The surgical approach to nodule Thyr 3-4 after the 2.2014 NCCN and 2015 ATA guidelines

Río, Paolo Del; Pisani, Paola; Montana, Chiara; Cataldo, Simona; Marina, Michela; Ceresini, Graziano

doi:10.1016/j.ijsu.2017.05.014

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…In the case of FN/SFN, while the first recommendation is lobectomy, it is stated that TT may be preferred instead of lobectomy in the presence of malignancyrelated risk factors, such as a family history of TC, nodules larger than 4 cm, presence of other nodules in the contralateral lobe or the presence of associated hyperthyroidism. 1,2,13 Although molecular tests are practical and cost-effective, they may not be easily accessible in countries with limited resources. On the other hand, recurrent FNACs can be very uncomfortable and weary for patients.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of modified systemic inflammation score for prediction of malignancy in patients with indeterminate thyroid nodules

Ataş

Körüklüoğlu

Özdemir

et al. 2021

The American Journal of Surgery

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Background: Approximately 20% of the thyroid biopsies render an indeterminate (ID) cytology. We evaluated the diagnostic value of preoperative modified systemic inflammation score (mSIS) in predicting the malignancy of ID thyroid nodules (TNs). Methods: Data of 162 patients with indeterminate TNs were examined retrospectively. The mSIS was calculated as follows: mSIS 0 [patients with albumin (ALB) ! 4.0 g/dL and lymphocyte-to-monocyte ratio (LMR) ! 3.4], mSIS 1 [ALB < 4.0 g/dL or LMR < 3.4], and mSIS 2 [ALB < 4.0 g/dL and LMR < 3.4]. Results: Patients were classified into mSIS 0 (n ¼ 105), mSIS 1 (n ¼ 34) and mSIS 2 (n ¼ 23) groups. The malignancy rates for the mSIS 0, 1 and 2 groups were 34.3%, 64.7% and 100% respectively. Preoperative mSIS was significantly associated with the presence of thyroid malignancy (p < 0.001). Conclusions: If the mSIS of patients with ID cytology is 1 or 2, appropriate surgical treatment should be performed without delay, due to the increased risk of malignancy.

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Section: Discussionmentioning

confidence: 99%

Diagnostic value of modified systemic inflammation score for prediction of malignancy in patients with indeterminate thyroid nodules

Ataş

Körüklüoğlu

Özdemir

et al. 2021

The American Journal of Surgery

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“…Although lobectomy is first advised in cases with FN/SFN, total thyroidectomy may be recommended over lobectomy if nodules are in the opposite lobes and there are other characteristics that increase the risk of malignancy, such as a history of thyroid malignancy in family and nodules bigger than 4 cm. 1,2,14 Even though molecular testing is useful, it may not always be available.…”

Section: Discussionmentioning

confidence: 99%

Is Modified Systemic Inflammation Score a Predictor of Malignancy in Indeterminate Thyroid Nodules?

Duymaz¹,

Tekın²,

Önder³

et al. 2023

KBB ve BBC Dergisi

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The aim of this study is to evaluate the preoperative diagnostic value of modified systemic inflammation score (mSIS) in predicting the presence of malignancy in patients with indeterminate thyroid nodules. Material and Methods: It is a retrospective study. Three hundred and sixty eight patients who underwent thyroid lobectomy were screened. Patients were divided into 3 groups according to modified SIS; mSIS 0 for those were albumin (alb) ≥ 4.0 gr/dL and lymphocyte monocyte ratio (LMR) ≥ 3.4, mSIS 1 for those were alb<4.0 gr/dL or LMR<3.4, mSIS 2 for those were alb<4.0 gr/dL and LMR<3.4. According to the results of the postoperative pathology, the patients were divided into two groups as benign and malignant. Results: The malignancy was found in 24 patients in histopathological examination. Ten (41.7%) of these were micropapillary, 8 (33.3%) were papillary, and 6 (25%) were follicular carcinomas. There was no difference between the malignant and benign groups in terms of LMR and albumin values. mSIS 0 had a 65% malignancy rate, mSIS 1 69.2%, and mSIS 2 66.6%. There was no statistically significant difference between the groups. Conclusion: MSIS may not be a predictor of malignancy in indeterminate thyroid nodules. Further studies are needed to understand this issue.

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“…From the data of this retrospective study, a strong impact of the 2015 ATA Guidelines emerged on the choice of the surgical approach, with a progressive propensity towards a conservative approach for the treatment of thyroid nodules with indeterminate cytology ( 17 ). We found an increase of lobectomies, from 7.2% to 41.5%, after the introduction of the new guidelines.…”

Section: Discussionmentioning

confidence: 99%

Malignancy risk in Bethesda class IV thyroid nodules in an iodine deficient region

Loderer¹,

Bonati²,

Donato³

et al. 2023

Gland Surg

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Background According to the latest guidelines, in patients with high-risk nodules with indeterminate cytology, diagnostic lobectomy should be the preferable surgical approach in the absence of factors that suggest a total thyroidectomy. Methods This retrospective observational study has as its main aim the evaluation of the cases that underwent surgery, for Bethesda class IV nodules in our iodocarent geographical area. Particular attention was paid to carcinoma incidence, preoperative nodule size, histological characteristics of the neoplasm, surgical approach and eventual need of radiometabolic treatment. A total of 320 patients were included that underwent surgery for Bethesda IV nodules, between January 2010 and December 2020, at the General Surgical Clinic of the University Hospital of Parma, Italy. Results A total of 230 total thyroidectomies (71.9%) and 90 lobectomies (28.1%) were performed. Our data showed a strong impact of the 2015 ATA Guidelines on the surgical approach choice, with a progressive propensity towards a conservative approach and an increase of lobectomies from 7.2% to 41.5% after the new guidelines introduction. However, in our sample the percentage of lobectomies remains below 50%; this data is certainly influenced by the number of cases of multinodular pathology, often bilateral, in our geographical area. The nodules malignancy rate resulted 28.8%. Our data showed that increasing size correlated with an increasing malignancy rate (P<0.01), and follicular carcinomas were found to be larger than papillary carcinomas (P<0.001). A statistically significant correlation also emerged between nodule size increase and local/lymphovascular invasion (P<0.05). On the other hand, there was no statistically significant correlation between nodule size and multifocality, and between nodule size and presence of lymph node metastases. Out of the patients where it was possible to find this data, 66% underwent radioiodiometabolic treatment: 59% with papillary carcinoma, and 85% with follicular carcinoma. Conclusions In patients with Bethesda IV thyroid nodules, diagnostic lobectomy should be the preferable surgical approach in absence of factors that suggest total thyroidectomy. In our opinion, total thyroidectomy remains the first choice in large nodules (≥4 cm) as these nodules have a high malignancy rate, greater local/lymphovascular invasion and a consequent frequent indication for post-operative radiometabolic treatment.

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The surgical approach to nodule Thyr 3-4 after the 2.2014 NCCN and 2015 ATA guidelines

Abstract: The indications to treat related to Thyr 3 and Thyr4 are changed in the two periods. The number of cancer is lower in patients treated with lobectomy. The new guidelines have changed the surgical approach to thyroid nodule.

Cited by 5 publications

References 18 publications

Diagnostic value of modified systemic inflammation score for prediction of malignancy in patients with indeterminate thyroid nodules

Diagnostic value of modified systemic inflammation score for prediction of malignancy in patients with indeterminate thyroid nodules

Is Modified Systemic Inflammation Score a Predictor of Malignancy in Indeterminate Thyroid Nodules?

Malignancy risk in Bethesda class IV thyroid nodules in an iodine deficient region

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