Ultrasound is helpful to differentiate Bethesda class III thyroid nodules

Gao, Luying; Wang, Ying; Jiang, Yuxin; Yang, Xiao; Liu, Ruyu; Xi, Xuehua; Zhu, Shenling; Zhao, Ruina; Lai, Xingjian; Zhang, Xiaoyan; Zhang, Bo

doi:10.1097/md.0000000000006564

Cited by 33 publications

(36 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of DC II (benign) nodules, 1.3% were found to be malignant, which is similar to that reported by Cibas al [4]. The rate of thyroid cancer among those with DCIII (AUS/FLUS) nodules was 20.8%, which is higher than the rates in other studies that reported a 5-15% risk of cancer [4,5]; the rate of cancer among DCIV (FN/SFN) nodules was 27.2% in our patients, which is within the expected rate of 15-30% [4]. Among patients with DCV and DCVI nodules, the rate of cancer in our patients was lower than expected (52.4 and 69.2%, respectively), which may be due to the inclusion of FNA reports from different pathology labs that may not have much experience with thyroid cytology.…”

Section: Discussionsupporting

confidence: 83%

“…Thyroid nodules are palpable in 5% of the population on examination of the thyroid and detected in 50-67% of those undergoing thyroid ultrasound [2,3]. The incidence of cancer differs from country to country; thyroid cancer occurs in approximately 5-15% of patients with thyroid nodules [4,5], with the highest rate recorded in Korea (62.5/100, 000). Other countries with high incidence rates include the USA (13.2), Canada (12.7), Turkey (10.9) and Italy (10.8) [6,7].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Thyroid cancer among patients with thyroid nodules in Yemen: a three-year retrospective study in a tertiary center and a specialty clinic

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Thyroid cancer among patients with thyroid nodules in Yemen: a three-year retrospective study in a tertiary center and a specialty clinic

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Few studies have addressed the role of US scores in indeterminate TNs [19–24]. Gao et al [25] suggested that US is helpful for differentiating benign and malignant Bethesda III through a meta-analysis that included 2405 nodules. The specificity was 71% and sensitivity was 66% in nodules with 3 suspicious US features.…”

Section: Introductionmentioning

confidence: 99%

ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology

et al. 2019

View full text Add to dashboard Cite

BackgroundCytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. The main aim of our study was to determine whether the classifications, American College of Radiology (ACR) TI-RADS and 2015 American Thyroid Association (ATA) guidelines, in association with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), could be used to stratify the malignancy risk of indeterminate thyroid nodules and guide their clinical management.MethodsThe institutional review board approved this retrospective study of a cohort of 140 thyroid nodules in 139 patients who were referred to ultrasound-guided fine-needle aspiration cytology (FNAC) from January 2012 to June 2016 with indeterminate cytological results (44 Bethesda III, 52 Bethesda IV and 44 Bethesda V) and in whom pre-FNAC thyroid US images and histological results after surgery were available. Each included nodule was classified by one radiologist blinded to the cytological and histological diagnoses according to the ACR TIRADS scores and the US patterns as recommended in the 2015 ATA guidelines. The risk of malignancy was estimated for Bethesda, TI-RADS scores, ATA US patterns and their combination.ResultsOf the 140 indeterminate thyroid nodules examined, 74 (52.9%) were histologically benign. A different rate of malignancy (p < 0.001) among Bethesda III, IV and V was observed. The rate of malignancy increased according to the US suspicion categories (p < 0.001) in both US classifications (TI-RADS and ATA). Thyroid nodules classified as Bethesda III and the lowest risk US categories (very low, low and intermediate suspicion by ATA and 2, 3 and 4a by TI-RADS) displayed a sensitivity of 95.3% for both classifications and a negative predictive value of 94.3 and 94.1%, respectively. The highest risk US categories (high suspicion by ATA and 4b,4c and 5 by TI-RADS) were significantly associated with cancer (odds ratios [ORs] 14.7 and 9.8, respectively).ConclusionsUltrasound classifications, ACR TI-RADS and ATA guidelines, may help guide the management of indeterminate thyroid nodules, suggesting a conservative approach to nodules with low-risk US suspicion and Bethesda III, while molecular testing and surgery should be considered for nodules with high-risk US suspicion and Bethesda IV or V.

show abstract

“…US is useful and shows very good diagnostic accuracy for the differentiation of Bethesda class III AUS nodules. 5) Lee, et al 6) reported that US features are particularly useful for stratifying the level of malignant risk; however, a large proportion of nodules without any suspicious US features were eventually found to be malignant (6.25-32.4%). Therefore, repeated FNAB has been recommended for diagnostic accuracy; however, AUS nodules with low suspicious patterns as defined by the 2015 American Thyroid Association guidelines might be followed up with US instead of repeat FNA, because of low malignancy in that group.…”

Section: Discussionmentioning

confidence: 99%

“…3) Fine needle aspiration biopsy (FNAB) is a useful technique that is used worldwide to evaluate thyroid nodules and is a simple, cost-effective and relatively accurate test for differentiating benign from malignant nodules. [4][5][6] The results of thyroid cytopathology following FNAB are categorized using the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), which is now recognized as a standardized reporting system. [7][8][9] Despite this, the diagnostic value of atypia of undetermined significance (AUS) as defined by Bethesda criteria is still vague.…”

Section: Introductionmentioning

confidence: 99%

BRAFV600E Mutation is a Strong Preoperative Indicator for Predicting Malignancy in Thyroid Nodule Patients with Atypia of Undetermined Significance Identified by Fine Needle Aspiration

Choi¹,

Choi²,

Cho³

et al. 2018

Korean J Otorhinolaryngol-Head Neck Surg

View full text Add to dashboard Cite

Background and Objectives This study aimed to identify a reliable preoperative predictive factor for the development of thyroid cancer in patients with atypia of undetermined significance (AUS) identified by fine needle aspiration biopsy (FNAB). Subjects and Method This was a retrospective cohort study. Two hundred and ninety-nine patients diagnosed with AUS by preoperative FNAB who underwent curative thyroid surgery at our institution between September 2005 and February 2014 were analyzed. Clinical, radiological and molecular features were investigated as preoperative predictors for postoperative permanent malignant pathology. Results The final pathologic results revealed 36 benign tumors including nodular hyperplasia, follicular adenoma, adenomatous goiter, nontoxic goiter, and lymphocytic thyroiditis, as well as 263 malignant tumors including 1 follicular carcinoma and 1 invasive follicular carcinoma; the rest were papillary thyroid carcinomas. The malignancy rate was 87.9%. The following were identified as risk factors for malignancy by univariate analysis: BRAF V600E gene mutation, specific ultrasonographic findings including smaller nodule size, low echogenicity of the nodule, and irregular or spiculated margin (p＜0.05). Multivariate analysis revealed that only BRAF V600E mutation was a statistically significant risk factor for malignancy (p＜0.05). When BRAF V600E mutation was positive, 98.5% of enrolled patients developed malignant tumors. In addition, the diagnostic rate of malignancy in these cases was approximately 16-fold higher than BRAF-negative cases. Conclusion Patients with AUS thyroid nodules should undergo BRAF V600E gene mutation analysis to improve diagnostic accuracy and if the mutation is confirmed, surgery is recommended due to the high risk of malignancy.

show abstract

Ultrasound is helpful to differentiate Bethesda class III thyroid nodules

Abstract: Supplemental Digital Content is available in the text

Cited by 33 publications

References 33 publications

Thyroid cancer among patients with thyroid nodules in Yemen: a three-year retrospective study in a tertiary center and a specialty clinic

Thyroid cancer among patients with thyroid nodules in Yemen: a three-year retrospective study in a tertiary center and a specialty clinic

ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology

BRAFV600E Mutation is a Strong Preoperative Indicator for Predicting Malignancy in Thyroid Nodule Patients with Atypia of Undetermined Significance Identified by Fine Needle Aspiration

Contact Info

Product

Resources

About