Does fine needle aspiration from a different nodule other than the dominant nodule provide additional benefit in thyroid diseases with nodules?

Abstract

Objectives: The incidence of thyroid nodules has increased significantly and malignancy detected in 5-15% of them. While biopsy is recommended for all nodules larger than 1 cm in multinodular goiter, this is practically not possible in many patients. In addition, the relationship between nodule size and malignancy is not clear. We aimed to examine the value of additional biopsy from a nondominant nodule in terms of changing treatment and follow-up decisions and the relationship between nodule size and malignancy risk. Material and Method: Patients (n=2,541) with thyroid nodules who applied to our clinic for various indications and performed fine needle aspiration between January 1, 2016 and March 1, 2021 were included in the study. Some of our patients with multinodular goiter were biopsied from a second additional nodule. Cytologic evaluations reported according to the Bethesta system. Pathology reports of the operated patients were scanned retrospectivelly. Results: Fine needle aspiration biopsy was performed from a total of 3382 nodules of 2541 patients. The average age of our patient group was 56 (46-65) and 79% of them were women. When a comparison was made between nodule size and malignancy rate; the highest malignancy rate was detected in nodules between 1-2 cm (61,8%). Finally, a diagnosis of Bethesta-4,-5,-6 was reached in only 7 (0.9%) of 823 patients who underwent additional biopsy from nondominant nodule. Conclusion: The value of an additional biopsy from a second nodule in terms of changing follow-up is very low and not significant and most of the cancers arise from nodules between 1-2 cm. According to our study, the assumptions that the malignancy risk increases as the nodule size or nodule count increase were not found to be correct.

Keywords

• Thyroid nodule
• Fine Needle Aspiration Biopsy
• Thyroid Cancer

References

1. Ross DS,Cooper DS, Mulder JE, et al. Overview of Thyroid Nodule Formation. UpToDate Clinical Review. Online Available at http://www.uptodate.com Searched at May 2021.
2. Ross DS,Cooper DS, Mulder JE, et al. Diagnostic Approach to and Treatment of Thyroid Nodules. UpToDate Clinical Review. Online Available at http://www.uptodate.com Searched at May 2021.
3. Burman KD, Wartofsky L. Clinical practice thyroid nodules. N Engl J Med 2015; 10: 2347-56.
4. Cavallo A, Johnson DN, White MG, et al. Thyroid nodule size at ultrasound as a predictor of malignancy and final pathologic size. Thyroid 2017; 27: 641-50.
5. Er S, Akın T, Baba S, et al. Relationship between Thyroid Nodule Diameter and Malignancy: Nodüle Diameter Actually Increase Probability of Malignancy? Akd Med J 2017; 3: 191-6.
6. Brito JP, Yarur AJ, Prokop LJ, McIver B, Murad MH, Montori VM. Prevalence of thyroid cancer in multinodular goiter versus single nodule: a systematic review and meta-analysis. Thyroid 2013; 23: 449-55.
7. Frates MC, Benson CB, Doubilet PM, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab 2006; 91: 3411-7.
8. Lin YS, Wu HY, Yu MC, Hsu CC, Chao TC. Patient outcomes following surgical management of multinodular goiter: Does multinodularity increase the risk of thyroid malignancy? Medicine (Baltimore) 2016; 95: e4194.

9. Sachmechi I, Miller E, Varatharajah R, et al. Thyroid carcinoma in single cold nodules and in cold nodules of multinodular goiters. Endocr Pract 2000; 6: 5-7.
10. Keh SM, El-Shunnar SK, Palmer T, Ahsan SF. Incidence of malignancy in solitary thyroid nodules. J Laryngol Otol 2015; 129: 677-81.
11. Paksoy N, Yazal K, Corak S. Malignancy rate in nondominant nodules in patients with multinodular goiter: Experience with 1,606 cases evaluated by ultrasound-guided fine needle aspiration cytology. Cytojournal 2011; 8: 19-28.
12. 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: 1-133.
13. Gharib H, Papini E, Garber JR, et al. American association of clinical endocrinologists, american college of endocrinology, and associazione medici endocrinology medical guıdelines for clinical practice for the diagnosis and management of thyroid nodules 2016 Update. AACE/ACE/AME task force on thyroid nodules. Endocr Pract 2016; 22: 622-39.
14. Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid 2017; 27:1341–6.
15. Erdem H, Yıldırım Ü, Özaydın İ, et al. Retrospective comparison of histopathologic results of thyroid fine-needle aspiration biopsies. Konuralp Tıp Derg 2012; 4: 26-30.
16. Arısoy K, Köksoy FN, Gönüllü D, Ayyıldız İğdem A, Kuru B. The relationship of thyroid cancer with dominant nodule in patients with nodular goiter who underwent total thyroidectomy and had thyroid carcinoma. Ulusal Cerrahi Derg 2012; 28: 182-85.
17. Yong JS, Loh KS, Petersson BF, Thong M. Multinodular goiter: A study of malignancy risk in nondominant nodules. Ear Nose Throat J 2017; 96: 336-42.
18. Erbil Y, Barbaros U, Salmaslioglu A, et al. Effect of thyroid gland volume in preoperative detection of suspected malignant thyroid nodules in a multinodular goiter. Arch Surg 2008; 143: 558-63.
19. Mehanna R, Murphy M, McCarthy J, et al. False negatives in thyroid cytology: impact of large nodule size and follicular variant of papillary carcinoma. Laryngoscope 2013; 123: 1305–09.
20. Shin JJ, Caragacianu D, Randolph GW. Impact of thyroid nodule size on prevalence and post-test probability of malignancy: a systematic review. Laryngoscope 2015; 125: 263-72.
21. Polyzos SA, Kita M, Efstathiadou Z, et al. The use of demographic, ultrasonographic and scintigraphic data in the diagnostic approach of thyroid nodules. Exp Clin Endocrinol Diabetes 2009; 117: 159–64.
22. Kamran SC, Marqusee E, Kim MI, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab 2013; 98: 564–70.
23. Shrestha M, Crothers BA, Burch HB. The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-needle aspiration: a 10-year study from a single institution. Thyroid 2012; 22: 1251–6.
24. Baser H, Topaloglu O, Bilginer MC, et al. Are cytologic and histopathologic features of hot thyroid nodules different from cold thyroid nodules? Diagn Cytopathol 2019; 47: 898-903.