Large (≥3cm) thyroid nodules with benign cytology: Can Thyroid Imaging Reporting and Data System (TIRADS) help predict false-negative cytology?

Nam, Se Jin; Kwak, Jin Young; Moon, Hee Jung; Yoon, Jung Hyun; Kim, Min Jung; Koo, Ja Seung

doi:10.1371/journal.pone.0186242

Cited by 21 publications

(15 citation statements)

References 41 publications

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“…Larger thyroid nodules (>3 cm) could have higher false-negative rates (~3%) due to larger amounts of background colloid mistaken for benign adenomatous colloid. General recommendations are to consider clinical suspicion, size and suspicious radiological features/TIRADS classification to facilitate surgical decision making (9).…”

Section: Discussionmentioning

confidence: 99%

Occult metastatic thyroid cancer diagnosed during breast cancer axillary sentinel node biopsy

Herle

Boyages

Hui³

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary In most developed countries, breast carcinoma is the most common malignancy in women and while thyroid cancer is less common, its incidence is almost three to five times greater in women than in men. Since 1966, studies have demonstrated an association between thyroid and breast cancer and despite these studies, the mechanism/s by which they are related, remains unclear. We present a case of a 56-year-old lady who initially presented in 2014 with a screen detected left breast carcinoma but was subsequently found to have occult metastatic thyroid cancer to the axilla, diagnosed from a sentinel node biopsy from the primary breast procedure. The patient underwent a left mastectomy, left axillary dissection and total thyroidectomy followed by three courses of radioactive iodine ablation. Despite this, her thyroglobulin level continued to increase, which was secondary to a metastatic thyroid cancer parasternal metastasis. Breast and thyroid cancer presents metachronously or synchronously more often than by chance. With improving mortality in primary cancers, such as breast and differentiated thyroid cancer, it is likely that as clinicians, we will continue to encounter this association in practice. Learning points: There has been a long-standing observation of an association between breast and thyroid cancer although the exact mechanism of this association remains unclear. Our patient presented with thyroid cancer with an incidental diagnosis from a sentinel node biopsy during her primary breast operation for breast cancer and was also found to have a parasternal distant bony metastasis. Thyroid axillary metastases are generally rare. The interesting nature in which this patient’s metastatic thyroid carcinoma behaved more like a breast carcinoma highlights a correlation between these two cancers. With improving mortality in these primary cancers, clinicians are likely to encounter this association in clinical practice. Systemic therapy for metastatic breast and thyroid cancers differ and therefore a clear diagnosis of metastasis is crucial.

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Section: Discussionmentioning

confidence: 99%

Occult metastatic thyroid cancer diagnosed during breast cancer axillary sentinel node biopsy

Herle

Boyages

Hui³

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…A retrospective study that evaluated 632 nodules of at least 3 cm found an overall false negative rate of 3.6% that increased from 0.9% to 12% according to the ultrasound risk category. A large variation of false negative rate in nodules of 3 cm or larger has been reported in the literature (0.7-25%) suggesting that various clinical factors, rather than just nodule size, might be related to the diagnostic performance of FNA 147148…”

Section: Estimating the Risk Of Thyroid Cancer And Management After Tmentioning

confidence: 99%

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Ospina

Iñiguez-Ariza

Castro

2020

BMJ

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Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient’s values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.

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“…Cytology generally shows abundant cellularity and the cells may be typical of the primary site (Chung et al 2012), leading to the correct diagnosis in 74% of cases (Chung et al 2012, Khan et al 2018. However, it exhibits a high false-negative rate in nodules larger than 3 cm (Agcaoglu et al 2013, Nam et al 2017. The most common thyroid metastases for which FNA did not make the correct diagnosis originated from the oesophagus (50%), the cervix (33%), the kidney (28.5%) and melanomas (20%) (Chung et al 2012).…”

Section: Pathologymentioning

confidence: 99%

Neoplastic metastases to the endocrine glands

Angelousi

Alexandraki

Kyriakopoulos

et al. 2020

Endocrine-Related Cancer

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Endocrine organs are metastatic targets for several primary cancers, either through direct extension from nearby tumour cells or dissemination via the venous, arterial and lymphatic routes. Although any endocrine tissue can be affected, most clinically relevant metastases involve the pituitary and adrenal glands with the commonest manifestations being diabetes insipidus and adrenal insufficiency respectively. The most common primary tumours metastasing to the adrenals include melanomas, breast and lung carcinomas, which may lead to adrenal insufficiency in the presence of bilateral adrenal involvement. Breast and lung cancers are the most common primaries metastasing to the pituitary, leading to pituitary dysfunction in approximately 30% of cases. The thyroid gland can be affected by renal, colorectal, lung and breast carcinomas, and melanomas, but has rarely been associated with thyroid dysfunction. Pancreatic metastasis can lead to exo-/endocrine insufficiency with renal carcinoma being the most common primary. Most parathyroid metastases originate from breast and lung carcinomas and melanoma. Breast and colorectal cancers are the most frequent ovarian metastases; prostate cancer commonly affects the testes. In the presence of endocrine deficiencies, glucocorticoid replacement for adrenal and pituitary involvement can be life saving. As most metastases to endocrine organs develop in the context of disseminated disease, surgical resection or other local therapies should only be considered to ameliorate symptoms and reduce tumour volume. Although few consensus statements can be made regarding the management of metastases to endocrine tissues because of the heterogeneity of the variable therapies, it is important that clinicians are aware of their presence in diagnosis.

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Large (≥3cm) thyroid nodules with benign cytology: Can Thyroid Imaging Reporting and Data System (TIRADS) help predict false-negative cytology?

Cited by 21 publications

References 41 publications

Occult metastatic thyroid cancer diagnosed during breast cancer axillary sentinel node biopsy

Occult metastatic thyroid cancer diagnosed during breast cancer axillary sentinel node biopsy

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Neoplastic metastases to the endocrine glands

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