, patients were recommended for surgery and histopathology examinations. RESULTS Compared with palpation-found nodules, ultrasound-found nodules were presenting less as purely cystic nodules (10.1 % vs. 39.9 %, x2 = 355.69, p = 0.000), smaller size (17.5 ± 9.9 mm vs. 28.0 ± 12.5 mm, t = 23.876 p = 0.000), and higher TI-RADS score (5.5 ± 2.9 vs. 3.4 ± 3.3, t = 18.084, p = 0.000), respectively. More ultrasound-found nodules were diagnosed as carcinoma by histology examinations [136 (11.2 %) nodules found by ultrasound vs. 68 (3.9 %) by palpation, x2 = 59.737, p = 0.000], and 88 (64.7 %) nodules found by ultrasound were non-microcarcinoma. Among the malignant nodules confirmed by histopathology, a higher proportion of microcarcinoma was detected in ultrasound-found nodules [35.3 % (48/136) vs. 16.2 % (11/68), x2 = 8.183, p = 0.004]. CONCLUSIONS In view of the results observed in our research, malignant nodules were more common in nodules screened out by ultrasound, and nearly two thirds of them were non-microcarcinoma. We suggest the recommendation against screening thyroid nodules by ultrasound needs to be re-evaluated.
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Affiliation(s)
- Zhi Chen
- Department of Endocrinology, The Third Affiliated Hospital, Southern Medical University, No.183 Zhongshan Avenue West, Tianhe District, 510630, Guangzhou, China
| | - Singla Sethiel Mosha
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China
| | - Tong Zhang
- Department of Endocrinology, The Third Affiliated Hospital, Southern Medical University, No.183 Zhongshan Avenue West, Tianhe District, 510630, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasound, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China
| | - Yanli Li
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China
| | - Zhuoqing Hu
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China
| | - Weiqiang Liang
- Department of Endocrinology, Affiliated Nanhai Hospital of Southern Medical University, No.40 Foping Road, Nanhai District, 528200, Foshan, China
| | - Xiaoyi Deng
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China
| | - Tingting Ou
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China
| | - Ling Li
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China.
| | - Wangen Li
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China.
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Daniels K, Gummadi S, Zhu Z, Wang S, Patel J, Swendseid B, Lyshchik A, Curry J, Cottrill E, Eisenbrey J. Machine Learning by Ultrasonography for Genetic Risk Stratification of Thyroid Nodules. JAMA Otolaryngol Head Neck Surg 2021; 146:36-41. [PMID: 31647509 DOI: 10.1001/jamaoto.2019.3073] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Thyroid nodules are common incidental findings. Ultrasonography and molecular testing can be used to assess risk of malignant neoplasm. Objective To examine whether a model developed through automated machine learning can stratify thyroid nodules as high or low genetic risk by ultrasonography imaging alone compared with stratification by molecular testing for high- and low-risk mutations. Design, Setting, and Participants This diagnostic study was conducted at a single tertiary care urban academic institution and included patients (n = 121) who underwent ultrasonography and molecular testing for thyroid nodules from January 1, 2017, through August 1, 2018. Nodules were classified as high risk or low risk on the basis of results of an institutional molecular testing panel for thyroid risk genes. All thyroid nodules that underwent genetic sequencing for cytological results with Bethesda System categories III and IV were reviewed. Patients without diagnostic ultrasonographic images within 6 months of fine-needle aspiration or who received definitive treatment at an outside medical center were excluded. Main Outcomes and Measures Thyroid nodules were categorized by the model as high risk or low risk using ultrasonographic images. Results were compared using genetic testing. Results Among the 134 lesions identified in 121 patients (mean [SD] age, 55.7 [14.2] years; 102 women [84.3%]), 683 diagnostic ultrasonographic images were selected. Of the 683 images, 556 (81.4%) were used for training the model, 74 (10.8%) for validation, and 53 (7.8%) for testing. Most nodules had no mutation (75 [56.0%]), whereas 43 nodules (32.1%) had a high-risk mutation and 16 (11.9%) had an unknown or a low-risk mutation (χ2 = 39.060; P < .001). In total, 228 images (33.4%) were of nodules classified as genetically high risk (n = 43), and 455 (66.6%) were of low-risk nodules (n = 91). The model performed with a sensitivity of 45% (95% CI, 23.1%-68.5%), a specificity of 97% (95% CI, 84.2%-99.9%), a positive predictive value of 90% (95% CI, 55.2%-98.5%), a negative predictive value of 74.4% (95% CI, 66.1%-81.3%), and an overall accuracy of 77.4% (95% CI, 63.8%-97.7%). Conclusions and Relevance The study found that the model developed through automated machine learning could produce high specificity for identifying nodules with high-risk mutations on molecular testing. This finding shows promise for the diagnostic applications of machine learning interpretation of sonographic imaging of indeterminate thyroid nodules.
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Affiliation(s)
- Kelly Daniels
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sriharsha Gummadi
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.,Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Ziyin Zhu
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuo Wang
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jena Patel
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Brian Swendseid
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joseph Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elizabeth Cottrill
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Jin H, Fan J, Lu L, Cui M. A Propensity Score Matching Study Between Microwave Ablation and Radiofrequency Ablation in Terms of Safety and Efficacy for Benign Thyroid Nodules Treatment. Front Endocrinol (Lausanne) 2021; 12:584972. [PMID: 33767666 PMCID: PMC7985541 DOI: 10.3389/fendo.2021.584972] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/25/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Large benign thyroid nodules often lead to cosmetic problems and compression on trachea. Thermal ablation is an effective method for benign thyroid nodules treatment. Among all the thermal ablation techniques, microwave and radiofrequency are frequently used energy sources. However, treatment outcomes of the two ablation types have not been compared in detail. Therefore, we conducted this study aiming for comparing the safety and efficacy of the two ablation techniques in benign thyroid nodules treatment. METHODS Information was retrospectively collected from patients with benign thyroid nodules, who received radiofrequency ablation or microwave ablation between January 1, 2018, and December 31, 2019, in a main hospital in South China. Patients were divided into microwave ablation group and radiofrequency ablation group according to the techniques applied. A propensity score matching was performed to balance the baseline indexes between the two groups. We also recorded and analyzed the operative variables including operative duration, intraoperative blood loss, hospitalization time, and overall costs. Postoperative quality of life, volume reduction rates, and complication rates were routinely evaluated during the follow-up by asking patients to fulfil questionnaires at the 1st, 3rd, 6th, 12th, and 18th postoperative month. RESULTS A total of 943 patients receiving microwave ablation or radiofrequency ablation in the years of 2018 and 2019 met our inclusion criteria. After 1:1 propensity score matching, 289 pairs of patients were matched. There was no significant difference between the two groups in operative duration, intraoperative blood loss, hospitalization time, overall cost, quality of life scores, complication rates or volume reduction rates. CONCLUSION There was no significant difference between microwave and radiofrequency ablation in terms of safety and efficacy. Both of the two techniques` are ideal therapeutic methods in benign thyroid nodules treatment. REGISTRATION NUMBER ChiCTR2000034764.
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Affiliation(s)
- Hao Jin
- The Second Department of General Surgery, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Jinrui Fan
- The Second Department of General Surgery, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Ligong Lu
- Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
- *Correspondence: Ligong Lu, ; Min Cui,
| | - Min Cui
- Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
- *Correspondence: Ligong Lu, ; Min Cui,
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Duman G, Sariakcali B. Thyroid Nodules Located in the Lower Pole Have a Higher Risk of Malignancy than Located in the Isthmus: A Single-Center Experience. Int J Endocrinol 2021; 2021:9940995. [PMID: 34335749 PMCID: PMC8298157 DOI: 10.1155/2021/9940995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/09/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of our study is to investigate whether thyroid nodules (TNs) localization has value as a predictor of malignancy. Ultrasonography provides very valuable information in the evaluation of TNs, but it does not correlate perfectly with histopathologic findings. Therefore, studies that will include new diagnostic methods that can improve these unknowns can be welcomed gratefully. METHODS This study was carried out retrospectively in a tertiary care center from September 2016 to January 2020. The study included 862 adult patients who have one or more nodules. Ultrasonography of characteristics of nodules such as echogenicity, content, margins, calcifications, size, and localization was recorded. Fine-needle aspiration biopsy (FNAB) was performed on dominant and suspicious 1142 nodules. RESULTS The patients were composed of 692 (80.3%) females and 170 (19.7%) males. Compared to nodules located in the isthmus; the malignancy risk increased 8.39 (OR: 8.39 (2.34-30.12), p = 0.001) times in the lower pole, 4.27 (OR: 4.27 (1.16-15.72), p = 0.029), times in the middle pole, 8.09 (OR: 8.09 (2.11-30.94), p = 0.002) times in the upper pole, and 7.63 (OR: 7.63 (1.95-29.81), p = 0.003) times in the nodules covering the whole of the lobe. Although the most nodular location was in the middle pole, the risk of malignancy was less than that in the lower and upper poles. CONCLUSIONS Unlike the other localization studies, we found a higher risk of malignancy in the lower and similarly upper thyroid poles. Besides well-defined malignancy indicators in the literature and guidelines, localization information is promising for this purpose in the future.
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Affiliation(s)
- Gulhan Duman
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Sivas Cumhuriyet University, Sivas 58140, Turkey
| | - Baris Sariakcali
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Sivas Cumhuriyet University, Sivas 58140, Turkey
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Wang Z, Zhu X, Yu X, Guan H, Zhao L, Zhang Y, Li Y, Sang L, Han Y, Li Y, Shan Z, Teng W. The combination of ATA classification and FNA results can improve the diagnostic efficiency of malignant thyroid nodules. Endocr Connect 2020; 9:903-911. [PMID: 32810845 PMCID: PMC7583133 DOI: 10.1530/ec-20-0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE To determine the diagnostic efficiency of the ATA classification and ultrasound-guided fine-needle aspiration (FNA) results in identifying the risk factors of malignancy, we analyzed the thyroid nodules of patients who underwent thyroidectomy and compared preoperative ATA classifications with FNA results. METHODS We retrospectively analyzed 274 nodules of 196 patients who underwent ultrasonography, FNA and thyroidectomy. Histopathological findings of thyroid nodules were considered as the Au standard in the analysis of the diagnostic efficiency of the ATA classification and FNA results. Univariate analysis and binary multivariate logistic regression analysis were applied to identify the ultrasound features associated with malignancy. RESULTS The overall malignancy rate of 274 nodules was 41.6%. The areas under the ROC curves (AUCs) for the ATA classification and FNA results were 0.88 and 0.878, respectively (P < 0.001). The sensitivity and specificity of the ATA classification were 86 and 86.9%, whereas those of FNA results were 68.5 and 91.4%, respectively. The specificity (98.7%) and sensitivity (94.3%) increased after the combined use of the ATA classification and FNA results. Taller-than-wide shape, microcalcifications, hypoechogenicity and irregular margins were independent risk factors for malignancy. Microcalcifications had the highest OR (7.58), and taller-than-wide shape had the highest specificity in BSRTC I, II, III and IV cytology. CONCLUSION The diagnostic efficiency of the ATA classification and FNA results in identifying malignant nodules was high, and the use of both criteria improved the diagnostic accuracy. Taller-than-wide shape, microcalcifications, hypoechogenicity and irregular margins were independent risk factors for malignancy.
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Affiliation(s)
- Zhenzhen Wang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiangying Zhu
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaohui Yu
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Haixia Guan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Lei Zhao
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yixia Zhang
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yuge Li
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Liang Sang
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yuchen Han
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yushu Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
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Kim E, Pudhucode R, Chen H, Lindeman B. Discordance Between the American Thyroid Association and the American College of Radiology Guideline Systems for Thyroid Nodule Biopsy. J Surg Res 2020; 255:469-474. [PMID: 32622161 DOI: 10.1016/j.jss.2020.05.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Previously, fine-needle aspiration biopsy was recommended for any thyroid nodule >1.0 cm in size. In 2015, the American Thyroid Association (ATA) introduced a pattern-based approach for biopsy recommendations based on size and ultrasound (US) characteristics. In 2016, the American College of Radiology (ACR) published the Thyroid Imaging Reporting and Data System, using a point-based system that assesses risk of US characteristics. METHODS This study aims to compare recommendations for thyroid nodule biopsy between the ATA and ACR systems and identify outcomes of nodules with discordant recommendations (DRs). US characteristics, fine-needle aspiration biopsy, and surgical pathology results were evaluated for all patients with >1.0 cm thyroid nodules treated at a single tertiary-care institution from 2010 to 2018. RESULTS Inclusion criteria were met by 1100 nodules from 687 patients; 42.8% (n = 471) had DR between the ATA and ACR guidelines. All (100%) DR nodules were not recommended for biopsy by ACR, though 53% were recommended to have follow-up. A majority (79%) of DR nodules were recommended for biopsy by ATA, with the remaining 21% recommended for follow-up. Among surgically excised DR nodules (n = 292), 10.3% (n = 30) nodules were found to be malignant, with the vast majority (90.3%) being well-differentiated carcinoma. Among malignant nodules, the ACR would not have recommended biopsy or follow-up for 26.7% (n = 8). CONCLUSIONS The ACR classification system is more restrictive compared with the ATA system for recommending thyroid nodule biopsy. This discrepancy could result in confusion for clinicians and delay in diagnosis or therapy for patients with thyroid cancer.
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Affiliation(s)
- Eric Kim
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Herbert Chen
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brenessa Lindeman
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
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Al-Sharafi BA, AlSanabani JA, Alboany IM, Shamsher AM. Thyroid cancer among patients with thyroid nodules in Yemen: a three-year retrospective study in a tertiary center and a specialty clinic. Thyroid Res 2020; 13:8. [PMID: 32518593 PMCID: PMC7275581 DOI: 10.1186/s13044-020-00082-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022] Open
Abstract
Background The prevalence of thyroid cancer is increasing worldwide. No previous data are available on the prevalence of thyroid cancer in Yemen. We performed this study to determine the prevalence of thyroid cancer among patients with thyroid nodules in Yemen. Methods A retrospective chart review was performed for 550 patients with thyroid nodules who underwent fine needle aspiration and/or thyroid surgery at a private endocrine clinic and at an endocrine clinic in a tertiary hospital in Yemen over a 3 -year period from October 2016–2019. The prevalence of thyroid cancer; the sonographic findings, Bethesda classification, age, sex, thyroid stimulating hormone (TSH) levels of the patients; and the nodule size and number were reviewed. Results A total of 550 charts were reviewed [501 females (91.1%) and 49 males (8.9%)]. The thyroid cancer prevalence among the patients was 13.8% (CI = 10.9–16.7), and the mean age of the patients was 38.5 years (SD = 12.2). The TSH level and the rate of cancer were significantly related (P = 0.01), but no significant difference in the prevalence of thyroid cancer was found between females (13.4%) and males (18.4%) (P = 0.334). When correlating the rate of cancer with the ultrasound guided fine needle aspiration (UG-FNA) result, those with Bethesda system category III and IV, V and VI had malignancy rates of 20.8, 27.2, 52.4 and 69.2%, respectively. Thyroid nodules highly suspicious for malignancy on ultrasound had a 70% cancer diagnosis rate. The most common thyroid cancer was papillary cancer (71%), followed by follicular cancer (23.7%). Among those undergoing surgery, 44.2% had thyroid cancer, and 5.2% had a premalignant diagnosis. Conclusion Thyroid cancer has a higher prevalence in Yemen than in other middle eastern countries. Our study also reports a higher rate of follicular thyroid cancer than that in other published data, which has to be confirmed by further studies. The malignancy and premalignant diagnosis rate was ~ 50% in our patients who underwent surgery. Many centers in Yemen still do not perform FNA before thyroid surgery. It is important that other centers in the country start emphasizing the need for FNA before surgery. This will decrease the number of unnecessary surgeries and associated complications.
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Affiliation(s)
| | | | - Ibraheem M Alboany
- Department of Radiology, University of Science and Technology, Sana'a, Yemen
| | - Amani M Shamsher
- Department of Pathology, University of Science and Technology Hospital, Sana'a, Yemen
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 281] [Impact Index Per Article: 56.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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Chung SR, Baek JH, Choi YJ, Sung TY, Song DE, Kim TY, Lee JH. The relationship of thyroid nodule size on malignancy risk according to histological type of thyroid cancer. Acta Radiol 2020; 61:620-628. [PMID: 31554409 DOI: 10.1177/0284185119875642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Although several studies have examined the value of thyroid nodule size as a malignancy predictor, the results are conflicting. Purpose To investigate the relationship between nodule size and malignancy risk and to evaluate the impact of nodule size on the false-negative rate of fine needle aspiration or core needle biopsy according to the histological type of thyroid cancer. Material and Methods From January 2013 to December 2013, 3970 thyroid nodules that underwent ultrasound-guided fine needle aspiration or core needle biopsy were retrospectively reviewed. We assessed the relationship between nodule size and malignancy risk according to histological type of thyroid cancer. In addition, we compared the false-negative rate by thyroid nodule size category. Results Of 3970 thyroid nodules, 1170 nodules were malignant. For papillary thyroid carcinoma, nodule size was inversely related to malignancy risk, whereas in nodules of follicular carcinoma and follicular variant papillary thyroid carcinoma, nodule size was positively related to malignancy risk ( P < 0.001). The false-negative rate tended to increase as nodule size increased ( P = 0.002) for all nodules and the overall false-negative rate was 2.3%. Conclusion Overall, nodule size does not correlate with risk of malignancy, but the relationship between nodule size and malignancy risk depends on the histological type of thyroid cancer.
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Affiliation(s)
- Sae Rom Chung
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Tae-Yon Sung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Tae Yong Kim
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Cawood TJ, Mackay GR, Hunt PJ, O'Shea D, Skehan S, Ma Y. TIRADS Management Guidelines in the Investigation of Thyroid Nodules; Illustrating the Concerns, Costs, and Performance. J Endocr Soc 2020; 4:bvaa031. [PMID: 32285020 PMCID: PMC7138277 DOI: 10.1210/jendso/bvaa031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/03/2020] [Indexed: 01/21/2023] Open
Abstract
Context Ultrasound (US) risk-stratification systems for investigation of thyroid nodules may not be as useful as anticipated. Objective We aimed to assess the performance and costs of the American College of Radiology Thyroid Image Reporting And Data System (ACR-TIRADS). Design, Settings and Participants We examined the data set upon which ACR-TIRADS was developed, and applied TR1 or TR2 as a rule-out test, TR5 as a rule-in test, or applied ACR-TIRADS across all nodule categories. We assessed a hypothetical clinical comparator where 1 in 10 nodules are randomly selected for fine needle aspiration (FNA), assuming a pretest probability of clinically important thyroid cancer of 5%. Results The gender bias (92% female) and cancer prevalence (10%) of the data set suggests it may not accurately reflect the intended test population. Applying ACR-TIRADS across all nodule categories did not perform well, with sensitivity and specificity between 60% and 80% and overall accuracy worse than random selection (65% vs 85%). Test performance in the TR3 and TR4 categories had an accuracy of less than 60%. Using TR5 as a rule-in test was similar to random selection (specificity 89% vs 90%). Using TR1 and TR2 as a rule-out test had excellent sensitivity (97%), but for every additional person that ACR-TIRADS correctly reassures, this requires >100 ultrasound scans, resulting in 6 unnecessary operations and significant financial cost. Conclusions Perhaps surprisingly, the performance ACR-TIRADS may often be no better than random selection. The management guidelines may be difficult to justify from a cost/benefit perspective. A prospective validation study that determines the true performance of TIRADS in the real-world is needed.
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Affiliation(s)
- Tom James Cawood
- Department of Endocrinology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Georgia Rose Mackay
- University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Penny Jane Hunt
- Department of Endocrinology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.,University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Donal O'Shea
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
| | - Stephen Skehan
- Department of Radiology, St Vincent's University Hospital, Dublin 4 and University College Dublin, Ireland
| | - Yi Ma
- Biostatistician, Department of Medical & Women's Business Management, Canterbury District Health Board, Christchurch, New Zealand
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Al-Hakami HA, Alqahtani R, Alahmadi A, Almutairi D, Algarni M, Alandejani T. Thyroid Nodule Size and Prediction of Cancer: A Study at Tertiary Care Hospital in Saudi Arabia. Cureus 2020; 12:e7478. [PMID: 32351856 PMCID: PMC7188016 DOI: 10.7759/cureus.7478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Thyroid noduleshave become relatively common in clinical practice,and their prevalence increases with age. The majority of thyroid nodules are benign, with 5-15% being malignant. There are a number of well-established predictors of malignancy in thyroid nodules, but thyroid nodule size has been a cause for concern for many researchers and results of the studies are still controversial about their probability of malignancy. Up to the current knowledge, there is no published study that evaluates if thyroid nodule size is associated with the risk of malignancy in Saudi Arabia, so in this study, we aim to find that. Methods This is a retrospective study of 987 patients who underwent thyroid nodule fine-needle aspiration (FNA) and subsequent thyroidectomy for thyroid nodules measuring ≥ 1 cm. Results Thyroid cancer was more prevalent in males than females, and in patients who were older than or equal to 45 years. Nodular size of 1 - 1.9 cm was more prevalent among cancer patients than in benign cases (p<0.001). Conclusions The highest malignancy risk was observed in nodules <2 cm and no increase in malignancy risk for nodules >2 cm. Nevertheless, when examined by type of thyroid malignancy, the rate of follicular carcinoma and other rare malignancy increased with increasing nodule size.
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Affiliation(s)
- Hadi Afandi Al-Hakami
- Otolaryngology, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Raneem Alqahtani
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | | | - Dakheelallah Almutairi
- Otolaryngology, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Mohammed Algarni
- Otolaryngology, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, SAU
| | - Talal Alandejani
- Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.,Otolaryngology, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Sipos JA. The Thyroid Nodule Conundrum: Evaluate or Leave it Alone? J Clin Endocrinol Metab 2020; 105:5607891. [PMID: 31665335 DOI: 10.1210/clinem/dgz124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/18/2019] [Indexed: 02/13/2023]
Affiliation(s)
- Jennifer A Sipos
- Division of Endocrinology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Suh J, Choi HS, Kwon A, Chae HW, Kim HS. Adolescents with thyroid nodules: retrospective analysis of factors predicting malignancy. Eur J Pediatr 2020; 179:317-325. [PMID: 31741093 DOI: 10.1007/s00431-019-03507-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 01/10/2023]
Abstract
Thyroid nodules are less common in children than in adults. However, pediatric thyroid nodules have a higher rate of malignancy compared to those in adults, and increased risk of metastasis and recurrence. In the present study, we analyzed the clinical features as well as laboratory and thyroid ultrasound (US) findings of children and adolescents with thyroid nodules to identify predictive factors of thyroid cancer. We retrospectively analyzed 275 patients with thyroid nodules under 18 years of age who visited Severance Children's Hospital between January 2005 and May 2017. Among them, 141 patients who underwent ultrasonography-guided fine needle aspiration biopsy (FNAB), and four patients without FNAB who underwent surgical resection, were included in this study. The remaining 125 patients without FNAB and five patients with follow-up loss after FNAB were excluded. Clinical, laboratory, and US data were evaluated in 145 patients to establish the potential predictive factors of thyroid cancer. Thyroid malignancies were observed in 101 patients. Grade 2 goiters were seen more often in benign nodule group. Hypoechoic nodules, nodules with microcalcifications, abnormal lymph nodes, and irregular margins were findings significantly associated with thyroid cancer. The findings of hypoechoic nodule, nodule with microcalcifications, and abnormal lymph nodes showed statistical significance in predicting thyroid cancer.Conclusion: Hypoechoic nodules, nodules with microcalcifications, and abnormal lymph nodes are predictive factors for thyroid cancer in children. Therefore, further diagnostic evaluations, including FNAB, should be considered in patients with such findings.What is Known:• Thyroid nodules are less common in children than in adults, but pediatric thyroid nodules have a higher rate of malignancy, and also have increased risk of metastasis and recurrence.• Research on ways to predict thyroid cancer have mostly been accomplished in adult patients, and the application of risk stratification system has not been fully satisfactory in children, which requires further studies in pediatric thyroid nodules.What is New:• Hypoechoic nodules, nodules with microcalcifications, and abnormal lymph nodes are predictive factors for thyroid cancer in Korean children.
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Affiliation(s)
- Junghwan Suh
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Han Saem Choi
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
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Jinih M, Faisal F, Abdalla K, Majeed M, Achakzai AA, Heffron C, McCarthy J, Redmond HP. Association between thyroid nodule size and malignancy rate. Ann R Coll Surg Engl 2020; 102:43-48. [PMID: 31865760 PMCID: PMC6937614 DOI: 10.1308/rcsann.2019.0156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2019] [Indexed: 01/21/2023] Open
Abstract
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.
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Affiliation(s)
- M Jinih
- Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - F Faisal
- School of Medicine, University College Cork, Cork, Ireland
| | - K Abdalla
- Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - M Majeed
- Department of ENDOCRINE SURGERY, Cork University Hospital, Wilton, Cork, Ireland
| | - AA Achakzai
- Department of ENDOCRINE SURGERY, Cork University Hospital, Wilton, Cork, Ireland
| | - C Heffron
- Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland
| | - J McCarthy
- Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland
| | - HP Redmond
- Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland
- Department of ENDOCRINE SURGERY, Cork University Hospital, Wilton, Cork, Ireland
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48
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Fradin JM. ACR TI-RADS: An advance in the management of thyroid nodules or Pandora's box of surveillance? JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:3-6. [PMID: 31418860 DOI: 10.1002/jcu.22772] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/28/2019] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
Numerous sets of guidelines have been proposed regarding ultrasound of thyroid nodules. None has been universally accepted. American College of Radiology-Thyroid Imaging, Reporting and Data System (ACR-TIRADS) has been promoted as an improvement to existing guidelines such as the 2015 revised American Thyroid Association (ATA) guidelines. This commentary compares and contrasts these two guidelines. Adoption of TI-RADS is likely to result in large-scale, costly surveillance without clear benefit. Replacement of 2015 revised ATA guidelines by TI-RADS is not justified. The shortcomings that exist in the ATA guidelines can be addressed as described in this commentary.
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Affiliation(s)
- Joel M Fradin
- Imaging Department, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
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49
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Clinical and Ultrasound Thyroid Nodule Characteristics and Their Association with Cytological and Histopathological Outcomes: A Retrospective Multicenter Study in High-Resolution Thyroid Nodule Clinics. J Clin Med 2019; 8:jcm8122172. [PMID: 31818026 PMCID: PMC6947274 DOI: 10.3390/jcm8122172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Thyroid nodules are a common finding. A high-resolution thyroid nodule clinic (HR-TNC) condenses all tests required for the evaluation of thyroid nodules into a single appointment. We aimed to evaluate the clinical outcomes at HR-TNCs. DESIGN AND METHODS A retrospective cross-sectional multicenter study including data from four HR-TNCs in Spain. We evaluated fine-needle aspiration (FNA) indications and the association between clinical and ultrasound characteristics with cytological and histopathological outcomes. RESULTS A total of 2809 thyroid nodules were included; FNA was performed in 82.1%. Thyroid nodules that underwent FNA were more likely larger, isoechoic, with microcalcifications, and in younger subjects. The rate of nondiagnostic FNA was 4.3%. A solid component, irregular margins or microcalcifications, significantly increased the odds of Bethesda IV-V-VI (vs. Bethesda II). Irregular margins and a solid component were independently associated with increased odds of malignancy. Thyroid nodules <20 mm and ≥20-<40 mm had a 6.5-fold and 3.3-fold increased risk for malignancy respectively in comparison with those ≥40 mm. CONCLUSION In this large multicenter study, we found that the presence of a solid component and irregular margins are factors independently related to malignancy in thyroid nodules. Since nodule size ≥40 mm was associated with the lowest odds of malignancy, this cut-off should not be a factor leading to indicate thyroid surgery. HR-TNCs were associated with a low rate of nondiagnostic FNA.
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50
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Ma JM, Wu LF, Hu JS, Zhu ZW, Li GZ, Li GQ, Sun B, Wang G. Evaluation of surgical risk and prognosis between thyroid nodules of size <1 and ≥1 cm. Gland Surg 2019; 8:674-682. [PMID: 32042675 DOI: 10.21037/gs.2019.11.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background The objective of this study was to evaluate the surgical risk and prognosis between thyroid nodules of size <1 and ≥1 cm and to explore whether it is reasonable generally to ignore the diagnosis and treatment of thyroid nodules and thyroid carcinoma <1 cm in wide areas of China. Methods A retrospective observational study included all first-time thyroid surgery patients between January 2005 and December 2016 of the First Affiliated Hospital of Harbin Medical University. All patients were divided into two groups (group A: <1 cm, group B: ≥1 cm) according to the maximum diameter of the nodules and demographics, surgery procedure, pathology, postoperative complications, morbidity, and mortality were analyzed. Results A total of 6,317 patients were reviewed and 3,424 (54.20%) of them were malignant; 2,128 patients in group A and 4,189 in group B. Patients in group A had better pathological diagnosis, inferior extent of lymph node metastasis, less surgical complexity, fewer postoperative complications, and longer disease-free survival (DFS). Conclusions Thyroid operations were safer and involved fewer postoperative complications when thyroid nodules were <1 cm and patients who were diagnosed with malignant thyroid disease had superior prognoses. Underdeveloped regions of China should diagnose and treat thyroid nodules <1 cm early.
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Affiliation(s)
- Jia-Min Ma
- Ward Two of Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Lin-Feng Wu
- Ward Two of Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Ji-Sheng Hu
- Ward Two of Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Zong-Wen Zhu
- Ward Two of Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Guang-Zhou Li
- Ward Two of Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Guo-Qing Li
- Ward Two of Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Bei Sun
- Ward Two of Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Gang Wang
- Ward Two of Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
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