Definition of Clinical Risk Factors for Differential Thyroid Cancers in Patients with Nodular Goiter

Öz

Objective: This study aimed to evaluate the clinical, radiological, and laboratory risk factors for differentiated thyroid cancers in patients with nodular thyroid disease and to investigate the relationship between these findings and the cytopathological features of the nodules. Materials and Methods: Demographic data, laboratory and imaging findings, and fine-needle aspiration pathology results of 323 patients with incidentally detected thyroid nodules during clinical or radiological examination at the Endocrinology Clinic were retrospectively evaluated and recorded. Results: Fine-needle aspiration biopsy of the dominant nodules revealed that 309 (95.6%) patients had benign nodules, while 14 (4.33%) had malignant nodules. Among patients with benign nodules, microcalcifications were detected in 274 (88.7%) cases, and macrocalcifications were observed in 18 (5.8%). In the malignant group, irregular nodule margins were noted in 1 (7.1%) patient, and multinodular goiter was present in 8 (57.1%). On thyroid ultrasound imaging, 8 (57.1%) patients with malignant nodules exhibited hypoechoic nodules, and 4 (28.6%) displayed microcalcifications. The internal structure of malignant dominant nodules was heterogeneous in 10 (71.4%) cases. Conclusion: This study examined the relationship between histological results and various nodule characteristics, including echogenicity, diameter, calcification type, edge irregularity, autoimmunity, thyroid hormone levels, and cystic content. No significant associations were identified in the analyses, including the presence of microcalcifications (p = 0.074). Broad-spectrum prospective studies with larger patient cohorts are needed to provide further insights and contribute to the existing literature.

Anahtar Kelimeler

• Nodular goiter
• Thyroid cancer
• Risk factors

Nodüler Guatrli Hastalarda Diferansiye Tiroid Kanserleri için Klinik Risk Faktörlerinin Tanımlanması

Öz

Amaç: Çalışmamızda, nodüler tiroid hastalarda diferansiye tiroid kanserleri için klinik, radyolojik ve laboratuar risk faktörlerinin değerlendirilmesi ve bu bulguların nodüllerin sitopatolojik özellikleri ile ilişkisinin saptanması amaçlanmıştır. Gereç ve Yöntemler: Endokrinoloji Polikliniğine başvuran, muayene ile veya radyolojik tetkik sırasında tesadüfi olarak tiroid nodülü saptanan 323 hastanın demografik verileri, laboratuvar ve görüntüleme bulguları, ince iğne aspirasyon patoloji sonuçları retrospektif olarak değerlendirildi ve kaydedildi. Bulgular: Olguların dominant nodüllerinden yapılan ince iğne aspirasyon biyopsisi sonucunda 309(%95,6) hastanın benign, 14(%4,33) hastanın ise malign nodüle sahip olduğu saptanmıştır. Benign nodüle sahip olguların 274’ünde(%88,7) mikrokalsifikasyon, 18’inde(%5,8) makrokalsifikasyon saptandı. Malign nodüllü olguların 1 (%7.1) inde nodül sınırları düzensiz, hastaların 8(%57,1) inde multinodüler guatr tespit edildi. Tiroid ultrason görüntülemesinde 82(%57,1) hastanın nodülleri hipoekoik iken 4(%28,6) hastada mikrokalsifikasyon mevcuttu. Malign dominant nodülün iç yapısı 10(%71,4) olguda heterojen izlendi. Sonuç: Histolojik sonuçlarla nodüllerin yapısı, ekojenitesi, çapı, kalsifikasyon içeriği, kenar düzensizliği, eşlik eden otoimmunite, tiroid hormon düzeyi, kistik içeriği arasında ilişki araştırılmış ancak yapılan analizlerde ilişki saptanmamıştır. Mikrokalsifikasyon varlığı açısından tüm gruplarda anlamlı fark izlenmemiştir (p=0.074). Bu konuda literatüre katkı amaçlı daha çok hasta içeren geniş spektrumlu prospektif çalışmaların dizayn edilmesine ihtiyaç vardır.

Anahtar Kelimeler

• Noduler guatr
• Tiroid kanser
• Risk faktörleri

Kaynakça

1. Guth S., Theune U., Aberle J., Galach A., Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest 2009; 39(8):699-706. Doi: 10.1111/j.1365-2362.2009.02162.x.
2. Pacini F., Schlumberger M., Dralle H., Elisel R., Smit J., Wiersinga W. European consensus for the management of patients with differentisted thyroid carcinoma of the follicular epitelium. Eur J End 2006; 154(6):787-803. Doi:10.1530/eje.1.02158.
3. Haugen BR., Alexander EK., Bible KC., et al. American Thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016; 26(1):1-133. Doi:10.1089/thy.2015.0020.
4. Tan GH., Gharib H. Thyroid incidentalomas management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 1997; 126(3):226-31. Doi:10.7326/0003-4819-126-3-199702010-00009.
5. Wang C., Crapo LM. The epidemiology of thyroid disease and implications for screening. Endocrinol Metab Clin North Am 1997; 26(1):189-218. Doi:10.1016/s0889-8529(05)70240-1.
6. Oyar O. Neck ultrasonography first ed. Izmir: E.U.Basimevi; 2000 .p.85-100.
7. Haymart MR., Reyes-Gastelum D., Caoili E., Norton EC,. Banerjee M. The relationship between imaging and thyroid cancer diagnosis and survival. The Oncologist 2020; 25(9): 765–771. Doi:10.1634/theoncologist.2020-0159.
8. Witczak J., Taylor P., Chai J., et al. Predicting malignancy in thyroid nodules: feasibility of a predictive model integrating clinical, biochemical, and ultrasound characteristics. Thyroid Res 2016; 9(4). Doi:10.1186/s13044-016-0033-y.

9. Bessey LJ., Lai NB., Coorough NE., Chen H., Sippel RS. The incidence of thyroid cancer by fine needle aspiration varies by age and gender. J Surg Res 2013; 184(2):761-65. Doi:10.1016/j.jss.2013.03.086.
10. Ugurlu S., Caglar E., Yesim TE., Tanrikulu E., Can G., Kadioglu P. Evaluation of thyroid nodules in Turkish population. Intern Med 2008; 47(4):205-9. Doi:10.2169/internalmedicine.47.0608.
11. Al-Hakami HA., Alqahtani R., Alahmadi A., Almutairi D., Algarni M., Alandejani T. Thyroid nodule size and prediction of cancer: a study at tertiary care hospital in Saudi Arabia. Cureus 2020; 12(3):7478. Doi:10.7759/cureus.7478.
12. Clark DP. Thyroid cytopathology, First ed.B oston: Springer; 2005. p.1-178.
13. Yang J., Schnadig V., Logrono R., Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer 2007; 111(5):306-315. Doi:10.1002/cncr.22955.
14. Pasha HA., Dhanani R., Mughal A., Ahmed KS., Suhail A. Malignancy rate in thyroid nodules with atypia or follicular lesion of undetermined significance. Int Arch Otorhinolaryngol 2020; 24(2):221-26. Doi:10.1055/s-0039-1698784.
15. Seagrove-Guffey MA., Hatic H., Peng H., Bates KC., Odugbesan AO. Malignancy rate of atypia of undetermined significance follicular lesion of undetermined significance in thyroid nodules undergoing FNA in a suburban endocrinology practice: a retrospective cohort analysis. Cancer cytopathol 2018; 126(10):881–8. Doi.org/10.1002/cncy.22054.
16. Mizukami Y., Michigishi T., Nonomura A, et al. Autonomously functioning (hot) nodule of the thyroid gland. a clinical and histopathologic study of 17 cases. Am J Clin Pathol 1994; 101(1):29-35. Doi:10.1093/ajcp/101.1.29.
17. Jeh SK., Jung SL., Kim BS., Lee YS. Evaluating the degree of conformity of papillary carcinoma and follicular carcinoma to the reported ultrasonographic findings of malignant thyroid tumor. Korean J Radiol 2007; 8(3):192-97. Doi:10.3348/kjr.2007.8.3.192.
18. Cappelli C., Castellano M., Pirola I, et al. Thyroid nodule shape suggests malignancy. Eur J Endocrinol 2006; 155(1):27-31. Doi:10.1530/eje.1.02177.