Preoperative evaluation of thyroid nodules – Diagnosis and management strategies

Antonia, Tapoi Dana; Maria, Lambrescu Ioana; Ancuta-Augustina, Gheorghisan-Galateanu

doi:10.1016/j.prp.2023.154516

Cited by 8 publications

(5 citation statements)

References 203 publications

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“…Among these tests, the detection of BRAF V600E mutation is highly specific for identifying PTC. When combined with thyroid ultrasonography or cytology, BRAF V600E detection significantly enhances the diagnostic sensitivity for PTC [ 9 , 10 ]. Preoperative use of molecular analyses has been demonstrated to accurately identify most papillary cell lesions, medullary thyroid cancer, and parathyroid tumors [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Difficulties of Preoperative Diagnosis of Cribriform Morular Thyroid Carcinoma

Pan,

Hang,

Chen

et al. 2024

Case Reports in Endocrinology

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Background. Cribriform morular thyroid carcinoma has been recently renamed in the 2022 WHO classification as a thyroid tumor of uncertain histogenesis. The epidemiologic, pathological, and pathophysiological characteristics distinguish it from papillary thyroid carcinoma (PTC). Preoperative genetic testing plays a role in facilitating the differential diagnosis. Methods. This report presents a confirmed case of cribriform morular thyroid carcinoma. Initially, fine-needle aspiration cytology suggested a diagnosis of PTC. However, a genetic analysis did not reveal the typical mutations associated with follicular-cell-derived neoplasms. Results. A 31-year-old woman was found to have a thyroid nodule at the left lobe measuring 11.8 × 10.2 × 12.4 mm. Ultrasonography indicated a hypoechoic, solid nodule with regular margins. Cytology revealed a papillary structure of tall cells, leading to a PTC diagnosis. Nevertheless, the genetic analysis failed to detect mutations such as BRAF V600E, NRAS Q61R, NRAS Q61K, HRAS Q61R, or HRAS Q61K mutation or the fusion of CCDC6-RET, NCOA4-RET, PAX8-PPARG, ETV6-NTRK3, TPM3-NTRK1, IRF2BP2-NTRK1, or SQSTM1-NTRK1 in the aspirated follicular cells. The patient subsequently underwent total thyroidectomy with central lymph node dissection. Pathological examination revealed a cribriform pattern of spindle-shaped cells with morular areas. Immunohistochemical staining showed positive results for β-catenin and TTF-1, except in the morular regions, and negative results for PAX8, thyroglobulin, and BRAF (clone VE1). The diagnosis was confirmed to be cribriform morular thyroid carcinoma. Conclusion. Significant cytological similarity exists between PTC and cribriform morular thyroid carcinoma. Preoperative genetic analysis is important to differentiate these two diseases. Cribriform morular thyroid carcinoma can be differentiated from common follicular-cell-derived tumors by the absence of typical mutations; the presence of nuclear and cytoplasmic expressions of β-catenin; the presence of TTF-1, except in morular areas; and the absence of thyroglobulin.

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Section: Discussionmentioning

confidence: 99%

Difficulties of Preoperative Diagnosis of Cribriform Morular Thyroid Carcinoma

Pan,

Hang,

Chen

et al. 2024

Case Reports in Endocrinology

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“…CD56 negativity, CK19, HBME-1, and galectin-3 positivity are some of the most appropriate markers in the differential diagnosis of malignant and benign lesions of the thyroid. [ 68 ] Although the use of these immunohistochemical markers in FNAB specimens has been limited to date, some studies have reported that a single or a combination of two or three may contribute to the detection of malignancy in FNAB specimens. In the latest meta-analysis, Galectin-3, HBME-1, CK-19, CD-56, and TPO are stated as high-confidence marker candidates whose efficacy should be confirmed in thyroid cytology.…”

Section: Other Cross-sectional Imaging Methodsmentioning

confidence: 99%

“…In recent years, the use of tru-cut biopsy has been increasing as an alternative, especially in non-diagnostic (Bethesta I, III, and IV) biopsied thyroid nodules. [ 68 ] Tru-cut biopsy has low non-diagnostic outcome rates and high specificity for the diagnosis of malignancy in thyroid nodules whose initial FNAB is non-diagnostic. Tru-cut biopsy is indicated as a safe diagnostic technique with higher diagnostic efficiency and low complication rate, especially in cases where molecular testing is not available or FNAB cannot obtain enough cells for molecular testing.…”

Section: Other Cross-sectional Imaging Methodsmentioning

confidence: 99%

“…It is essential to ensure that the Bethesda system is also used by children. [68] In this edition, ROM rates for childhood thyroid cancers were calculated according to six categories, associated with frequently used practical guidelines, and treatment recommendations are given separately. [67] Non-diagnostic (Bethesda I): Approximately 15% of FNABs are in the non-diagnostic category.…”

Section: Cytological Evaluation Of Fnabmentioning

confidence: 99%

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Management of Thyroid Nodules

Uludag

2023

Sisli Etfal

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Thyroid nodules are common and the prevalence varies between 4 and 7% by palpation and 19–68% by high-resolution USG. Most thyroid nodules are benign, and the malignancy rate varies between 7 and 15% of patients. Thyroid nodules are detected incidentally during clinical examination or, more often, during imaging studies performed for another reason. All detected thyroid nodules should be evaluated clinically. The main test in evaluating thyroid function is thyroid stimulating hormone (TSH). If the serum TSH level is below the normal reference range, a radionuclide thyroid scan should be performed to determine whether the nodule is hyperfunctioning. If the serum TSH level is normal or high, ultrasonography (US) should be performed to evaluate the nodule. US is the most sensitive imaging method in the evaluation of thyroid nodules. Computed tomography (CT) and magnetic resonance imaging are not routinely used in the initial evaluation of thyroid nodules. There are many risk classification systems according to the USG characteristics of thyroid nodules, and the most widely used in clinical practice are the American Thyroid Association guideline and the American College of Radiology Thyroid Imaging Reporting and Data System. Fine needle aspiration biopsy (FNAB) is the gold standard method in the evaluation of nodules with indication according to USG risk class. In the cytological evaluation of FNAB, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is the most frequently applied cytological classification. TBSRTC is a simplified, 6-category reporting system and was updated in 2023. The application of molecular tests to FNAB specimens, especially those diagnosed with Bethesda III and IV, is increasing to reduce the need for diagnostic surgery. Especially in Bethesda III and IV nodules, different methods are applied in the treatment of nodules according to the malignancy risk of each category, these are follow-up, surgical treatment, radioactive iodine treatment, and non-surgical ablation methods.

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“…FNAC remains the first-line tool with satisfactory results in the preoperative diagnosis of thyroid nodules. Nevertheless, ultrasonographic assessment of thyroid lesions and its utilization in FNAC guidance have proven very helpful in establishing the correct diagnosis [ 6 ]. In the past few years, standardization of diagnostic terminology following the Bethesda System for Reporting Thyroid Cytology has been adopted in clinical practice worldwide, providing an evidence-based approach for the management of thyroid nodules [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of fine-needle aspiration cytology in thyroidectomy extent and associated surgical morbidity in thyroid cancer

Lind,

Nordenström,

Johansson

et al. 2024

Langenbecks Arch Surg

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Purpose To assess the impact of fine-needle aspiration cytology (FNAC) in the extent of surgery in patients with thyroid cancer (TC) and the associated surgical morbidity in primary and completion setting. Methods A Swedish nationwide cohort of patients having surgery for TC (n = 2519) from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal surgery between 2004 and 2013 was obtained. Data was validated through scrutinizing FNAC and histology reports. Results Among the 2519 cases operated for TC, the diagnosis was substantiated and validated through the histology report in 2332 cases (92.6%). Among these, 1679 patients (72%) were female, and the median age at TC diagnosis was 52.3 years (range 18–94.6). Less than total thyroidectomy (LTT) was undertaken in 944 whereas total thyroidectomy (TT) in 1388 cases. The intermediate FNAC categories of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/ FLUS), as well as suspicion for follicular neoplasm (SFN) lesions were more often encountered in LTT (n = 314, 33.3%) than TT (n = 63, 4.6%), whereas FNACs suspicion for malignancy and/or malignancy were overrepresented in TT (n = 963, 69.4%). Completion thyroidectomies were undertaken in 553 patients out of 944 that initially had LTT. In 201 cases with cancer lesions > 1 cm, other than FTC (Follicular TC)/ HTC (Hürthle cell TC) subjected to primary LTT, inadequate procedures were undertaken in 81 due to absent, Bethesda I or II FNAC categories, preoperatively. Complications at completion of surgery in this particular setting were 0.5% for RLN palsy (n = 1) and 1% (n = 2) for hypoparathyroidism 6 months postoperatively. The overall postoperative complication rate was higher in primary TT vs. LTT for RLN palsy (4.8% [n = 67] vs. 2.4% [n = 23]; p = 0.003) and permanent hypoparathyroidism (6.8% [n = 95] vs. 0.8% [n = 8]; p < 0.0001). Conclusions FNAC results appear to affect surgical planning in TC as intermediate FNAC categories lead more often to LTT. Overall, inadequate procedures necessitating completion surgery are encountered in up to 15% of TC patients subjected to LTT due to absent, inconclusive, or misleading FNAC, preoperatively. However, completion of thyroidectomy in this setting did not yield significant surgical morbidity. Primary LTT is a safer primary approach compared to TT in respect of RLN palsy and permanent hypoparathyroidism complication rates; therefore, primary TT should probably be reserved for lesions > 1 cm or even larger with suspicion for malignancy or malignant FNAC.

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Preoperative evaluation of thyroid nodules – Diagnosis and management strategies

Cited by 8 publications

References 203 publications

Difficulties of Preoperative Diagnosis of Cribriform Morular Thyroid Carcinoma

Difficulties of Preoperative Diagnosis of Cribriform Morular Thyroid Carcinoma

Management of Thyroid Nodules

Impact of fine-needle aspiration cytology in thyroidectomy extent and associated surgical morbidity in thyroid cancer

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