Value of Ultrasound and Cytological Classification System to Predict the Malignancy of Thyroid Nodules with Indeterminate Cytology

Maia, Frederico Fernandes Ribeiro; Matos, Patrícia Francisca de; Pavin, Elizabeth João; Vassallo, José; Zantut-Wittmann, Denise Engelbrecht

doi:10.1007/s12022-011-9159-6

Cited by 29 publications

(30 citation statements)

References 40 publications

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“…The second opinion increased the FNAB diagnostic accuracy by 14% and reduced the surgery rate by 25%. Such results demonstrate the importance of cytological review by a pathologist experienced in thyroid surgery recommendations for patients with indeterminate cytology (82,83). …”

Section: Fine-needle Aspiration Cytologymentioning

confidence: 56%

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

Maia¹,

Zantut-Wittmann²

2012

Clinics

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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.

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Section: Fine-needle Aspiration Cytologymentioning

confidence: 56%

“…Maia et al (82) evaluated the correlation between the cytological variables of the Bethesda system and clinical, sonographic, and scintigraphic data on indeterminate thyroid nodules. In a sample of nodules with a 25% malignancy rate, category IV of the Bethesda system was an independent predictor of malignancy.…”

Section: Fine-needle Aspiration Cytologymentioning

confidence: 99%

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

Maia¹,

Zantut-Wittmann²

2012

Clinics

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“…This study confirmed a significant increase of risk for malignancy in thyroid nodules with indeterminate cytology showing Bethesda System category IV and suspicious features at US. These findings enhance our current limited predictive armamentarium and can be used to guide surgical decision making [53].…”

Section: Tips and Tricksmentioning

confidence: 68%

Thyroid Ultrasound: State of the Art. Part 2 – Focal Thyroid Lesions

et al. 2017

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Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.

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“…Many of these studies combine clinical and imaging features in order to predict malignancy (30–32). Most of these models rely heavily on ultrasound features such as calcifications, irregular borders, hypoechogenicity, and nodule size.…”

Section: Discussionmentioning

confidence: 99%

Gauging The Extent Of Thyroidectomy For Indeterminate Thyroid Nodules: An Oncologic Perspective

et al. 2017

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Introduction Increasing emphasis is being placed on appropriateness of care and avoidance of over- and under-treatment. Indeterminate thyroid nodules (ITN), present a particular risk for this problem because cancer found via diagnostic lobectomy (DL) often requires a completion thyroidectomy (CT). However, initial total thyroidectomy (TT) for benign ITN results in lifelong thyroid hormone replacement. We sought to measure the accuracy and factors associated with the extent of initial thyroidectomy for ITN. Methods We queried a single institution thyroid surgery database for all adult patients undergoing an initial operation for ITN. Multivariate logistic regression identified factors associated with either oncologic under- or over-treatment at initial operation. Results There were 639 patients with ITN. The median age was 52 (range 18 – 93), 78.4% were female, and final pathology revealed a cancer > 1 cm in 24.7%. The most common cytology was follicular neoplasm (45.1%) followed by Hurthle cell neoplasm (20.2%). CT or initial oncologic under-treatment was required in 58 patients (9.3%). Excluding those with goiters, 19.0% were treated with total thyroidectomy for benign final pathology. Multivariate analysis failed to identify any factor that independently predicted the need for CT. Female gender was associated with total thyroidectomy in benign disease (OR 2.1, 95% C.I. 1.0 – 4.5, p = 0.05). Age >45 predicted correct initial use of DL (OR 2.6, 95% C.I. 1.2 – 5.7, p = 0.02). Suspicious for PTC (OR 5.7, 95% C.I. 2.1 – 15.3, p<0.01) and frozen section (OR 9.7, 95% C.I. 2.5 – 38.6, p<0.01) were associated with oncologically appropriate initial TT. The highest frequency of CT occurred in patients with follicular lesion of undetermined significance (11.6%). Total thyroidectomy for benign final pathology occurred most frequently in patients with a Hurthle cell neoplasm (24.8%). Conclusions In patients with ITN, nearly 30% received an inappropriate extent of initial thyroidectomy from an oncologic standpoint. Tools to preoperatively identify both benign and malignant disease can assist in the complex decision-making to gauge the proper extent of initial surgery for ITN.

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Value of Ultrasound and Cytological Classification System to Predict the Malignancy of Thyroid Nodules with Indeterminate Cytology

Cited by 29 publications

References 40 publications

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

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

Thyroid Ultrasound: State of the Art. Part 2 – Focal Thyroid Lesions

Gauging The Extent Of Thyroidectomy For Indeterminate Thyroid Nodules: An Oncologic Perspective

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