High Rates of Underlying Thyroid Cancer in Patients Undergoing Thyroidectomy for Hyperthyroidism

Alvarez, Alexandra L.; Mulder, Michelle B.; Handelsman, Rachel S.; Lew, John I.; Farrá, Josefina C.

doi:10.1016/j.jss.2019.07.048

Cited by 12 publications

(15 citation statements)

References 23 publications

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“…Among DTCs, papillary thyroid cancer (PTC) is the most frequent histological type (90%), while follicular thyroid cancer (FTC) and medullary thyroid cancer (MTC) are rare [8][9][10]. Thyroid disease, radiation exposure, previous neoplasms, family history, young age, male gender, and genetic predisposition are considered to be the most important risk factors for developing thyroid cancer [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Predictive factors of malignancy in pediatric patients with thyroid nodules and performance of the Italian classification (SIAPEC 2014) in the outcome of the cytological FNA categories

et al. 2021

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Purpose The rate of malignancy (ROM) among pediatric studies using the Bethesda System is 39.5% and 41.5% for atypia of undetermined significance/follicular lesion of undetermined significance and for suspected follicular neoplasm, respectively. Data reported on the basis of Bethesda System showed lower ROM in adults with indeterminate nodules (30.5 and 28.9% respectively). Studies on adults based on the Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification, report ROM of 14.2% for TIR3a and 44.6% for TIR3b category, showing greater sensitivity in detecting malignancy. To date, no performance data are available about SIAPEC classification in pediatric age. Methods Retrospective data were collected from 200 pediatric subjects with thyroid nodules in the period 2000–2020. Results The distribution of cytological categories after fine needle aspiration biopsy (FNAB) was 7 TIR1, 4 TIR1c, 22 TIR2, 14 TIR3a, 9 TIR3b, 3 TIR4, and 16 TIR5. The surgical approach was performed in 40/200 subjects, with total ROM of 65% (0% for TIR1-TIR3a, 77.8% for TIR3b, and 100% for TIR4–TIR5). Total FNAB accuracy was 95%, while the sensibility and specificity were 92.3 and 92.6%, respectively. Conclusions The reported data seem to confirm a greater sensitivity of SIAPEC classification to identify malignancy within the indeterminate category also in pediatric age and not only in adulthood. This finding may orient clinicians toward clinical follow-up for the indeterminate TIR3a group and toward surgical approach with total thyroidectomy in the indeterminate TIR3b group, although this indication should be confirmed in further national multicenter studies including larger cohorts.

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Section: Introductionmentioning

confidence: 99%

Predictive factors of malignancy in pediatric patients with thyroid nodules and performance of the Italian classification (SIAPEC 2014) in the outcome of the cytological FNA categories

et al. 2021

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show abstract

“…Among DTCs, papillary thyroid cancer (PTC) is the most frequent histological type (90%), while follicular thyroid cancer (FTC) and medullary thyroid cancer (MTC) are rare [8][9]. Thyroid disease, radiation exposure, previous neoplasms, family history, young age, male gender, and genetic predisposition are considered to be the most important risk factors for developing thyroid cancer [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

“…Anamnestic and clinical data, thyroid hormone pro le, and ultrasound evaluation are critical for the initial assessment [10][11][12][13][14][15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

“Predictive Factors of Malignancy in Pediatric Patients with Thyroid Nodules and Performance of the Italian Classification (SIAPEC 2014) in the Outcome of the Cytological FNA Categories”

Tuli

Munarin

Agosto

et al. 2021

Preprint

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Purpose: The rate of malignancy (ROM) among pediatric studies using the Bethesda System is 39.5% and 41.5% for atypia of undetermined significance/follicular lesion of undetermined significance and for suspected follicular neoplasm, respectively. Data reported on the basis of Bethesda System system showed lower ROM in adults with indeterminate nodules (30.5% and 28.9% respectively). Studies on adults based on the Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification, report ROM of 14.2 % for TIR3a and 44.6% for TIR3b category, showing greater sensitivity in detecting malignancy. To date, no performance data are available about SIAPEC classification in pediatric age.Methods: retrospective data were collected from 200 pediatric subjects with thyroid nodules in the period 2000-2020.Results: The distribution of cytological categories after fine needle aspiration biopsy (FNAB) was 7 TIR1, 4 TIR1c, 22 TIR2, 14 TIR3a, 9 TIR3b, 3 TIR4 and 16 TIR5. Surgical approach was performed in 40/200 subjects, with total ROM of 65% (0% for TIR1-TIR3a, 77.8% for TIR3b and 100 % for TIR4-TIR5). Total FNAB accuracy was 95%, while the sensibility and specificity were 92.3% and 92.6%, respectively. Conclusions: The reported data seem to confirm a greater sensitivity of SIAPEC classification to identify malignancy within the indeterminate category also in pediatric age and not only in adulthood. This finding may orient clinicians towards clinical follow-up for the indeterminate TIR3a group and towards surgical approach with total thyroidectomy in the indeterminate TIR3b group, although this indication should be confirmed in further national multicenter studies including larger cohorts.

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“…Patients with both hyperfunctioning disease and carcinoma presented a toxic adenoma in 50%, toxic MNG in 24% and Graves' disease in 16%. Therefore, they suggested that hyperthyroid patients with nodularity on ultrasound examination should perform appropriate FNA assessment to value the risk of malignancy (13).…”

Section: Discussionmentioning

confidence: 99%

“…Alvarez et al reported that 60% of patients undergone to thyroidectomy for hyperthyroidism had tumor with a diameter <1 cm, and overall, all malignancy were <3 cm in size. The clinical impact of these small cancers is still unclear, especially after the introduction of the 2015 ATA guidelines in which tumor dimensions influence the extent of surgery (13).…”

Section: Discussionmentioning

confidence: 99%

Can we still consider thyroid hyperfunction a protective condition for the onset of thyroid cancer?

Bonati¹,

Bettoni²,

Loderer³

et al. 2021

Gland Surg

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High Rates of Underlying Thyroid Cancer in Patients Undergoing Thyroidectomy for Hyperthyroidism

Cited by 12 publications

References 23 publications

Predictive factors of malignancy in pediatric patients with thyroid nodules and performance of the Italian classification (SIAPEC 2014) in the outcome of the cytological FNA categories

Predictive factors of malignancy in pediatric patients with thyroid nodules and performance of the Italian classification (SIAPEC 2014) in the outcome of the cytological FNA categories

“Predictive Factors of Malignancy in Pediatric Patients with Thyroid Nodules and Performance of the Italian Classification (SIAPEC 2014) in the Outcome of the Cytological FNA Categories”

Can we still consider thyroid hyperfunction a protective condition for the onset of thyroid cancer?

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