SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules : Recommendations in thyroid cytology: from technique to interpretation

One- or Two-Step Total Thyroidectomy for Cancer Indications: A 20-Year Retrospective Study from a Referral Center

BACKGROUND

The ATA guidelines suggest lobectomy as an option for select patients with thyroid cancer (TC), but some may need completion thyroidectomy because of unfavorable characteristics on the final pathology. This study aimed to compare postoperative morbidity of patients with TC who underwent total thyroidectomy in two steps (TT2) or one step (TT1).

METHODS

This was a retrospective comparative study in a high-volume endocrine surgery center. All consecutive adult patients who underwent total thyroidectomy in one step (TT1 group) or two steps (TT2 group) for follicular, oncocytic, or papillary TC between 2000 and 2020 were included. Surgical complications were compared between the two groups using propensity score matching, with a 2:1 allocation, according to age, sex, BMI, tumor stage, lymph node dissection, and year of surgery.

RESULTS

In total, 5693 patients were enrolled, with 684 with TT2 and 5009 with TT1. Following adjustment, TT2 patients had significantly lower rates of transient hypocalcemia than TT1 patients did (3.2% versus 13.8%, p < 0.001). There was no significant difference in permanent hypocalcemia (2.1% versus 1.3%, p = 0.290), transient or permanent recurrent laryngeal nerve (RLN) injury (2.3% versus 3.5%, p = 0.201; 1.3% versus 1.3%, p = 0.998), hematoma (0.9% versus 1.2%, p = 0.591), or wound infection rates (0% versus 0.7%, p = 0.062).

CONCLUSIONS

Total thyroidectomy in two steps for thyroid cancer can be performed safely, with short- and long-term complications at least similar to those of total thyroidectomy in one step.

[SFE-AFCE-SFMN 2022 consensus on the management of thyroid nodules: Interest and place of thyroid cytology]

The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a symptom that is a frequent reason for consultation in endocrinology. Thyroid nodules are very common and mostly benign. Thyroid ultrasound and thyroid fine-needle aspiration biopsy (FNAB) are the reference tests for the analysis of these nodules. The aim of this article is to describe for the cytopathologist the key points of the SFE-AFCE-SFMN 2022 consensus involving thyroid cytology: the indications for thyroid FNAB, the technique and analysis, and the management (treatment, follow-up) following this cytological screening examination, a key element in the management of the thyroid nodule.

Diagnostic Performance of ACR TI-RADS and ATA Guidelines in the Prediction of Thyroid Malignancy: A Prospective Single Tertiary Center Study and Literature Review

AIM

This study sought to compare two common risk stratification systems in terms of their diagnostic performance for the evaluation of thyroid malignancy.

METHODS

The American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA) guidelines were compared among 571 thyroid nodules with definitive fine needle aspiration (FNA) cytology or postoperative histopathology. Ultrasound characteristics such as composition, echogenicity, shape, margin, size, and vascularity were assessed for each thyroid nodule. Diagnostic performance measures were determined and compared through receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).

RESULTS

Of 571 nodules, 65 (11.4%) were malignant. The AUC, sensitivity, specificity, positive predictive value, and negative predictive value were 0.691, 49.2%, 84.9%, 29.6%, and 92.8% for ATA guideline, and 0.776, 72.3%, 79.2%, 30.9%, and 95.7%, for ACR TI-RADS, respectively. ACR TI-RADS was more sensitive (p = 0.003), while the ATA guideline was more specific (p < 0.001). DCA demonstrated that the ACR TI-RADS provided a greater net benefit than the ATA guideline. In addition, the net reduction in unnecessary biopsies is higher for ACR TI-RADS than ATA guidelines. The total number of indicated biopsies and unnecessary FNA rates were lower in ACR TI-RADS compared to ATA guideline (293 vs. 527 and 80.2 vs. 87.8). ACR TI-RADS presented no biopsy indication in seven malignant nodules (all categorized as TR2), whereas ATA guideline missed one. Hypoechogenicity was the most significant predictor of malignancy (OR = 8.34, 95% CI: 3.75-19.45), followed by a taller-than-wide shape (OR = 6.73, 95% CI: 3.07-14.77).

CONCLUSIONS

Our findings suggest that each system has particular advantages in the evaluation of thyroid nodules. ACR TI-RADS reduces unnecessary FNA rates, however, malignant nodules categorized as TR2 might be missed using this system. Further evaluation of this group of nodules using Doppler and other ultrasound modalities is recommended.