Effects of preoperative fine needle aspiration biopsy on surgical strategy in patients with papillary thyroid carcinomas

Abstract

Aim: Papillary thyroid carcinomas (PTCs) usually have good prognosis. In the presence of lymph node metastasis, capsular invasion and extra-thyroidal extension, some PTCs may display aggressive behavior. Early diagnosis of these cases is extremely important. Ultrasound-guided fine needle aspiration biopsy (FNAB) is an important diagnostic procedure and may identify the PTC likely to behave aggressively. Our study aimed to examine the effects of FNAB on surgical strategy in patients with PTC. 

Methods: The data of 269 patients who underwent total thyroidectomy were evaluated in our retrospective cohort study. FNAB had been performed in 188 (70%) patients. Patients with non-incidental diagnoses were compared with patients who had incidental diagnoses in terms of parameters likely to be related to aggressive PTC. 

Results: Patients ≤ 45 years old were more common in the non-incidental group (P=0.041). Incidental diagnoses were common in females (P=0.014), those with nodules larger than 2 cm in diameter and in patients with ≥2 nodules (P=0.001). Postoperative remnant thyroid tissue was observed more commonly in incidental cases (P=0.008). Lymph node metastasis (P=0.044), capsular invasion (P=0.009), and extra-thyroidal extension (P=0.022) were more common in the non-incidental group. 

Conclusion: It is difficult estimate the behavior of PTCs preoperatively. Only a small number of PTCs can be preoperatively diagnosed with ultrasound-guided FNAB. The extent of surgery generally is defined by FNAB results. Detailed examination of all suspicious nodules is of great importance for earlier detection of aggressive PTCs and avoiding surgical over-treatment.

Keywords

• Papillary thyroid carcinoma,FNAB,Incidental,Non-incidental

Papiller tiroid karsinomlu hastalarda ince iğne aspirasyon biyopsinin cerrahi strateji üzerine etkileri

Öz

Amaç: Papiller tiroid karsinomları (PTK) genellikle iyi prognozludur. Lenf nodu metastazı, kapsül invazyonu ve ekstratiroidal yayılım varlığında, bazı PTK’lar agresif seyir gösterebilir. Bu vakaların erken teşhisi son derece önemlidir. Ultrason eşliğinde ince iğne aspirasyon biyopsi (İİAB) önemli bir tanı prosedürüdür ve agresif davranış gösteren muhtemel PTK’ları erken tanıyabilir. Çalışmamız, PTK'lı hastalarda İİAB’nin cerrahi strateji üzerindeki etkilerini incelemeyi amaçlamıştır.

Yöntemler: Retrospektif kohort çalışmamızda total tiroidektomi uygulanan 269 hastanın verileri gözden geçirildi. Preoperatif İİAB 188 (%70) hastaya uygulanmıştı. Non insidental tanı konan hastalar, insidental tanı konan hastalar ile PTK’nın agresif davranışına bağlı olabilecek parametreler açısından istatistiksel olarak karşılaştırıldı.

Bulgular: Non-insidental grupta yaşı ≤ 45 olan hastalar daha sıktı (P=0,041). İnsidental vakalar kadınlarda (P=0,014), çapı 2 cm’den büyük nodüllerde ve nodül sayısı ≥2 olan hastalarda daha sıktı (P=0,001). Postoperatif rezidü tiroid dokusu insidental grupta daha sık gözlendi (P=0,008). Lenf nodu metastazı (P=0,044), kapsül invazyonu (P=0,009) ve ekstratiroidal yayılım (P=0,022) non-insidental grupta daha sıktı. 

Sonuç: PTK’ların biyolojik davranışlarını preoperatif olarak tahmin etmek zordur. Ameliyat öncesi ultrason eşliğinde İİAB kullanılarak PTK’ların az bir kısmı teşhis edilebilir. Genellikle ameliyatın kapsamı İİAB sonuçlarıyla belirlenmektedir. Tüm şüpheli nodüllerin detaylı muayenesi, agresif davranış gösteren PTK’ların daha erken tespiti ve aşırı cerrahi tedavinin önlenmesi açısından çok önemlidir.

Anahtar Kelimeler

• Papiller tiroid karsinomu,İİAB,İnsidental,Non-insidental

Kaynakça

1. 1. Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol. 2013:965212.
2. 2. Alevizaki M, Papageorgiou G, Rentziou G, Saltiki K, Marafelia P, Loukari E, et al. Increasing prevalence of papillary thyroid carcinoma in recent years in Greece: the majority are incidental. Thyroid. 2009;19:749-54.
3. 3. Vaccarella S, Dal Maso L, Laversanne M, Bray F, Plummer M, Franceschi S. The impact of diagnostic changes on the rise in thyroid cancer incidence: a population-based study in selected high-resource countries. Thyroid. 2015;25:1127-36.
4. 4. Griniatsos J, Tsigris C, Kanakis M, Kaltsas G, Michail O, Dimitriou N, et al. Increased incidence of papillary thyroid cancer detection among thyroidectomies in Greece between 1991 and 2006. Anticancer Res. 2009;29:5163-9.
5. 5. Nikiforov YE, Steward DL, Robinson-Smith TM, Haugen BR, Klopper JP, Zhu Z, et al. Molecular testing for mutations in improving the fine-needle aspiration diagnosis of thyroid nodules. J Clin Endocrinol Metab. 2009;94:2092-8.
6. 6. Du L, Wang Y, Sun X, Li H, Geng X, Ge M, et al. Thyroid cancer: trends in incidence, mortality and clinical-pathological patterns in Zhejiang Province, Southeast China. BMC Cancer. 2018;18:291.
7. 7. Özçelik S , Çelik M , Özçelik M . Evaluation of preoperative neutrophil-lymphocyte ratio in differentiated thyroid carcinoma with lymph node metastasis. J Surg Med. 2019;3:377-80.
8. 8. Ito Y, Nikiforov YE, Schlumberger M, Vigneri R. Increasing incidence of thyroid cancer: controversies explored. Nat Rev Endocrinol. 2013;9:178-84.

9. 9. Welker MJ, Orlov D. Thyroid nodules. Am Fam Physician. 2003;67:559-66.
10. 10. Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008;22:901-11.
11. 11. Dauksiene D, Petkeviciene J, Klumbiene J, Verkauskiene R, Vainikonyte-Kristapone J, Seibokaite A, et al. Factors Associated with the Prevalence of Thyroid Nodules and Goiter in Middle-Aged Euthyroid Subjects. Int J Endocrinol. 2017;2017:8401518.
12. 12. Tamhane S, Gharib H. Thyroid nodule update on diagnosis and management. Clin Diabetes Endocrinol. 2016;2:17.
13. 13. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2005:237:794-800.
14. 14. Remonti LR, Kramer CK, Leitão CB, Pinto LC, Gross JL. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid. 2015;25:538-50.
15. 15. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167-214.
16. 16. Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154:787-803.
17. 17. Lang BH, Ng SH, Lau LL, Cowling BJ, Wong KP, Wan KY. A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid. 2013;23:1087-98.
18. 18. Wang TS, Dubner S, Sznyter LA, Heller KS. Incidence of metastatic well-differentiated thyroid cancer in cervical lymph nodes. Arch Otolaryngol Head Neck Surg. 2004;130:110-3.
19. 19. Shi RL, Qu N, Yang SW, Ma B, Lu ZW, Wen D, et al. Tumor size interpretation for predicting cervical lymph node metastasis using a differentiated thyroid cancer risk model. Onco Targets Ther. 2016;9:5015-22.
20. 20. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 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.
21. 21. Lombardi CP, Bellantone R, De Crea C, Paladino NC, Fadda G, Salvatori M, et al. Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area. World J Surg. 2010;34:1214-21.
22. 22. Pisanu A, Reccia I, Nardello O, Uccheddu A. Risk factors for nodal metastasis and recurrence among patients with papillary thyroid microcarcinoma: differences in clinical relevance between nonincidental and incidental tumors. World J Surg. 2009;33:460-8.
23. 23. Kaliszewski K, Zubkiewicz-Kucharska A, Kiełb P, Maksymowicz J, Krawczyk A, Krawiec O. Comparison of the prevalence of incidental and non-incidental papillary thyroid microcarcinoma during 2008-2016: a single-center experience. World J Surg Oncol. 2018;16:202.
24. 24. Pagni F, Jaconi M, Delitala A, Garancini M, Maternini M, Bono F, et al. Incidental papillary thyroid carcinoma: diagnostic findings in a series of 287 carcinomas. Endocr Pathol. 2014;25:288-96.
25. 25. Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH. Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality. Cancer. 2003;98:31-40.
26. 26. Wang Y, Li L, Wang YX, Feng XL, Zhao F, Zou SM, et al. Ultrasound findings of papillary thyroid microcarcinoma: a review of 113 consecutive cases with histopathologic correlation. Ultrasound Med Biol. 2012;38:1681-8.
27. 27. Vlassopoulou V, Vryonidou A, Paschou SA, Ioannidis D, Koletti A, Klonaris N, et al. No considerable changes in papillary thyroid microcarcinoma characteristics over a 30-year time period. BMC Res Notes. 2016;9:252.