Epidemiologic, Clinical, Ultrasonographic, and Cytological Features of Thyroid Nodules in Predicting Malignancy Risk: A Retrospective Study of 442 French Afro-Caribbean Patients

Abstract

Objective. To evaluate epidemiologic, clinical, cytological, and ultrasonographic features of thyroid nodules in a sample French Afro-Caribbean population to determine if the standard criteria for predicting malignancy risk are applicable to this specific ethnic population. Methods and Design. This retrospectively designed study consisted of 442 patients who had consulted with the Endocrinology Department in Martinique (French overseas department) between 2007 and 2011. Of the 442 patients, 641 ultrasound-guided fine-needle aspirations (US-FNA) were performed by two experienced endocrinologists, and 212 patients underwent surgery. The geographical situation, age, gender of the patient, clinical and ultrasonographic features, TSH level, and US-FNA results were considered and cross-referenced with their pathology results. Results. The overall malignancy rate on final histopathology was 9% (women only), 80% of which were papillary cancer, and 20% were follicular cancer. Occult micropapillary carcinoma represented 35% of the papillary cancer. There was no significant difference in age, nodule localization, number of nodules, or thyroid function test between benign and malignant nodules. Contrary to the literature, we found only 12% incidentaloma in our series, while more than half of the nodules were discovered on palpation or as a clinical symptom. Hypoechogenicity in solid pattern nodules and nodules between 2 and 3 cm in size revealed a high diagnostic value in detecting malignancy. The corresponding rate of malignancy on Bethesda system histopathologic examination was as follows: 0% in undiagnosed (I), 0% benign (II) (micropapillary), 5% (FLUS)/atypia (III), 9% follicular neoplasm (IV), 33% suspected malignancy (V), and no malignant cytology (VI). These results show a different Bethesda system predictive value for this French Afro-Caribbean population. Conclusion. Studies evaluating ethnic cancer disparities among patients with thyroid cancer are limited and do not specifically focus on the French Afro-Caribbean population. Despite rare thyroid incidentaloma, 35% of the papillary cancer cases were micropapillary carcinoma, and the incidence and standardized mortality rate in Martinique are lower than in metropolitan France. The malignant risk distribution of thyroid FNA Bethesda classification in this sample population differs from the standard risk, and it is necessary to take that into account in the decision to operate by associating it with echographic malignancy criteria.

Evaluation of Children and Adolescents with Thyroid Nodules: A Single Center Experience

“…US findings, such as hypoechogenicity, increased blood flow, irregular margins, solid structure, microcalcification of the nodule and presence of abnormal cervical lymph nodes, which were identified as malignancy risk factors in our cohort, are in keeping with previous studies which have reported these characteristics to be more common in malignant nodules ( 38 , 39 , 40 , 41 ). Although hypoechogenicity and increased blood flow have high negative predictive value and high sensitivity, microcalcifications and presence of abnormal cervical lymph nodes have the highest specificity and positive predictive value and because of this, FNA is recommended for nodules with microcalcifications and abnormal lymph nodes, independent of nodule size ( 21 ).…”

Practice of thyroid nodule management in the Gulf Cooperation Council countries

“…Problems in referrals that delay or hamper diagnosis and proper management of cases include insufficient information from the history and examination, incomplete laboratory and radiology tests, inappropriate FNAs, and even the experience of pathologists and cytologists in giving an accurate cytopathological diagnosis. 8 , 14 This paves the way for surgical and non-surgical management of benign cases indeterminate malignancy, and unnecessary surgeries will expose patients to surgical risks and complications. Molecular testing has become the current standard of care in most developed countries and has a huge advantage in reducing unnecessary thyroid surgeries and avoiding surgical complications, particularly in cases with indeterminate cytology results.…”

“…11 In 2015, the American Thyroid Association (ATA) published the updated clinical practice guidelines for the management of thyroid nodules; however, it was not clear on how this clinical practice guidelines differed from what doctors actually practice. [12][13][14] Several reports have noted that the 2015 guideline has a restricted approach to tissue sampling while others had distinguished its benefit in terms of quality, cost, and availability. 11,15,16 The management of thyroid nodules starts with a referral from a general practitioner to a family medicine practitioner, an internal medicine specialist, or an endocrinologist, and sometimes to an ear, nose, and throat (ENT) specialist or a general or endocrine surgeon.…”

“…In 2015, the American Thyroid Association (ATA) published the updated clinical practice guidelines for the management of thyroid nodules; however, it was not clear on how this clinical practice guidelines differed from what doctors actually practice. 12 - 14 Several reports have noted that the 2015 guideline has a restricted approach to tissue sampling while others had distinguished its benefit in terms of quality, cost, and availability. 11 , 15 , 16 …”

Correlation of Ultrasound Thyroid Imaging Reporting And Data System With Histopathology Findings Among Patients In Uganda

“…Thyroid nodule (TN) is a common thyroid disorder with global prevalence ranging; 4-7% by palpation, 19-68% by ultrasound, and 8-65% by pathologic examination at autopsy (1,2). This increase is thought to be related to early detection by high-resolution ultrasound and the discovery of subclinical TNs (3,4). TN can be classi ed as either benign or malignant.…”