Malignancy rates and risk factors in Bethesda category IV thyroid nodules: Is lobectomy enough in an endemic region?

Yıl 2022, Cilt: 39 Sayı: 3, 749 - 754, 30.08.2022

Ali Özdemir Mikail Uyan Süleyman Kalcan Muhammet Kadri Çolakoğlu Ahmet Pergel

Öz

In this paper, we determined the rates of Bethesda IV thyroid nodules and we calculated the malignancy rates of these nodules in a university hospital located in an endemic area for thyroid diseases. We aimed to define the predictive factors for malignancy to select patients who need surgery. Between January 2012 and December 2018, 221 patients who had preoperative biopsy as follicular neoplasm/suspicious for a follicular neoplasm and underwent thyroidectomy were included in the study. The datas about patient characteristics, preoperative ultrasound results indications for operation and postoperative pathologicale valuation results were evaluated. Index and incidental malignancy rates were calculated. The malignancy rate of index Bethesda Category IV nodules was 48.9 %. Incidental malignancy rate was 30.7 %. There was no statistical difference between patients who had benign and malignant pathology results in terms of gender, age, preoperative diagnosis, size of the index nodule, number and results of biopsies and the operation performed. The most important risk factor among all parameters was hypoechogenicity of the nodule. Solid structure increase this risk. Ultrasonographic hypoechogenicity is the most important risk factor for preoperative malignancy risk assessment for Bethesda Category IV thyroid nodules. Centers should determine their malignancy rates with particular risk factors and determine their surgical approaches in endemic regions.

Anahtar Kelimeler

Bethesda category IV nodules, follicular neoplasm/suspicious for follicular neoplasm, thyroid nodules

Kaynakça

• 1. Dal Maso L, Panato C, Franceshi S, Serraino D, Buzzoni C , Busco S, et al. The impact of overdiagnosis on thyroid cancer epidemic in Italy, 1998-2012. Eur J Cancer 2018; 94: 6-15.
• 2. Horn-Ross PL, Lichtensztajn DY, Clarke CA, Dosiou C, Oakley-Girvan I, Reynolds P, et al. Continued rapid increase in thyroid cancer incidence in California: trends by patient, tumor and neighborhood characteristics. Cancer Epidemiol Biomarkers Prev 2014;23:1067-79.
• 3. 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. Thyroid 2016; 26: 1–133.
• 4. Wong LQ, Baloch ZW. Analysis of the bethesda system for reporting thyroid cytopathology and similar precursor thyroid cytopathology reporting schemes. Adv Anat Pathol 2012; 19: 313-19.
• 5. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol 2009; 132: 658–65.
• 6. Seiberling KA, Dutra JC and Gunn J. Ultrasound-guided fine needle aspiration biopsy of thyroid nodules performed in the office. Laryngoscope 2008; 118: 228-31.
• 7. Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid 2017; 27: 1341-46.
• 8. Gulcelik NE, Gulcelik MA, Kuru B. Risk of malignancy in patients with follicular neoplasm: predictive value of clinical and ultrasonographic features. Arch Otolaryngol Head Neck Surg 2008;134:1312–15.
• 9. Kiernan CM, Solorzano CC. Bethesda Category III, IV and V. Thyroid Nodules Can nodule size help predict malignancy? J Am Coll Surg 2017; pii: S1072–7515(17)30178-3.
• 10. Lee SH, Baek JS, Lee JY, Lim JA, Cho SY, Lee TH, et al. Predictive factors of malignancy in thyroid nodules with a cytological diagnosis of follicular neoplasm. Endocr Pathol 2013;24:177–83.
• 11. Acar Y, Dogan L, Güven HE, Aksel B, Karaman N, Özaslan C, et al. Bethesda made it clearer: A review of 542 patients in a single institution. Oncol Res Treat 2017;40:277-80.
• 12. Rosenblum RC, Shtabsky A, Marmor S, Trejo L, Yaish I, Barnes S, et al. Indeterminate nodules by the Bethesda system for reporting thyroid cytopathology in Israel: Frequency and risk of malignancy after reclassification of follicular thyroid neoplasm with papillary-like features. Eur Surg Oncol 2019; doi:10.1016/j.ejso.2019.03.015.
• 13. Thewjitcharoen Y, Butadej S, Nakasatien S, Chotwanvirat P, Porramatikul S, Krittiyawong S, et al. Incidence and malignancy rates classified by the Bethesda system for reporting thyroid cytopathology (TBSRTC) – An 8-year tertiary center experience in Thailand. J Clin Transl Endocrinol 2018;16:100175.
• 14. Lee KH, Shin JH, Ko ES, Hahn SY, Kim JS, Kim JH, et al. Predictive factors of malignancy in patients with cytologically suspicious for Hurthle cell neoplasm of thyroid nodules. Int J Surg 2013;11:898-902.
• 15. Najafian A, Olson MT, Schneider EB, Zeiger MA. Clinical presentation of patients with a thyroid follicular neoplasm: are there preoperative predictors of malignancy? Ann Surg Oncol 2015;22:3007-13.
• 16. Kuru B, Kefeli M. Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category IV (FN/SFN). Diagn Cytopathol 2018;46:489-94.
• 17. Conzo G, Calo PG, Gambardella C, Tartaglia E, Mauriello C, Pietra CD, et al. Controversies in the surgical management of thyroid follicular neoplasms. Retrospective analysis of 721 patients. Int J Surg 2014;1:29-34.
• 18. Conzo G, Avenia N, Ansaldo GL, Calò P, Palma MD, Dobrinja C, et al. Surgical treatment of thyroid follicular neoplasms: results of a retrospective analysis of a large clinical series. Endocrine 2017;55:530-38.
• 19. Nikiforov YE, Seethala RR, Tallini G, Baloch ZW, Basolo F, Thompson LD, et al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol 2016;2:1023-29.