Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Li, Fu; Pan, Denghua; Wu, Yuquan; Peng, Jiao; Li, Qing; Gui, Xiaolong; Ma, Wei; Yang, Hong; He, Yun; Chen, Junqiang

doi:10.1002/dc.24248

Cited by 16 publications

(14 citation statements)

References 51 publications

(100 reference statements)

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“…In a study supporting our result, the frequency of benign nodules with large sizes was found to be significantly higher. [ 30 ] In a meta-analysis study in which the USG features of thyroid nodules (14 criteria) were reviewed, it was reported that internal calcification was a high level of evidence for malignancy (especially for PC) and cystic-spongioform structure for benignity. It has been suggested that other USG features are low-to-moderate evidence and that nodule size does not have a precise predictive value in all BCs.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of clinical-radiological-pathological factors in FN / SFN Bethesda category thyroid nodules, contribution of FNAB repeat, single center experience

et al. 2021

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Objectives: Follicular neoplasm/suspected follicular neoplasm (FN/FNS) Bethesda Category (BC)-4 group cases are known as the gray zone. Nodules diagnosed in cytology are excised. However, very few of these nodules are malignant. Our aim is to investigate the usability of clinical-radiological-pathological parameters to reduce unnecessary surgery. In addition, we questioned the benefit of repeating fine-needle aspiration biopsy (rFNAB) in these nodules, which is not recommended, but performed for clinical or patient-related reasons. Methods: The files of all thyroid FNAB patients conducted in our institution between January 2014 and September 2020 were scanned in the database. In our study, 185 (5.1%) nodules with cytology results of which were classified as FN/FNS were identified among 3624 nodules that were applied FNAB during this period. Twenty-eight patients were excluded from the study group. 157 nodules belonging to 157 patients between the ages of 21 and 82 years who were operated and met the study criteria were identified from patients with these nodules. The files of all patients were scanned and the results of age, gender, ultrasonographic nodule characteristics, FNAB repeat, type of surgery, and postoperative pathology were recorded. All data were analyzed by comparing them with nodule features. SPSS 15.0 for Windows program was used for statistical analysis. Results: A significant correlation was found between the incidence of malignancy and male gender and hypervascularization (p=0.017 and p=0.002, respectively). Malignancy was less in nodules larger than 2 cm (p=0.014). There was no relationship between other clinical and radiological features and malignancy. In 29 nodules with rFNAB, a significant correlation was found between malignancy and advanced age (52.9-years-old), presence of nodules smaller than 2 cm and hypervascularization (p=0.047, p=0.047, and p=0.030, respectively). Conclusion: We recommend careful review of patients with hypervascular, hypoechogenic, and microcalcific BC-4 nodules (male gender and older patients at greater risk). Because of the serious risk of malignancy, patients with these features should be prepared for patient management with total thyroidectomy after examination with frozen section applied to the nodule during the operation.

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Section: Discussionmentioning

confidence: 99%

“…The authors based their recommendations on the idea that rFNAB is not effective in detecting FC and poorly differentiated carcinomas. [ 30 ] In a study evaluating multiple FNAB repeats in BC-4 nodules, 90 nodules were examined. In the 2 nd FNAB, 53 of these were again determined as BC-4.…”

Section: Discussionmentioning

confidence: 99%

Analysis of clinical-radiological-pathological factors in FN / SFN Bethesda category thyroid nodules, contribution of FNAB repeat, single center experience

et al. 2021

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“…Malignancy rate was found to be 54.2% in cases of Bethesda III/ IV class who subsequently underwent surgical intervention. 7 The aim of this study was to investigate which EU-TIRADS groups had no malignancy as a result of FNAB.…”

Section: Introductionmentioning

confidence: 99%

The relationship between thyroid ultrasonography and cytopathology

Arslan¹,

Karasu²,

Keskin³

et al. 2021

Turkish Journal of Internal Medicine

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Background Thyroid fine needle aspiration biopsy (FNAB) is a method performed under ultrasound guidance for diagnosis. The nodule is described according to EU-TIRADS (European Thyroid Imaging and Reporting Data System). FNAB results are classified according to Bethesda system. The aim of this single center retrospective study was to investigate which EU-TIRADS groups had no malignancy based on FNAB results. Material and Methods Ultrasonography and pathology reports of the patients whom FNAB was performed at the State Hospital between January 2016 and December 2018 were reviewed. 251 patients (201 female, 50 male) who were over 18 years of age (mean age 52.62±12.29 years) were included. Distribution of EU-TIRADS categories by Bethesda Classification was shown. Numbers and percentages, means, and standard deviation, minimum and maximum for variables were used for descriptive statistics. The level of significance was set at p<0.05. Results Of the 7 cases in Bethesda group V, which were 'suspicious for papillary carcinoma', 42.9% were in EU-TIRADS-5 and 57.1% were in EU-TIRADS-4. None of the EU-TIRADS-2 were in the Bethesda IV, V and VI groups. EU-TIRADS category 4 and 5 (p=0.003) and Bethesda category V (p=0.008) were significantly higher in the papillary carcinoma diagnosed group as a result of thyroid surgery. Conclusions With larger number of cases, it can be investigated whether it will be considered safe to follow-up the cases in EU-TIRADS-2 group without applying FNAB.

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“…If high-resolution ultrasound (USG) was used, up to 68 % of randomly selected individuals may have nodules -more in women and increasing with age in both sexes [5]. There is a linear increase in the prevalence from almost none at age 15-50 % by the age of 65 years [6]. Thyroid nodules are the clinical manifestation of a myriad of pathologic processes.…”

Section: Introductionmentioning

confidence: 99%

Діагностика, Клінічне Значення Та Лікування Вузлів Щитоподібної Залози

Korsak¹,

Nykytiuk²

2021

Mìžnarodnij endokrinologìčnij žurnal

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A thyroid nodule is a discrete lesion within the thyroid gland that is radiologically distinct from the surrounding thyroid parenchyma. Thyroid nodules are prevalent in up to 68 % of randomly selected individuals in whom high resolution ultrasound is performed. The majority of nodules are benign. Thyroid nodules are the clinical manifestation of a myriad of pathologic processes. The use of ultrasound has dramatically reduced the number of patients who undergo surgery for nodules. Several risk scoring systems have been developed which aim to reduce interobserver variability and allow clinicians to make decisions regarding further workup and follow-up. The most useful of these is the Thyroid Imaging Reporting and Data System (TIRADS) classification. The six tier Bethesda scoring system has reduced variability and increased the ability to clinicians to guide patients with thyroid nodules. There is good correlation between cytology and histopathologic outcomes. A significant proportion of patients will however fall into an indeterminate category. The American Thyroid Association uses a different system based on an estimated risk of malignancy from centers that deal with a high volume of patients with thyroid nodules and malignancy. The availability of molecular markers enhanced with next generation sequencing technology and the expression classifier are added diagnostic aids that can help in management. However, these are not available in many countries and in resource limited settings. A pragmatic approach to the diagnosis of indeterminate nodules includes utilizing pre- and posttest probability, clinical acumen, correlation of ultrasound findings and expert opinion in some settings. Using this approach high risk patients can be appropriately chosen for surgery while relegating patients with lower risk to watchful follow-up.

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Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Cited by 16 publications

References 51 publications

Analysis of clinical-radiological-pathological factors in FN / SFN Bethesda category thyroid nodules, contribution of FNAB repeat, single center experience

Analysis of clinical-radiological-pathological factors in FN / SFN Bethesda category thyroid nodules, contribution of FNAB repeat, single center experience

The relationship between thyroid ultrasonography and cytopathology

Діагностика, Клінічне Значення Та Лікування Вузлів Щитоподібної Залози

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