In The Presence of Risk Factors High Rate of Incidental Multifocal Microcarcinoma Detection in Solitary Thyroid Nodule and Multinodular Goitre Justifies Total Thyroidectomy

Abstract

Aim: Thyroid nodules are commonly encountered with increasing age. Majority of them are benign. In the present study, our goal was to identify both the false negative rate (FNR) of preoperative cytology, radiology results, risk factors for malignancy, and the prevalence of thyroid carcinoma in cases to whom operation performed for solitary thyroid nodule (STN) with multinodular goitre (MNG) and the final histopathological report. Methods: A retrospective study among 141 patients who were operated for suspicion of thyroid cancer between 2019-2022. 118 were women (83.6%) and 23 were men (16.3%). The mean age was 50.2(23.1). Demographic characteristics and factors predicting malignancy were questioned for all patients preoperatively. Preoperative ultrasonography (US), fine needle aspiration cytology (FNAc) results and postoperative histopathology data were collected. Ultrasound features (ACR-TIRADS), FNAc results, histopathology records, risk factors and malignancy rates was registered. Statistical analysis was done with Fisher's precision and Mann-Whitney U tests. Results: 141 patients underwent total thyroidectomy for STN (n=28, 19.8%) and MNG (n=113, 80.1%). The correlation of FNAc with final histopathology revealed that FNR in MNG was more often than that of STN (33.3% vs 66.6%, p<0.001). Malignancy was detected in 43 of 141 patients with total thyroidectomy due to STN and MNG (30.4%).Family history and previous radiotherapy were risk factors in patients with STN (25%). The histopathology results of 129 patients were compatible with ACR-TIRADS in ultrasound (91.4%). Conclusion: Although multinodular goiter (MNG) is generally believed to have a lower risk of malignancy compared to solitary thyroid nodules (STN), the prevalence of malignancy is significantly higher in STN and MNG. Optimal patient management depends on a good interaction between radiologist, pathologist and surgeon to decrease false negative and false positive cases.

Keywords

• Cytology
• solitary thyroid nodule
• multinodular goitre
• malignancy

References

1. 1.Ajarma KY, Al-Faouri AF, Al Ruhaibeh MK, et al.The risk of thyroid carcinoma in multinodular goitercompared to solitary thyroid nodules: Aretrospective analysis of 600 patients. Med J ArmedForces India. 2020;76(1): 23–9. doi:10.1016/j.mjafi.2018.05.001
2. 2.Alyanak A, Aslan F. Nodule and cancer assessmentfollowing thyroid surgery: a cohort of 460 patients.Eur Rev Med Pharmacol Sci. 2020;24(18):9565-70.doi: 10.26355/eurrev_202009_23042.
3. 3.Mohammadi M, Betel C, Burton KR, et al.Retrospective application of the 2015 AmericanThyroid Association Guidelines for ultrasoundclassification, biopsy indications, and follow-upimaging of thyroid nodules: Can improved reporting decrease testing? AssocRadiol J 2019;70(1):68-73.doi: 10.1016/j.carj.2018.09.001
4. 4. Pezzolla A, Lattarulo S, Madaro A, et al. What really is an indeterminate FNA thyroid nodule? Ann ItalChir2017;88:275–81.
5. 5.Tessler FN, Middleton WD, Grant EG, et al. ACRThyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee.J Am CollRadiol 2017;14(5):587–95.doi:10.1016/j.jacr.2017.01.046.
6. 6.Cibas ES, Ali SZ. The 2017 Bethesda System forReporting Thyroid Cytopathology. Thyroid 2017;27(11):1341–6. doi: 10.1089/thy.2017.0500
7. 7. RadioGyan, TI-RADS online calculatorhttps://radiogyan.com/tirads-calculator/#tirads-calculator 2020.
8. 8.Tessler FN, Middleton WD, Grant EG. ThyroidImaging Reporting and Data System (TI-RADS): Auser's guide. Radiology 2018;287(3):29–36. doi:10.1148/radiol.2017171240

9. 9.Popoveniuc G, Jonklaas J. Thyroid Nodules. MedClin North Am. 2012;96(2):329–49.
10. 10.Smith JJ, Chen X, Schneider DF, et al. Cancer afterthyroidectomy: a multiinstitutional experience with1,523 patients. J Am Coll Surg. 2013;216(4):571–7.http://dx. doi.org/10.1016/j.jamcollsurg.2012.12.022.
11. 11.Rago T, Fiore E, Scutari M, et al. Male sex, singlenodularity, and young age are associated with therisk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series ofpatients with nodular thyroid disease. Eur JEndocrinol. 2010;162(4):763–70.http://dx.doi.org/ 10.1530/EJE-09-0895.
12. 12.Frates MC, Benson CB, Doubilet PM, et al.Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules onsonography. J ClinEndocrinolMetab.2006;91(9):3411–7.
13. 13.Luo J, McManus C, Chen H, Sippel RS. Are therepredictors of malignancy in patients withmultinodular goiter? J Surg Res 2012;174(2):207-10.doi: 10.1016/j.jss.2011.11.1035.
14. 14.Rossi ED, Adeniran AJ, Faquin WC. Pitfalls inThyroid Cytopathology. SurgPatholClin2019;12(4):865–81. doi:10.1016/j.path.2019.08.001
15. 15.Renshaw AA, Gould EW. Characteristics of False-Negative Thyroid Fine-Needle Aspirates. ActaCytol2018;62(1):12–8. doi: 10.1159/000481722.
16. 16.Evranos B, Polat SB, Cuhaci FN, et al. A cancer ofundetermined significance: Incidental thyroidcarcinoma. DiagnCytopathol 2019;47(5):412–6. doi: 10.1002/dc.24117.
17. 17.So YK, Kim MW, Son YI: Multifocality andbilaterality of papillary thyroid microcarcinoma.ClinExpOtorhinolaryngol 2015; 8(2):174–8. doi:10.3342/ceo.2015.8.2.174.
18. 18.Zupunski L, Ostroumova E, Drozdovitch V, et al.Thyroid Cancer after Exposure to Radioiodine inChildhood and Adolescence: 131I-Related Risk andthe Role of Selected Host and EnvironmentalFactors. Cancers (Basel) 2019;11(10):1481. doi:10.3390/cancers11101481
19. 19.DiMarco AN, Wong MS, Jayasekara J, et al. Risk ofneeding completion thyroidectomy for low-riskpapillary thyroid cancers treated by lobectomy. BJSOpen 2019;3(3):299–304.doi: 10.1002/bjs5.50137.
20. 20.Li YJ, Wang YZ, Yi ZB, Chen LL, Zhou XD.Comparison of completion thyroidectomy and primary total surgery for differentiated thyroid cancer: A meta-analysis. Oncol Res Treat 2015;38(10):528–31. doi: 10.1159/000440690.
21. 21.Dalquen P, Rashed B, Hinsch A, et al.Feinnadelaspiration (FNA) der Schilddrüse:Analysediskrepanterzytologischer undhistologischerDiagnosen [Fine-needle aspiration(FNA) of the thyroid gland: Analysis of discrepancies between cytological and histological diagnoses].Pathologe 2016;37(5):465–72. doi: 10.1007/s00292-016-0172-x.
22. 22.Zimmermann MB, Boelaert K. Iodine deficiencyand thyroid disorders. Lancet Diabetes Endocrinol2015;3(4):286–95. doi: 10.1016/S2213-8587(14)70225-6.
23. 23.Weiss W. Chernobyl thyroid Cancer: 30 years offollow-up overwiew. RadiatProt Dosimetry2018;182(1):58–61. doi: 10.1093/rpd/ncy147
24. 24.Tronko M, Brenner AV, BogdanovaT,et al.Thyroid neoplasia risk is increased nearly 30 yearsafter the Chernobyl accident. Int J Cancer 2017;141(8):1585–8. doi: 10.1002/ijc.30857.
25. 25.Fridman M, Krasko O, Lam AK. Optimizingtreatment for children and adolescents withpapillary thyroid carcinoma in post-Chernobylexposed region: The roles of lymph node dissectionsin the central and lateral neck compartments. Eur JSurgOncol 2018;44(6):733–43.doi:10.1016/j.ejso.2017.12.004.
26. 26.Cahoon EK, Nadyrov EA, Polyanskaya ON, et al.Risk of Thyroid Nodules in Residents of BelarusExposed to Chernobyl Fallout as Children andAdolescents. J ClinEndocrinolMetab2017;102(7):2207–17. doi: 10.1210/jc.2016-3842
27. 27.Kaliszewski K, Zubkiewicz-Kucharska A,Wojtczak B, Strutynska-Karpinska M. Multi- andUnifocal Thyroid Microcarcinom: Are there anydifferences? AdvClinExp Med 2016;25(3):485-92.Doi: 10.17219/acem/62327