Thyroid incidentaloma as a “PAIN” phenomenon— does it always require surgery?

Abstract

A thyroid nodule discovered during imaging study performed due to unrelated thyroid disease is known as a thyroid incidentaloma, while positron emission tomography (PET) associated incidental neoplasm of thyroid is known as a “PAIN” phenomenon.To evaluate which patients with “PAIN” phenomenon should undergo surgery in regards to cytology results.Retrospective review of 4716 patients consecutively admitted and surgically treated in tertiary surgical center. 49 (1.04%) patients with “PAIN” phenomenon were identified. All of them had ultrasound-guided fine needle aspiration biopsy (UG-FNAB) performed and cytological results were evaluated according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Patients were divided into 2 subgroups according to histopathological diagnosis: group 1 (n = 25) with benign tumor and group 2 (n = 24) with thyroid cancer.Cytology results were the significant predictors of cancer occurrence in patients with “PAIN” phenomenon (P < .0001). Logistic regression analysis confirmed that category III or higher of TBSRTC in patients with “PAIN” phenomenon significantly increased the risk of cancer (OR = 168.7, P < .0001).Patients with “PAIN” phenomenon and cytology assigned to category III or higher of the Bethesda system should undergo surgery due to significant risk of thyroid malignancy.

The findings of 18F-fluorodeoxyglucose positron emission tomography–computed tomography scan in patients with hidradenitis suppurativa in Malaysia: A multicenter study

“…[ 29 31 32 ] The most common reported malignancy was papillary thyroid cancer and this was similarly found in our study. [ 33 34 ] This novel finding of thyroid malignancy has not been highlighted in previous literatures on HS. Most studies reported the association of thyroid disorders in HS without alluding to thyroid malignancy.…”

The dilemma of 18F-FDG PET/CT thyroid incidentaloma: what we should expect from FNA. A systematic review and meta-analysis

“…All studies but one [ 29 ] were reported in the English language. Nine studies were performed by Asian/Eastern [ 17 – 20 , 22 – 24 , 27 , 31 ] and six by Western [ 21 , 25 , 26 , 28 – 30 ] authors. They were single-center or observational cohort studies.…”

“…1. Of these, 289 were screened, 84 were assessed as eligible, and 15 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] were included in the final systematic review and meta-analysis. Table 1 summarizes the quality assessment of the 15 included studies.…”

Cancer screening activity results in overdiagnosis and overtreatment of papillary thyroid cancer: A 10-year experience at a single institution

“…Easy access to high-frequency ultrasound neck examination or to the other imaging tests results in a high number of newly diagnosed cases of PTC. Many studies based on autopsy evaluations confirm the high number of undiagnosed PTCs [ 5 , 35 ] and have highlighted three main estimated mechanisms that contribute to the increasing rate of newly diagnosed TC entities: opportunistic screening, i.e., palpation of asymptomatic patients with subclinical TC; diagnostic cascade performed in patients with general complaints, and incidental findings during neck imaging tests performed due to non-thyroid gland diseases [ 5 , 36 , 37 ]. In Poland, there are no recommendations for TC screening tests; however, ultrasound examinations of the thyroid and subsequent UG-FNAB are commonly ordered [ 38 ].…”