Evaluation of cytologically benign solitary thyroid nodules by ultrasonography: A retrospective analysis of 1877 cases

Effect of ultrasound parameters of benign thyroid nodules on radiofrequency ablation efficacy

BACKGROUND AND AIM

Ultrasound-guided radiofrequency ablation (RFA) is a minimally invasive therapy for thyroid nodules (TNs). Understanding the determinants of RFA efficacy can improve treatment and prognosis. This study aims to investigate the relationship between ultrasound parameters of benign TNs and the efficacy of RFA.

METHODS

A pretest-posttest interventional study was conducted in 2021 on 250 randomly sampled patients with benign TNs, receiving RFA. For this purpose, the volume reduction (VR) and the VR ratio (VRR) of the nodules were measured at the 1-, 3-, 6-, and 12-month follow-up periods after the RFA completion. The technical success rate (TSR) of this procedure was then categorized into four states, including low (VRR < 25%), moderate (VRR = 25-49%), high (VRR = 50-74%), and very high (VRR ≥ 75). Ordered logistic regression (OLR) was further utilized to investigate the effect of the ultrasound parameters of TNs on the TSR. The analyses were notably performed using Stata 14.2.

RESULTS

The VRR at the 1-, 3-, 6-, and 12-month follow-up periods were 38.7%, 53.6%, 59.3%, and 59.9%, respectively. The mean VR was also statistically significant at all follow-ups (p < 0.001). At the 1-, 3-, and 6-month follow-up periods, the VR of over 50% was observed in 28.2%, 52.1%, and 65.2% of the nodules, respectively. The odds ratios (ORs) of the RFA success were found to be 4.3 times higher for the nodules in the left lobe compared to the right lobe (OR: 4.31, p = 0.002), 6.3 times greater for isoechoic nodules compared to hyperechoic nodules (OR: 6.39, p < 0.001), 6.2 times higher for hyper-vascular nodules compared to hypo-vascular nodules (OR: 6.25, p = 0.005), and 2.3 times greater for mixed nodules compared to solid ones (OR: 2.37, p = 0.049).

CONCLUSION

The ultrasound parameters of TNs had a statistically significant effect on the efficacy of RFA. Small-sized, isoechoic, and hyper-vascular nodules, as well as those with mixed tissue, were observed to respond better to RFA, leading to a better prognosis in terms of VR after treatment.

Differential gene expression profile of multinodular goiter

Introduction

The goiter, a neglected heterogeneous molecular disease, remains a major indication for thyroidectomies in its endemic regions.

Objectives

This study analyzed differential gene expression in surgical specimens diagnosed with multi nodular and compared the data to that of thyroid tissue without multinodular goiter from patients undergoing thyroidectomy in Manaus-AM, Brazil using RNA-seq technology.

Methodology

The transcriptome information of the surgical specimen fragments with and without multinodular goiter was accessed by Illumina HiSeq 2000 New Generation Sequencing (NGS) using the RNA-seq NEBNext^® Ultra^™ RNA Library Prep Kit for Illumina^®—#E7530L protocol and differential gene expression analysis.

Results

Differences were found between the gene expression profiles of the diseased tissues and those of the healthy control tissues; at least 70 genes were differentially expressed. The HOTS gene was expressed only in multinodular goiter tissues (p < 0.05).

Conclusion

These results demonstrate that the gene expression profile of multinodular goiter is pro-tumoral and that HOTS can play a central role in multinodular goiter development.

Long-term outcomes of cytologically benign thyroid tumors: a retrospective analysis of 3,102 patients at a single institution

Some thyroid tumors that are cytologically diagnosed as benign may be pathologically diagnosed as malignant. Here, we investigated the long-term outcomes of patients with thyroid tumors with benign cytology, and the factors for malignancy. We retrospectively reviewed the cases of 3,102 patients with thyroid tumors >1 cm cytologically diagnosed as benign at our hospital during a 1-year period from January 2007. The median follow-up duration for all patients was 68.7 (range 0.0-168.7) months. Immediate surgery and delayed surgery were performed in 393 and 148 patients, respectively. Eventually, 541 (17.4%) of the 3,102 patients underwent a thyroidectomy, and 2,561 (82.6%) were observed without surgery. Among the surgically treated patients, the tumors of 525 (97.0%) and 16 (3.0%) were pathologically diagnosed as benign and malignant, respectively. There was no significant difference in age, gender, tumor size, serum thyroglobulin level at surgery, or the tumor volume-doubling rate (TV-DR) between the benign and malignant cases. Only the ultrasonographic findings based on our hospital's classification system were directly and significantly linked to pathological diagnosis (p < 0.01). Among the tumors of the 667 patients who were followed without surgery for >10 years, 89.9% remained unchanged and 7.2% were reduced in size. Ultrasonographic evaluation provides important information for therapeutic decision-making regarding surgery versus observation for cytologically benign tumors.

Patient satisfaction of radiofrequency ablation for symptomatic benign solid thyroid nodules: our experience for 2-year follow up

Background

The patient satisfaction of symptoms improvement and disease factors that may affect long-term treatment efficacy of radiofrequency ablation (RFA) for non-functioning solid benign thyroid nodules (TNs) over a 2-year follow up study was investigated.

Methods

This retrospective study evaluated 194 non-functioning solid benign TNs of 103 patients. The TNs were categorized as small (≤5 ml), medium (5.1 to 13 ml), intermediate (13.1 to 30 ml) and large (over 30 ml) according to the initial volume of TNs before ablation. Clinical evaluation and contrast-enhanced ultrasound (CEUS) were carried out before ablation and the follow up at 1, 3, 6 months and every 6 months after ablation. All patients were asked to assess the cosmetic score (1–4 scores) and symptom score (0–10 scores) before ablation and every follow up after ablation.

Results

All patients underwent RFA without any major complications. The mean treatment sessions were 1.5 ± 0.6. 98 nodules required a single session (98/194, 50.5%), 87 required two sessions (87/194, 44.9%), 9 required three sessions (9/194, 4.6%). The average follow up months were 16.3 ± 5.6 (range, 6–24 months) and no nodule regrew in our study. After RFA treatment, the TNs volume significantly decreased (P < 0.001). The small group of nodules shrunk larger compared to the medium, intermediate and large groups (P < 0.001). Cosmetic signs and pressure symptoms were significantly improved, particularly in the intermediate and large groups (P < 0.05).

Conclusions

RFA is effective for treating non-functioning solid benign TNs and controlling clinical symptoms with a low complication rate during 2 years follow up. The reduction rate was related to the initial volume of nodules. Patients were satisfied with cosmetic signs and pressure symptoms improvement, particularly in the intermediate and large groups. However, multiple RFA treatments should be used in larger nodules to achieve the desired clinical outcomes.

Type 2 diabetes mellitus is more prevalent among patients with thyroid carcinoma and influences overall survival: a propensity score matching analysis

The relationship between Type 2 Diabetes Mellitus(T2DM) and cancer risk has been investigated for more than a decade. Many types of cancer were confirmed to be related with T2DM. The aim of this study is to identify the relationship between T2DM and the prevalence and long-term survivals of Thyroid Carcinoma(TC) using propensity score matching. In present study, 1658 thyroid nodule patients who were diagnosis in Beijing Shijitan hospital were divided into two groups: the TC group (N = 455, 27.4%), and the benign thyroid nodule(BTN) group (N = 1203, 73.6%). Propensity scores analyses were used to compare the overall survival (OS) and recurrence-free survival (RFS) between patients with or without T2DM. After propensity scores analyses, the prevalance of T2DM was significantly increased in the TC group compared with BTN group. Of the 455 TC patients, with T2DM in thyroid carcinoma was associated with increasing 1-, 3-, 5-year OS rates from 98.8, 76.5, and 70.9% to 99.7, 92.2, and 82.7%, respectively (P=0.017). While the 1-, 3-, and 5-year RFS rates in the group with T2DM were 92.3, 69.5, and 58.3%, which were significantly lower than those in the group without T2DM (97.6, 82.7, and 72.4%, P=0.009). After propensity scores analyses, with T2DM was significantly associated with increased risks of OS and RFS in the entire TC cohort.

Evaluation of the safety and efficacy of radiofrequency ablation for treating benign thyroid nodules

Background: Radiofrequency ablation (RFA) is a relatively new procedure for treating benign thyroid nodules. The purpose of this study was to evaluate the safety and efficacy of RFA for treating benign thyroid nodules so as to serve as a reference for future clinical practice. Methods: This study retrospectively analyzed the clinical data of patients receiving percutaneous RFA for treating thyroid nodules from November 2014 to July 2015 in our medical center. One hundred and eight patients with a total of 380 nodules received ultrasound-guided RFA for treating thyroid nodules. Comparisons of the volume change of thyroid nodules before and after RFA treatment, post-treatment complication, and change of thyroid function, were carried out afterwards. Results: Before treatments, all patients received fine needle aspiration biopsy (FNA) which supported the diagnosis of benign tumor. There were 13 males and 95 females included in the study. Twenty-six cases (24.07%) had single nodule, and 82 cases (75.93%) had multiple nodules. Before treatments, the thyroid functions (FT3, FT4, and TSH) were normal originally or adjusted to normal range by endocrinology treatment. The preoperative nodules had minimum volume of 0.01mL, maximum volume of 70.89 mL, and mean volume of 1.02 ± 4.24mL. The volume of nodules one month and three months after RFA were 0.29 ± 0.72mL and 0.15 ± 0.87mL, respectively. In addition, volume reduction ratio (VRR) of nodules one month and three months after RFA were 64.12% and 85.54%, respectively. Both volume of nodules and VRR had statistically significant differences for pre-operative and post-operative comparison (P<0.05). Thyroid functions were in normal range after treatments, and there was no serious complications. Conclusions: Ultrasound-guided RFA treating benign thyroid nodules had the advantages of definite efficacy, safety, strong in control ability, no incision, less damage to surrounding normal tissues and no effect on thyroid function. It can be used as one of the main treatment methods for treating benign thyroid nodules.

Thyroid Hormones, Autoantibodies, Ultrasonography, and Clinical Parameters for Predicting Thyroid Cancer

Our objective was to evaluate thyroid nodule malignancy prediction using thyroid function tests, autoantibodies, ultrasonographic imaging, and clinical data. We conducted a retrospective cohort study in 1400 patients with nodular thyroid disease (NTD). The thyroid stimulating hormone (TSH) concentration was significantly higher in patients with differentiated thyroid cancer (DTC) versus benign thyroid nodular disease (BTND) (p = 0.004). The receiver operating characteristic curve of TSH showed an AUC of 0.58 (95% CI 0.53-0.62, p = 0.001), sensitivity of 74%, and specificity of 57% at a cut-off of 1.59 mIU/L. There was an incremental increase in TSH concentration along with the increasing tumor size (p < 0.001). Thyroglobulin antibody (TgAb) concentration was associated with an increased risk of malignancy (p = 0.029), but this association was lost when the effect of TSH was taken into account (p = 0.11). Thyroid ultrasonographic characteristics, including fewer than three nodules, hypoechoic appearance, solid component, poorly defined margin, intranodular or peripheral-intranodular flow, and punctate calcification, can be used to predict the risk of thyroid cancer. In conclusion, our study suggests that preoperative serum TSH concentration, age, and ultrasonographic features can be used to predict the risk of malignancy in patients with NTD.

Predicting the Size of Benign Thyroid Nodules and Analysis of Associated Factors That Affect Nodule Size

This study aimed to identify factors that affect the size of benign thyroid nodules and to predict nodule size by using a newly developed model. Because most thyroid nodules are benign, they are commonly only monitored. Only a few studies have evaluated the natural progression or regression of benign thyroid nodules. Large-scale studies on the subject are nonexistent. Between January 2001 and December 2011, our study subjects were selected from among 1,564 patients with benign thyroid nodules (2,469 nodules) in a retrospective analysis. We measured nodule size and volume and attempted to predict nodule size by using a newly developed model. Nodules were considered to have increased in size if the total volume increased by >15%. Nodules that increased in size over time required a longer follow-up period than nodules that decreased in size. The proportion of females and the cystic proportion of the nodules were relatively high in our study sample. For thyroid nodules that increased in size, we analyzed potential predictive factors. Larger nodule volume, extended follow-up period, and high cystic proportion were positively associated with increased nodule size. According to the model we developed in our study, the nodules in the group with an increase in size grew at an approximate rate of 0.034 cm³ per year when controlled for other factors. Percutaneous ethanol injection or radiofrequency ablation is performed for cosmetic purposes and proper functioning if or when nodules reach a certain size. The model used in our study may offer helpful insight in determining an optimal treatment schedule for benign thyroid nodules.

Is an Increase in Thyroid Nodule Volume a Risk Factor for Malignancy?

BACKGROUND

Most benign thyroid nodules found on fine-needle aspiration cytology (FNAC) can be followed with periodic ultrasonography. During follow-up, when nodules grow, re-aspiration or surgical resection for a histologic diagnosis is recommended. However, there is little evidence regarding the malignancy risk associated with nodule growth.

METHOD

We retrospectively reviewed the records of 542 patients with FNAC-diagnosed adenomatous nodules (ANs) who underwent surgery in 2011-2012 at Kuma Hospital. Among them, 196 patients had surgical resection because of nodule volume growth (median, 1.94 times; range, 1.21-27.60) during the observation period (mean, 45.9 months). Excluding nodule growth, the remaining 346 patients underwent surgery for various reasons including the large size of nodules or the appearance of undefined ultrasound features suspicious for malignancy during follow-up. For comparison, we reviewed 409 patients with FNAC-diagnosed follicular neoplasms (FNs) operated on in 2011-2013. Most (n=327) underwent surgery shortly after the FNAC diagnosis, while 82 patients were observed for a period of time and had a late operation due to nodule volume growth (median, 2.70 times; range, 1.27-15.82).

RESULTS

The histologic diagnoses of the 196 growing FNAC-diagnosed ANs were 158 ANs, 32 follicular adenomas (FAs), 4 follicular tumors of uncertain malignant potential (FT-UMP; 2%), and 2 malignancies (1%). The 346 patients who underwent surgery for reasons other than nodular growth had 16 FT-UMP (4.6%) and 16 malignancies (4.6%). This suggests that nodule growth itself is not a risk factor for malignancy. On the other hand, there were 23 FT-UMP (28%) and 15 malignancies (18.3%) in the 82 growing FNAC-diagnosed FNs, while 44 FT-UMP (13.5%) and 54 malignancies (16.5%) in the 327 FNAC-diagnosed FN patients who underwent immediate surgery. The malignant potential was significantly higher in the growing-FN group than the immediate-surgery FN group (p<0.05). No significant difference was found in the volume change between the benign and the FT-UMP plus malignant group in the growing FNs, suggesting that a growth rate does not correlate with malignant potential.

CONCLUSION

This is the first demonstration that the malignancy risk is low in FNAC-diagnosed ANs, even if the nodules grow significantly, whereas FNs have a higher risk when they grow.

The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules three centimeters or larger in size

BACKGROUND AND PURPOSE

Whether under ultrasonography (US) guidance or not, fine-needle aspiration biopsy (FNAB) has some limitations, particularly in larger nodules. In this study, we aimed to evaluate the diagnostic value of US-guided fine-needle aspiration biopsy (US-FNAB) in thyroid nodules equal to or larger than 3 cm.

MATERIALS AND METHODS

Data of 267 patients operated for nodular goiter in the period of January 2006 and March 2012 were reviewed retrospectively. The study group (40 males, 104 females; mean age 42.3 ± 12.3, between 17 and 71) consisted of patients with nodules with a diameter of 3 cm or larger. Patients with nodules less than 3 cm in diameter were considered as the control group (27 males, 96 females; mean age 44.4 ± 11.9, between 18 and 71).

RESULTS

For nodules smaller than 3 cm, US-FNAB had an accuracy rate of 60% and a false negativity rate of 21.9%. In nodules equal to or larger than 3 cm, the accuracy rate of US-FNAB was 80%, with a false negativity rate of 6.7%. Malignancy was observed in 16% of the study group and 42.3% of the control group.

CONCLUSION

This study showed that increased nodule diameter is not associated with limitations in the diagnostic value of US-FNAB. We also found that the malignancy rate was smaller for larger nodules. This finding reflects the importance of accurate and rational diagnostic work-up and clinical management for detecting malignancy and surgical decision-making.

Thyroid nodule with benign cytology: is clinical follow-up enough?

Objective

In this multicenter study, we investigated the management algorithm for thyroid nodules with benign cytology using US features from data collected from 7 institutions.

Materials and Methods

The institutional review board approved this retrospective study. Data on 700 focal thyroid nodules in 673 consecutive patients were collected from 7 university-affiliated hospitals. This study included nodules that were diagnosed as benign at initial cytologic evaluation and that underwent pathologic or follow-up study. The risk of malignancy was compared according to the US assessments of each institution as well as looking at all the nodules together as a whole.

Results

Of the 700 nodules, 688 (98.3%) were benign and 12 (1.7%) were malignant. If initial cytologic results were benign, the likelihood of the nodule actually being malignant was from 1 to 3%, varying by institution. The likelihood of a cytologically benign nodule with positive US being malignant (4.7%, 8/169) was higher than that of one without positive US (0.8%, 4/531) (P = .002).

Conclusion

Based on our multicenter study, repeat FNA should be performed in thyroid nodules with initial benign cytology showing suspicious US features in order to decrease the number of false negative cases.