Thyroid Nodule with Benign Cytology: Is Clinical Follow-Up Enough?

Choi, Yoon Jung; Jung, Inkyung; Min, Sung Ji; Kim, Hye Jung; Kim, Ji-Hoon; Kim, Soojin; Park, Jeong Seon; Shin, Jung Hee; Sohn, Yu‐Mee; Yoon, Jung Hyun; Kwak, Jin Young

doi:10.1371/journal.pone.0063834

Cited by 21 publications

(14 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, a very high cancer rate (32 %) was found. This finding was perfectly in agreement with that previous reported by papers analyzing the likelihood for malignancy in these specific nodules [46][47][48]. More recently, CNB or conventional FNAC was proposed to patients with newly discovered at risk thyroid lesions [24]; the diagnostic accuracy of CNB was significantly higher than that of FNAC [24].…”

Section: Use Of Cnb In Thyroid Neoplasms (Thy 3/class 3/category Iii-supporting

confidence: 91%

Thyroid core needle biopsy: taking stock of the situation

Trimboli

Crescenzi²

2014

Endocrine

View full text Add to dashboard Cite

Recently, the microhistologic evaluation by core needle biopsy (CNB) has been reported as high accurate to diagnose thyroid nodules with previous indeterminate or not adequate fine-needle aspiration cytology. In addition, sparse data have been reported regarding the use of CNB in other conditions. Aim of this review was to furnish the state of the art of this topic by summarizing published data about the diagnostic performance of CNB in thyroid lesions, and provide an easy to use reference for clinical practice. Sources encompass studies published through May 2014. Original articles were investigated and following specific aspects were discussed: 1. The "large" needle biopsy in 90's; 2. Complications by and patient's comfort with thyroid CNB; 3. Advantages provided by examination of a microhistologic sample of thyroid nodule; 4. Use of CNB in thyroid nodules with previous not adequate (Thy 1/Class 1/Category I) cytology; 5. Use of CNB in thyroid neoplasms (Thy 3/Class 3/Category III-IV) cytology; 6. Use of CNB in specific ultrasonographic presentations of thyroid nodules or in patients with peculiar clinical contexts; 7. First-line approach by CNB in thyroid nodules; 8. Immunohistochemistry and molecular tests on CNB samples; and 9. Future perspective.

show abstract

Section: Use Of Cnb In Thyroid Neoplasms (Thy 3/class 3/category Iii-supporting

confidence: 91%

Thyroid core needle biopsy: taking stock of the situation

Trimboli

Crescenzi²

2014

Endocrine

View full text Add to dashboard Cite

show abstract

“…The 15.8 % rate of malignancy identified in our specific series is substantially higher than that predicted by Bethesda and ATA guidelines for benign USFNAs. Yet, it is consistent with the higher rates reported throughout literature, reaching values as high as 24.2 % [ 2 , 5 , 10 – 12 ]. This wide range may be explained in part by variations in technique, expertise and subjective interpreting differences between pathologists reading the slides and physicians performing ultrasounds and USFNAs in different institutions.…”

Section: Discussionsupporting

confidence: 92%

The McGill Thyroid Nodule Score’s (MTNS+) role in the investigation of thyroid nodules with benign ultrasound guided fine needle aspiration biopsies: a retrospective review

Khalifé

Bouhabel

Forest

et al. 2016

J of Otolaryngol - Head & Neck Surg

View full text Add to dashboard Cite

BackgroundUltrasound guided fine needle aspiration (USFNA) biopsies of thyroid nodules sometimes create a decision-making dilemma for surgeons as they may yield falsely benign results. The McGill Thyroid Nodule Score + (MTNS+) was developed to aid in clinical guidance regarding the management of patients with these USFNA results. The aim of this study was to assess the MTNS+ as a clinical tool in patients with benign preoperative thyroid nodule USFNAs and to analyze the relationship between nodule size and malignancy in these patients.MethodsWe conducted a retrospective chart review of 1312 patients who underwent thyroidectomies between 2010 and 2015 at the McGill University Teaching Hospitals. Patients with Bethesda II (benign) USFNA results, calculated MTNS+, and nodule size evaluated on ultrasound were included in the study. The false-negative rate was calculated, and MTNS+ and nodule size were each compared to final pathology results. Binary logistic regression was used for statistical analysis.ResultsOf the 1312 patients, 101 met the inclusion criteria and together had an average MTNS+ score of 6.83, which corresponds to a predicted malignancy rate between 25 and 33 %. Final pathology revealed malignancy in 16 (15.8 %) subjects. The average MTNS+ of patients with malignant nodules on surgical pathology was 8.25, while that of patients with benign nodules was 6.56.Patients with nodule size 1–1.9 cm (a) and 2–2.9 cm (b) each had an equal rate of malignancy of 2.97 % (n = 3), nodule size 3–3.9 cm (c) had a rate of 1.98 % (n = 2), and nodule size ≥4 cm (d) a rate of 7.92 % (n = 8).ConclusionThe rate of malignancy (15.8 %) is higher than expected when reviewing the risk of malignancy in nodules considered as Bethesda class 2. On the other hand, the rate is lower than the 25–33 % predicted by the MTNS+. We also found a higher malignancy rate for nodules above 4 cm in size, but size was a poor predictor of malignancy when used alone. Therefore, while the MTNS+ may be helpful at helping to identify USFNAs that are incorrectly classified as benign, the percentage risk of malignancy is lower than expected.

show abstract

“…A study by Rosário and Purisch consisting of 895 nodules put in evidence that the repetition of FNA is useful in detecting false-negative cases, when the nodule shows characteristics of malignancy at ultrasound rather than when it grows [ 12 ]. This concept was more recently confirmed by a multicentre study stating that evaluating 700 nodules initially diagnosed as benign showed that false-negative results were found in 1–3% of cases (depending on the centre) and that the likelihood of a cytologically benign nodule with suspicious US characteristics being malignant was higher than that of one without suspicious US (4.7% versus 0.8%; P < 0.05) [ 13 ]. The same low rate of false-negative FNA was demonstrated by the studies by Torre and Oertel, while we have to be reminded that, in about 2/3 of cases, false-negative results pertain to nodules larger than 30 mm [ 14 – 16 ].…”

Section: Discussionmentioning

confidence: 95%

What Happens in a 5-Year Follow-Up of Benign Thyroid Nodules

Negro

2014

Journal of Thyroid Research

View full text Add to dashboard Cite

To determine an optimal time for follow-up of benign thyroid nodules, we retrospectively evaluated 249 euthyroid patients with uni-multinodular goiter, who underwent annual visit, and significant events that occurred in 5 years' time were registered. A significant event (appearance of new nodule, increase of nodule diameter >50%, appearance of compressive symptoms, thyroidectomy, repetition of FNA on the same nodule, and execution of FNA on new nodule) occurred in 26.1% of patients, with more than one event occurring in the same patient in 27.7% of cases. The majority of events (71.9%) were observed at 24- and 36-month follow-up visit. These results suggest that a patient diagnosed with benign nodular goiter may be safely followed-up at a 2-3-year interval time.

show abstract

Thyroid Nodule with Benign Cytology: Is Clinical Follow-Up Enough?

Cited by 21 publications

References 34 publications

Thyroid core needle biopsy: taking stock of the situation

Thyroid core needle biopsy: taking stock of the situation

The McGill Thyroid Nodule Score’s (MTNS+) role in the investigation of thyroid nodules with benign ultrasound guided fine needle aspiration biopsies: a retrospective review

What Happens in a 5-Year Follow-Up of Benign Thyroid Nodules

Contact Info

Product

Resources

About