Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category IV (FN/SFN)

Kuru, Bekir; Kefeli, Mehmet

doi:10.1002/dc.23923

Cited by 18 publications

(21 citation statements)

References 26 publications

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“…In this study, solidity, hypoechogenicity, irregular margins, taller-than-wide shape, microcalcifications and posterior echo attenuation associated with malignant nodules, whereas regular halo associated with benign nodules. Furthermore, taller-than-wide shape, microcalcifications, hypoechogenicity and irregular margins were independent risk factors for malignancy, consistent with the results of previous studies ( 15 , 18 , 39 , 40 , 41 ). Taller-than-wide shape is a highly specific indicator of thyroid cancer, with studies reporting a specificity of 81.5–98.5% for malignant thyroid nodules with a taller-than-wide shape ( 15 , 23 , 42 ).…”

Section: Discussionsupporting

confidence: 91%

“…In addition, ultrasonography can guide FNA, which can reduce the generation of non-diagnostic specimens. Ultrasound features, such as solidity, hypoechogenicity, microcalcifications, taller-than-wide shape and irregular margins, are useful in the diagnosis of malignant nodules ( 13 , 14 , 15 , 16 , 17 , 18 ). Furthermore, other studies have reported that a simple cystic and spongiform appearance have a higher negative predictive value (NPV) for malignancy ( 13 , 19 , 20 ).…”

Section: Introductionmentioning

confidence: 99%

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The combination of ATA classification and FNA results can improve the diagnostic efficiency of malignant thyroid nodules

Wang

Zhu

et al. 2020

Endocrine Connections

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Purpose: To determine the diagnostic efficiency of the ATA classification and ultrasound-guided fine-needle aspiration (FNA) results in identifying the risk factors of malignancy, we analyzed the thyroid nodules of patients who underwent thyroidectomy and compared preoperative ATA classifications with FNA results. Methods: We retrospectively analyzed 274 nodules of 196 patients who underwent ultrasonography, FNA and thyroidectomy. Histopathological findings of thyroid nodules were considered as the gold standard in the analysis of the diagnostic efficiency of the ATA classification and FNA results. Univariate analysis and binary multivariate logistic regression analysis were applied to identify the ultrasound features associated with malignancy. Results: The overall malignancy rate of 274 nodules was 41.6%. The areas under the ROC curves (AUCs) for the ATA classification and FNA results were 0.88 and 0.878, respectively (P<0.001). The sensitivity and specificity of the ATA classification were 86% and 86.9%, whereas those of FNA results were 68.5% and 91.4%, respectively. The specificity (98.7%) and sensitivity (94.3%) increased after the combined use of the ATA classification and FNA results. Taller-than-wide shape, microcalcifications, hypoechogenicity and irregular margins were independent risk factors for malignancy. Microcalcifications had the highest OR (7.58), and taller-than-wide shape had the highest specificity in BSRTC I, II, III and IV cytologies. Conclusion: The diagnostic efficiency of the ATA classification and FNA results in identifying malignant nodules was high, and the use of both criteria improved the diagnostic accuracy. Taller-than-wide shape, microcalcifications, hypoechogenicity and irregular margins were independent risk factors for malignancy.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The combination of ATA classification and FNA results can improve the diagnostic efficiency of malignant thyroid nodules

Wang

Zhu

et al. 2020

Endocrine Connections

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“…In the present study, we observed irregular borders, hypoechogenicity, microcalcifications, being taller than wide, and components of the nodules all increased the risk for malignancy in thyroid nodules. This finding is in accordance with a study by Kure et al Brito et al demonstrated that being taller than wide had the highest diagnostic OR for judging the malignancy of thyroid nodules compared to other graphic ultrasound features. In our study, a relationship between the dimension of being taller than wide and risk of cancer was observed.…”

Section: Resultsmentioning

confidence: 99%

Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Pan

et al. 2019

Diagnostic Cytopathology

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Background This study was designed to explore whether ultrasound of thyroid nodules facilitates the interpretation of the malignant risk of Bethesda III/IV thyroid nodules to inform further therapies. Methods We reviewed patient records in which the results of ultrasound‐guided fine‐needle aspiration (US‐FNA) were classified by the Bethesda III/IV in our institution between January 2016 and June 2018. Studies were retrieved from PubMed, Cochrane Central Register of Controlled Trials, ISI Web of Science, Science Direct, Wiley Online Library, EMBASE, China National Knowledge Infrastructure, WanFang, and Chinese VIP. The odds ratio (OR) was used to measure associations between risk factors and thyroid nodule malignancy. Results Fifty‐nine cases of Bethesda III/IV with corresponding surgeries were included, and the malignancy risk was 54.2%. Meta‐analysis revealed irregular borders, solitary nodules, hypoechogenicity, microcalcifications, and being taller than wide, all of which increased the malignancy risk of thyroid nodules. Combined ORs for these factors were 4.08 (95% CI: 2.34‐7.14, P < .001), 2.18 (95% CI: 1.39‐3.42, P = .001), 2.02 (95% CI: 1.35‐3.01, P = .001), 3.21 (95% CI: 2.26‐4.56, P < .001), and 4.35 (95% CI: 3.07‐6.15, P < .001), respectively. Conclusion As the risk of malignancy for papillary thyroid carcinoma (PTC) is high, when any one of the five ultrasound features of malignancy were confirmed, repeated FNA is recommended to confirm PTC‐type malignancy, even though nodules were Bethesda III/IV classification. However, repeated FNA should be avoided when none of these ultrasound features are identified because repeated FNA does not contribute to identifying non‐PTC type malignancies, such as follicular thyroid carcinoma and poorly differentiated thyroid carcinoma.

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“…Since 2009, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has had a well-established role in the diagnosis of thyroid nodules (TNs) 1,2 . Among the six categories in this classification, the third category is known as “atypia of undetermined significance and follicular lesion of undetermined significance” (AUS/FLUS), and the fourth category is known as “follicular neoplasm and suspicious for follicular neoplasm” (FN/SFN) 1,3 . The Bethesda categories III and IV describe varying risks of malignancy.…”

Section: Introductionmentioning

confidence: 99%

“…Because of the great clinical dilemma surrounding the management of thyroid nodules in the AUS/FLUS and FN/SFN categories and the variability in the rates of malignancy in these categories, this subject still garners much discussion. Though the risk of malignancy for category III and IV TNs has been estimated, some authors suggest, that the risk of malignancy for patients with AUS/FLUS and FN/SFN category nodules depends upon the specific clinical situation 3,6 . Others point out that, when using predictive factors for malignancy for the categories of AUS/FLUS and FN/SFN as a risk index, 17% of individuals without the risk factors do not need surgery 3 .…”

Section: Introductionmentioning

confidence: 99%

Patients with III and IV category of the Bethesda System under levothyroxine non-suppressive therapy have a lower rate of thyroid malignancy

Kaliszewski

Diakowska

Wojtczak

et al. 2019

Sci Rep

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Thyroid nodules (TNs) assigned to the Bethesda System categories III and IV include numerous clinical characteristics, which increase or decrease the risk of malignancy. However, there are very few data regarding the influence of TSH non-suppressive thyroid hormone therapy (NSTHT) on the risk of malignancy in patients in the aforementioned categories. We assessed the number of patients with thyroid nodules assigned to categories III and IV who take TSH NSTHT and if thyroid hormone therapy is associated with a rate of malignancy. We retrospectively analyzed the medical records of 4,716 individuals and selected 532 (11.28%) patients with Bethesda System category III and IV thyroid nodules. All participants underwent surgery, and histopathological verification was obtained in all cases. In all, 33.1% of individuals with category III and IV thyroid nodules took TSH NSTHT. In patients with category III nodules, application of NSTHT was associated with a lower rate of thyroid cancer (TC), though this observation was not significant (OR = 0.55, p = 0.381). In patients with category IV nodules, we demonstrated a significantly lower rate of TC when NSTHT was applied (OR = 0.44, p = 0.005). In conclusion, the prevalence of patients with Bethesda System category III and IV thyroid nodules who take NSTHT is high. TSH NSTHT significantly decreases a rate of malignancy in category IV, but not category III patients.

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Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category IV (FN/SFN)

Cited by 18 publications

References 26 publications

The combination of ATA classification and FNA results can improve the diagnostic efficiency of malignant thyroid nodules

The combination of ATA classification and FNA results can improve the diagnostic efficiency of malignant thyroid nodules

Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Patients with III and IV category of the Bethesda System under levothyroxine non-suppressive therapy have a lower rate of thyroid malignancy

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