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

Abstract

Based on the American (Bethesda, 2017) or Italian (SIAPEC 2014) cytological categories of thyroid nodules, the risk of malignancy and management vary. This risk is 5–10% or<3% (benign or TIR2), 6–18% or<10% (AUS/FLUS or TIR3A), 10–40% or 15–30% (FN/SFN or TIR3B), 45–60% or 60–80% (suspicious or TIR4), 94–96% or 95% (malignant or TIR5). In 408 thyroid nodules evaluated cytologically, we computed the malignancy rate in each category considering gender (325 females, 83 males), echotexture (268 isoechoic, 140 hypoechoic), intranodular chronic lymphocytic thyroiditis (ICLT: 113 with and 295 without); histology (263 benign, 145 malignant). It was 0–1.7% for the benign categories, except hypoechoic/ICLT+ve nodules of females (25%); 0–2.3% for the AUS/FLUS category, except isoechoic/ICLT–ve nodules of males (11.1%) and hypoechoic/ICLT–ve nodules of females (22.2%). For the FN/SFN category, rate was the most variable (from 0% in isoechoic/ICLT+ve nodules of males to 100% in hypoechoic/ICLT–ve nodules of males). The 30% threshold for risk was passed in four subgroups, and the 40% threshold in two subgroups (45% in isoechoic/ICLT–ve nodules of males, 80% in hypoechoic/ICLT+ve nodules of females). For the suspicious category, rate was 100% in males, except those with isoechoic/ICLT–ve nodules (75%), and>80% in females with hypoechoic nodules. For the malignant category, rate was always 100%. In conclusion, particular groups of nodules (based on gender, echotexture, and ICLT) within the cytologically benign through the suspiciously malignant category are at risk of malignancy substantially greater (even 100%) than the standard one. Accordingly, the suggested management cannot be standardized.

Ultrasound Parameters Can Accurately Predict the Risk of Malignancy in Patients with “Indeterminate TIR3b” Cytology Nodules: A Prospective Study

“…Another study evaluated how the rate of malignancy varied in each cytological category (from TIR2 to TIR5), taking into account gender, the echogenicity of the nodule and the presence or absence of intranodular chronic lymphatic thyroiditis (ICLT). In the TIR3b category, a rate over twice the expected 30% malignancy threshold was found in hypoechoic, ICLT-positive female nodules (80%), which contrasted sharply with the 38.5% rate of malignant tumours with the same characteristics but negative ICLT [37].…”

Thyroid Nodules with Indeterminate FNAC According to the Italian Classification System: Prevalence, Rate of Operation, and Impact on Risk of Malignancy. An Updated Systematic Review and Meta-analysis

“…Fourth, the prevalence of ITN, TIR3A, and TIR3B among all FNACs was analyzed. Among those 20 studies reporting the overall number of biopsies performed during the study period, after excluding papers reporting only FNACs with ITN results, there were 16 studies eligible for this analysis [ 21 , 25 , 27 – 29 , 32 – 35 , 37 , 40 , 42 – 44 , 47 ]. Overall, the prevalence of ITNs among FNACs was 29.6% (95% CI 25–34.1), with high heterogeneity ( I 2 98%).…”

Cytological patterns of thyroid lesions in Najran, Saudi Arabia

“…The latter observation has been reported previously in different studies that found that males with thyroid nodules displayed a higher incidence of malignancy than females. 13 , 14 …”

“…The latter observation has been reported previously in different studies that found that males with thyroid nodules displayed a higher incidence of malignancy than females. 13,14 The vast majority of thyroid nodules are known to be benign, while only up to 15% are malignant. 7 Results from the current study showed that most of the thyroid lesions in Najran were benign )72.5%(.…”