Thyroid nodule management: clinical, ultrasound and cytopathological parameters for predicting malignancy

Abstract

Although fine-needle aspiration cytology is considered to be the reference method for evaluating thyroid nodules, the results are inaccurate in approximately 10-30% of cases. Several studies have attempted to predict the risk of malignancy in thyroid nodules based on age, nodularity, thyrotropin values, thyroid autoimmune disease, hot/cold nodule status, and ultrasound parameters. However, no consensus has been found, and none of these parameters has significantly affected patient management. The management of indeterminate thyroid nodules and re-biopsies of nodules with initially benign cytological results remain important and controversial topics of discussion. The Bethesda cytological system and several studies on the use of molecular markers to predict malignancy from cytological samples of thyroid nodules need further clarification. More in-depth discussions among and continuous education of the specialists involved in treating thyroid disease are necessary to improve the management of these patients. This review aims to examine the clinical, laboratory, ultrasound, and scintigraphic parameters that can be used for thyroid nodule management.

Thyroid imaging reporting and data system score combined with Bethesda system for malignancy risk stratification in thyroid nodules with indeterminate results on cytology

“…Thus, we believe that the combined TI‐RADS score with Bethesda system could be used as a simple tool to better stratify thyroid cancer risk and may help clinicians to guide the surgical decision. In view of the high sensitivity and NPV of TI‐RADS 3/4A demonstrated for nodules resulting Bethesda III cytology, a conservative approach based on follow‐up and repeat FNAB, including molecular markers, may be discussed in these cases. In our series, the surgical indication for Bethesda III nodules occurred after the second re‐biopsy in almost 60% of these cases in about 1–2 years (median interval of 21 months).…”

“…After the results from Bethesda System for Reporting Thyroid Cytopathology, the indeterminate cytology is classified into atypia of undetermined significance (Bethesda category III), follicular neoplasm or suspicious for follicular neoplasm (Bethesda IV) and suspicious for malignancy (Bethesda V). As the majority of patients with thyroid nodules can be managed conservatively, efforts to better select candidates for thyroid surgery are justified …”

“…Furthermore, the first TI‐RADS systems were considered difficult to apply in the clinical field due to their complexity of combined US features. Previous data demonstrated the impact of thyroid US to predict malignancy in indeterminate thyroid nodules; none of them enrolled TI‐RADS score concomitant with Bethesda system. Thus, in 2011, Korean and French groups proposed two novel TI‐RADS interpretations .…”

Management of Thyroid Incidentalomas Encountered by Anesthesiologists and Pain Physicians

“…However, it is very beneficial to be aware of the sonographic patterns of TIs associated with malignancy (irregular margin, solid composition, hypoechogenicity, microcalcifications, shape more long than wide, absence of halo, central blood supply, and calcified lymph nodes). [12][13][14][15][16][17][18][19] Identification of thyroid cancer risk factors by a thorough patient history (previous head and neck irradiation, exposure to nuclear fallout, relevant family history, extremes of age, new hoarseness, dysphonia, dysphagia, dyspnea, and male sex) along with the evidence of cancer-associated features on US may warrant urgent referral to an endocrinologist. 3,6,8,9 The patient's general health and comorbidities should be taken into consideration, especially when diagnosis of thyroid cancer is unlikely to affect the life expectancy of the patient.…”

“…The terms "malignant" and "tumor" should be avoided, given that the probability of an incidentaloma developing into a fatal carcinoma is most likely less than 1%, not only with regard to the thyroid gland, but in general. 19 However, inadequate reassurance of indolence of a TI or an unreported TI would delay the diagnosis of a malignancy. The patient's perspective should be kept in mind: 90% of patients want to be informed of any aberrations found in their diagnostic images.…”