A Risk Model to Determine Surgical Treatment in Patients with Thyroid Nodules with Indeterminate Cytology

Macias, Cathaleene; Arumugam, Dena; Arlow, Renee L.; Eng, Oliver S.; Lu, Shou‐En; Javidian, Parisa; Davidov, Tomer; Trooskin, Stanley Z.

doi:10.1245/s10434-014-4190-8

Cited by 18 publications

(23 citation statements)

References 26 publications

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“…The malignancy rate in men in our study was 33.3%, while in women it was 27.1%. Similary, other studies reported that gender was no associated with malignancy (15,23,24).…”

Section: Discussionsupporting

confidence: 73%

Predictive Factors of Malignancy in Cytology of Indeterminate Follicular and Hürthle Cell Neoplasms of the Thyroid Gland

Öz

Doğan

Emek

et al. 2018

International Surgery

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The objective of the current study was to determine the risk of malignancy in patients with thyroid nodules with cytology of indeterminate follicular and indeterminate Hürthle cell neoplasm (HN). The cytologic diagnosis of follicular neoplasm (FN) or HN remains a diagnostic challenge. Often, surgery is recommended for such lesions. A retrospective analysis was performed on 80 patients who underwent thyroid surgery following a diagnosis of indeterminate FN and indeterminate HN in thyroid fine-needle aspiration biopsy. Sex; age; family history of thyroid cancer and radiation exposure; coexisting thyroid conditions, such as solitary nodule; multinodularity; cytologic diagnosis; sonographic features; type of surgical treatment; and histopathologic results were recorded. Of the 80 patients, 52 (65%) had FN on fine-needle aspiration biopsy cytology and 28 (35%) had HN. A total of 23 patients (28.7%) had primary thyroid cancers on surgical pathology, and 57 (71.3%) had benign diagnoses. Univariate analysis showed no differences between the benign and malignant groups by sex, nodule size, family history of thyroid cancer, history of radiation exposure, presence of solitary nodule or multinodularity in the nodular features. In multivariate binary logistic regression analysis, the factors that were statistically significant predictors of malignancy were microcalcification [odds ratio (OR), 10.9; 95% confidence interval (CI), 2.18–54.7; P = 0.004], being older than 45 years (OR, 4.2; 95% CI, 1.25–14.63; P = 0.02]. The independent predictors of malignancy in FN and HN are micorcalcification and being older than 45 years, the use of which may predict the risk of thyroid cancer.

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“…The malignancy rate in men in our study was 33.3%, while in women it was 27.1%. Similary, other studies reported that gender was no associated with malignancy (15,23,24).…”

Section: Discussionsupporting

confidence: 73%

Predictive Factors of Malignancy in Cytology of Indeterminate Follicular and Hürthle Cell Neoplasms of the Thyroid Gland

Öz

Doğan

Emek

et al. 2018

International Surgery

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“…Clinical factors such as age, gender, hard lesions on palpation, cervical lymphadenopathy, and suspicious ultrasound characteristics such as solid structure, solitary nodules, hypoechogenicity, microcalcification, nodule size, and increased vascularization have been reported by several studies as the predictive factors for malignancy in FN/SFN in pre‐Bethesda era . However, there are a few studies which queried the risk factors for malignancy for FN/SFN as Bethesda category IV …”

Section: Discussionmentioning

confidence: 99%

“…The ROM was 34% in the risk model developed by Macias et al to determine surgical treatments in 151 Bethesda category IV nodules. They retrospectively analyzed demographic, clinical, ultrasound, and cytological variables in relation to thyroid carcinoma, and concluded that a multivariable model based on calcification, larger mean nodule size, nuclear atypia, and tobacco use may predict the risk of thyroid cancer . However, in the study of Macias et al, many ultrasound factors such as vascularization on Doppler ultrasound, echogenicity, and margin status, were not included.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, selection of nodules for surgery diagnosed as FN/SFN (Bethesda category IV) is important to spare the patients with benign nodules from unnecessary surgery. A number of studies reported the predictive factors for malignancy of nodules in the FN/SFN category both before Bethesda classification, and after Bethesda classification . However, only one study has reported on risk groups described by predictive risk factors for malignancy and the factors associated with triage to surgery or observation of nodules in Bethesda category IV.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category IV (FN/SFN)

Kuru

Kefeli

2018

Diagnostic Cytopathology

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“…Actually, the thyroid nodules with a FN/SFN CNB diagnosis, malignant US features, or nuclear atypia were more likely to be malignant lesions [16, 17]. However, these preoperative histologic or radiologic findings were not associated with the subtypes of FVPTCs and about half of non-invasive EFVPTCs also presented malignant US features or concomitant nuclear atypia in CNB specimens [18].…”

Section: Discussionmentioning

confidence: 99%

Impact of Reclassification on Thyroid Nodules with Architectural Atypia: From Non-Invasive Encapsulated Follicular Variant Papillary Thyroid Carcinomas to Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features

et al. 2016

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BackgroundThe follicular variant of papillary thyroid cancer (FVPTC), especially the encapsulated non-invasive subtype, is a controversial entity. Recent study suggested using ‘non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)’ for these indolent carcinomas. We evaluated the impact of reclassification from non-invasive encapsulated FVPTCs (EFVPTCs) to NIFTPs in the diagnosis of thyroid nodules with architectural atypia.MethodsWe reviewed 1301 thyroid nodules with architectural atypia in core needle biopsy (CNB) specimens obtained from March 2012 to February 2013. Nodules were classified into atypia of undetermined significance with architectural atypia (AUS-A, 984, 76%) or follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN, 317, 24%). Among them, diagnostic surgery was performed in 384 nodules (30%).ResultsIn total, 160 nodules (42%) presented final malignant diagnoses including 39 non-invasive encapsulated FVPTCs (10%). The malignancy rate was estimated to be 7–35% in AUS-A nodules and 28–49% in FN/SFN nodules. After reclassification, the malignancy rate was much decreased and estimated to be 5–24% in AUS-A nodules, and 23–39% in FN/SFN nodules. Thyroid nodules with final malignant diagnoses were significantly more likely to have a FN/SFN CNB diagnosis, malignant US features and concomitant nuclear atypia in CNB specimens. However, these factors could not differentiate NIFTPs from other malignancies.ConclusionsAfter reclassification of non-invasive EFVPTCs to NIFTPs, the malignancy rate of thyroid nodules with architectural atypia in CNB specimens was decreased. However, there were no preoperative factors differentiating other malignancies from NIFTPs. The presence of malignant US features or concomitant nuclear atypia might help clinicians deciding diagnostic surgery but, these features also might indicate NIFTPs.

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A Risk Model to Determine Surgical Treatment in Patients with Thyroid Nodules with Indeterminate Cytology

Abstract: A multivariable model based on calcification, nodule size, nuclear atypia, and tobacco use may predict the risk of thyroid cancer requiring a total thyroidectomy in patients with thyroid nodules of indeterminate cytology.

Cited by 18 publications

References 26 publications

Predictive Factors of Malignancy in Cytology of Indeterminate Follicular and Hürthle Cell Neoplasms of the Thyroid Gland

Predictive Factors of Malignancy in Cytology of Indeterminate Follicular and Hürthle Cell Neoplasms of the Thyroid Gland

Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category IV (FN/SFN)

Impact of Reclassification on Thyroid Nodules with Architectural Atypia: From Non-Invasive Encapsulated Follicular Variant Papillary Thyroid Carcinomas to Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features

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