Does the Bethesda category predict aggressive features in differentiated thyroid cancer?

Abstract

Objective: To analyze the importance of preoperative cytology of thyroid nodules and its relationship with mortality risk, recurrence risk, dynamic stratification, and aggressive characteristics (vascular invasion, aggressive histology, incomplete tumor resection, extrathyroidal extension of the tumor, and presence of lymph node and distant metastases). Subjects and methods: Retrospective evaluation of 153 patients diagnosed with differentiated thyroid carcinoma (DTC) and following up at the Hospital Universitário Presidente Dutra between January 1999 and December 2016. Results: In all, 96% of the patients were female, 79.7% had papillary carcinoma and the most common fineneedle aspiration (FNA) result was Bethesda II (29.4%). The mean age was 43.11 ± 12.8 years. Overall, 85% of the patients progressed without any evidence of disease. There was a statistically significant relationship between the presurgical FNA and the presence of extrathyroidal extension, vascular invasion, and lymph node metastasis. Conclusions: The preoperative cytology of the nodule may have an impact on the follow-up of patients with DTC. Future studies in a larger population are required to confirm this finding.

Is there a relationship between preoperative cytological diagnosis and evolution in patients with differentiated thyroid carcinoma? A retrospective study

“…Our study did not reveal an association between cytological diagnosis and recurrence risk, corroborating results from other authors (12). However, a recent large study reported an association between both (10), guiding their conclusions towards a relationship between cytology and findings that could suggest a higher risk of recurrences, such as histological subtype and the presence of local recurrence and distant metastases.…”

“…In this study, the 7 th edition of AJCC/TNM (19) was considered, once that it was the parameter in force at the time of data collection. No association was seen between cytological diagnosis and risk of death, similar to descriptions by other authors (12,14), but different to the findings of VanderLaan and cols., who found an association between Bethesda cytology Class VI and the more advanced TNM stages (8). AJCC/TNM staging was also not associated to disease status in final evaluation, reinforcing the concept that it does not have prognostic value regarding therapeutic response or disease persistence, restricting itself as just a predictor of mortality from neoplasia (29).…”

“…Sample size was calculated according to Lima and cols. (12), in which excellent response rates (5) of 92.1% and 74.5% were seen in Bethesda categories II and V/VI, respectively. Considering a test power of 80% and an alpha of 0.017 (Bonferroni correction for comparison between the three cytological groups: I/II, III/IV, and V/VI), minimum sample size was found to be 104 patients.…”

“…In this context, some authors have reported that preoperative cytological diagnosis could be one more factor in DTC prognosis (8)(9)(10)(11)(12)(13). However, despite the relevance of Bethesda classification in thyroid neoplasia diagnosis, its prognostic role is still controversial (14,15).…”

Clinical risk predictors for differentiated thyroid cancer management: what is new?

“…The preoperative diagnosis of Bethesda II was observed in a higher than expected number of patients with DTC (29.4%). Fortunately, the vast majority of DTC patients that presented with Bethesda II evolved with excellent response to therapy and no evidence of disease (92.1%) (6). According to the Bethesda system the implied risk of malignancy for the diagnostic category II (benign) is of 0-3% and the recommended clinical approach is clinical and sonographic followup (7).…”