Gender-specific correlation of intranodular chronic lymphocytic thyroiditis with thyroid nodule size, echogenicity, and histologically-verified cytological class of malignancy risk

Abstract

No data are available on the cytologically and histologically demonstrated presence of intranodular chronic lymphocytic thyroiditis (ICLT) and on the ICLT relationship with thyroid nodule characteristics such as size, echotexture and nature (benign or malignant). We wished to fill this gap by analyzing data in a gender-specific fashion. We studied 408 thyroid nodules from 408 consecutive persons (325 females and 83 males). Nodules were isoechoic (n = 268) or hypoechoic (n = 140), ICLT +ve (n = 113 [27.7%]) or ICLT −ve (n = 295), cytologically low-risk (n = 197) or high-risk (n = 211), histologically benign (n = 263) or malignant (n = 145). ICLT prevailed in females (97/113) and in hypoechoic nodules (58/140 [41.4%] vs 55/268 [20.5%], P < 0.0001). Compared to males, females had (i) smaller nodules (18.5 ± 9.4 vs 23.3 ± 13.4 mm, P = 0.0002), a difference due to the isoechoic nodules (21.1 ± 9.8 vs 26.6 ± 14.1 mm, P = 0.0006), (ii) lower rates of high-risk nodules (161/325 [49.5%] vs 50/83 [60.2%], P = 0.082) and malignant nodules (110/325 [33.8%] vs 35/83 [42.2%] P = 0.16). ICLT +ve nodules were smaller than the ICLT −ve ones (15.4 ± 6.9 vs 20.9 ± 11.2 mm, P < 0.0001), a difference due to the isoechoic nodules (17.5 ± 6.5 vs 23.6 ± 11.7 mm, P = 0.0003). The smallest nodules were hypoechoic, cancerous and ICLT +ve nodules in males (9.5 ± 4.0 mm); the largest were isoechoic, cytologically risky and ICLT −ve in males (29.1 ± 13.2 mm). Compared to ICLT −ve nodules, malignancy prevailed in ICLT +ve nodules (55/113 [48.7%] vs 90/295 [30.5%], P = 0.0006), both in hypoechoic (37/58 [63.8%] vs 41/82 [50.0%]) and isoechoic nodules (18/55 [32.7%] vs 49/213 [23.0%]). ICLT +ve hypoechoic nodules of females and ICLT −ve hypoechoic nodules of males had the greatest rate of malignancy (67% both), while ICLT −ve isoechoic nodules of females had the lowest (19%).In conclusion, presence/absence of ICLT is associated with some sexually dimorphic characteristics of thyroid nodules. Adding the specification of ICLT positivity/negativity in cytological reports may help improving the risk of malignancy at least in some groups of thyroid nodules.

The Risk For Malignancy of the Thyroid Nodule is Modulated by Gender, Echotexture, and Intranodular Lymphocytic Thyroiditis

“…As mentioned in the Introduction, in the same cohort of patients of the present study, we have previously found that the presence/ absence of ICLT is associated with some sexually dimorphic characteristics of thyroid nodules [7]. One previous finding was that ICLT + ve hypoechoic nodules of females and ICLT-ve hypoechoic nodules of males had the greatest rate of histologically verified malignancy (67 % both), while ICLT-ve isoechoic nodules of females had the lowest (19 %).…”

“…In our clinical practice on thyroidectomized patients, we have noticed that when the presence of lymphocytic infiltration of the FNA-interrogated nodule had been mentioned in the cytological report, this had a different predictive value for malignancy depending on echotexture and gender [7]. For instance, nodules containing a lymphocytic infiltrate, having the same echotexture (hypoechogenicity) and belonging to the same FNA category (follicular neoplasm [FN] or suspicious for a follicular neoplasm [SFN]), had a relatively low risk of malignancy if the patient was male, but a very high one if the patient was female [7]. As well known, the detection of lymphocytic infiltration in the FNA-interrogated thyroid nodule (see below, Patients and Methods) and the ensuing diagnosis of chronic lymphocytic thyroiditis is just used to categorize the nodule as benign if there are no other associated cytological signs of malignancy.…”

Malignancy Rate of Bethesda Class III Thyroid Nodules Based on the Presence of Chronic Lymphocytic Thyroiditis in Surgical Patients

“…Hashimoto’s thyroiditis (HT), also known as chronic lymphocytic thyroiditis (CLT), interfere with the accurate cytological diagnosis of thyroid nodules ( 8 ), although CLT is diagnosed based on the pathologic findings in principle. CLT is characterized with enlarged nuclei as well as lymphocytic and plasma cell infiltration, and lesions of CLT vary in intensity from one part of the gland to another, which may complicate the preoperative diagnosis of thyroid nodules ( 3 , 9 ).…”

Chronic Lymphocytic Thyroiditis May Lower Accuracy of AUS/FLUS Cytopathology in Surgical Patients

“…1,6,7 Chronic lymphocytic thyroiditis (CLT) is an insidious inflammation of the thyroid gland that is known to increase cytologic atypia on FNA. 8 This disease process may microscopically resemble AUS/FLUS with cytologic findings of enlarged nuclei, lymphocytic and plasma cell infiltration, atrophic follicles with abundant oncocytes and often atypical epithelium. 1,6,7 As CLT progresses, features unique to this entity can be observed on final pathology (e.g., fibrosis, nodularity, atrophic parenchyma).…”