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Cheng J, Han B, Chen Y, Li Q, Xia W, Wang N, Lu Y. Clinical risk factors and cancer risk of thyroid imaging reporting and data system category 4 A thyroid nodules. J Cancer Res Clin Oncol 2024; 150:327. [PMID: 38914743 PMCID: PMC11196368 DOI: 10.1007/s00432-024-05847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Beyond the Thyroid Imaging Reporting and Data System (TIRADS) classification of thyroid nodules, additional factors must be weighed in the decision to perform fine needle aspiration (FNA). In this study, we aimed to identify risk factors for malignancy in patients with ultrasound-classified Chinese-TIRADS (C-TIRADS) 4 A nodules. METHODS Patients who underwent thyroid FNA at our institution between May 2021 and September 2022 were enrolled. We collected demographic data, including age, sex, previous radiation exposure, and family history. An in-person questionnaire was used to collect lifestyle data, such as smoking habits and alcohol consumption. Body mass index (BMI) was calculated. The serum levels of thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TGAb) were measured. Prior to FNA, ultrasonic inspection reports were reviewed. The cytologic diagnoses for FNA of thyroid nodules followed the Bethesda System for Reporting Thyroid Cytopathology (2017). RESULTS Among the 252 C-TIRADS 4 A nodules, 103 were malignant. Compared to those in the benign group, the patients in the malignant group had a younger age (42.2 ± 13.6 vs. 51.5 ± 14.0 years, P < 0.001). Logistic regression showed that advanced age was associated with a lower risk of malignancy in C-TIRADS 4 A nodules (OR = 0.95, 95% CI 0.93 ~ 0.97, P < 0.001). We demonstrated a decreased risk of malignancy in patients with 48.5 years or older. CONCLUSION Advanced age was associated with a decreased risk of malignancy in patients with C-TIRADS 4 A nodules. This study indicated that in addition to sonographic characteristics, patient age should be considered when assessing the risk of malignancy.
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Affiliation(s)
- Jing Cheng
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Bing Han
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Yingchao Chen
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Qin Li
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Wenwen Xia
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Ningjian Wang
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Yingli Lu
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China.
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Badash I, Moran M, Chambers T, Kokot N. Managing Bethesda IV thyroid nodules in an iodine-deficient population. Gland Surg 2023; 12:1332-1335. [PMID: 38021194 PMCID: PMC10660176 DOI: 10.21037/gs-23-361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023]
Affiliation(s)
| | - Marcela Moran
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tamara Chambers
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Niels Kokot
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Yang Z, Gao X, Yang L. Predictors and a prediction model for positive fine needle aspiration biopsy in C-TIRADS 4 thyroid nodules. Front Endocrinol (Lausanne) 2023; 14:1154984. [PMID: 37554760 PMCID: PMC10405816 DOI: 10.3389/fendo.2023.1154984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/04/2023] [Indexed: 08/10/2023] Open
Abstract
Objectives To screen out the predictors and establish a prediction model of positive fine needle aspiration biopsy (FNAB) in the Chinese Guidelines for Malignant Risk Stratification of Thyroid Nodule Ultrasound (C-TIRADS) 4 thyroid nodules, and this nomogram can help clinicians evaluate the risk of positive FNAB and determine if FNAB is necessary. Methods We retrospectively analyzed data from 547 patients who had C-TIRADS 4 thyroid nodules and underwent fine-needle aspiration biopsy (FNAB) at the Second Affiliated Hospital of Chongqing Medical University between November 30, 2021 and September 5, 2022. Patients who met our inclusion criteria were divided into two groups based on positive or negative FNAB results. We compared their ultrasound (US) features, BRAF V600E status, thyroid function, and other general characteristics using univariate and multivariate logistic regression analyses to identify independent predictors. These predictors were then used to construct a nomogram. The calibration plot, area under the curve (AUC), and decision curve analysis were employed to evaluate the calibration, discrimination, and clinical utility of the prediction model. Results Out of 547 patients, 39.3% (215/547) had a positive result on fine-needle aspiration biopsy (FNAB), while 60.7% (332/547) had a negative result. Univariate logistic regression analysis revealed no significant differences in TPOAb, TgAb, TSH, Tg, nodule location, sex, or solid status between the two groups (P>0.05). However, age, nodule size, internal or surrounding blood flow signal, microcalcifications, aspect ratio, morphology, and low echo showed significant differences (P<0.05). Multivariate logistic regression analysis was conducted to explore the correlation between potential independent predictors. The results showed that only age (OR=0.444, 95% Cl=0.296~0.666, P<0.001), low echo (OR=3.549, 95% Cl=2.319~5.432, P<0.001), microcalcifications (OR=2.531, 95% Cl=1.661~3.856, P<0.001), aspect ratio (OR=3.032, 95% Cl=1.819~5.052, P<0.001), and morphology (OR=2.437, 95% Cl=1.586~3.745, P<0.001) were independent predictors for a positive FNAB. These variables were used to construct a prediction nomogram. An ROC curve analysis was performed to assess the accuracy of the nomogram, and AUC=0.793, which indicated good discrimination and decision curve analysis demonstrated clinical significance within a threshold range of 14% to 91%. Conclusion In conclusion, 5 independent predictors of positive FNAB, including age (≤45 years old), low echo (yes), microcalcifications (yes), aspect ratio (>1) and morphology (irregular), were identified. A nomogram was established based on the above 5 predictors, and the nomogram can be used as a complementary basis to help clinicians make decisions on FNAB of C-TI-RADS 4 thyroid nodules.
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Affiliation(s)
| | | | - Lu Yang
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Barcelos RN, Camacho CP, da Conceição de O C Mamone M, Ikejiri ES, Vanderlei FAB, Yang JH, Padovani RP, Martins LAL, Biscolla RPM, Macellaro D, Lindsey SC, Maciel RMB, Martins JRM. Risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy in thyroid nodules with diameters greater than 4 centimeters. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e000644. [PMID: 37364146 PMCID: PMC10661008 DOI: 10.20945/2359-3997000000644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/04/2023] [Indexed: 06/28/2023]
Abstract
Objective The risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy (FNAB) of thyroid nodules (TN) with diameters ≥ 3-4 cm remains controversial. However, some groups have indicated surgical treatment in these patients regardless of the FNAB results. We aimed to evaluate the diagnostic accuracy of the FNAB in systematically resected ≥4 cm TN and if the risk of malignancy is higher in these patients. Subjects and methods We retrospectively evaluated 138 patients (142 nodules) with TN with diameters ≥4 cm who underwent thyroidectomy. Results The FNAB results were nondiagnostic/unsatisfactory (ND/UNS) in 2.1% of the cases and benign in 51.4%. They indicated atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 23.9% of cases, follicular neoplasia/suspicious for a follicular neoplasm (FN/SFN) in 9.2%, suspicion of malignancy (SUS) in 8.5%, and malignant in 4.9%. The histopathological analysis after thyroidectomy revealed a thyroid cancer rate of 100% in the FNABs classified as malignant, 33.3% in SUS cases, 7.7% in FN/SFN, 17.6% in AUS/FLUS, and 4.1% in benign FNABs. None of the ND/UNS FNABs were malignant. The global malignancy diagnosis was 14.8% (n = 21). However, the rate of false negatives for FNAB was low (4.1%). Conclusion We showed that the risk of malignancy in nodules with diameters ≥4 cm was higher compared to the risk of thyroid cancer in TN in general. However, we found a low rate of false-negative cytological results; therefore, our data do not justify the orientation of routine resection for these larger nodules.
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Affiliation(s)
- Rafaela N Barcelos
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Cléber P Camacho
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Laboratório de Inovação Molecular e Biotecnologia, Programa de Pós-graduação em Medicina, Universidade Nove de Julho (Uninove), São Paulo, SP, Brasil
| | - Maria da Conceição de O C Mamone
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Elza S Ikejiri
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Felipe A B Vanderlei
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Ji H Yang
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rosália P Padovani
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Leandro A L Martins
- Laboratório de Anatomia Clínica e Patológica, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Rosa Paula M Biscolla
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Danielle Macellaro
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Susan C Lindsey
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rui M B Maciel
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - João Roberto M Martins
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil,
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Babajani A, Rahmani S, Raoufi M, Eidgahi ES, Dastjerdi AV, Behfarnia P, Khalili S, Moghaddam NA. Clinico-cytopathological subcategorization in thyroid nodules of atypia of undetermined significance/follicular lesion of undetermined significance using the TIRADS and Bethesda classifications. Front Endocrinol (Lausanne) 2023; 14:1135196. [PMID: 37313444 PMCID: PMC10258349 DOI: 10.3389/fendo.2023.1135196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/28/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction Bethesda category III - atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is a heterogeneous class of the Bethesda system for thyroid nodules. In order to clarify the therapeutic road for clinicians, this category was subclassified based on the cytopathological features. In this study, we evaluated the risk of malignancy, surgical outcome, demographic characteristics, and correlation of ultrasound features with the final outcome in patients with thyroid nodules based on AUS/FLUS subclassification. Method After evaluating 867 thyroid nodules from three different centers, 70 (8.07%) were initially diagnosed as AUS/FLUS. The cytopathologists re-interpreted the FNA samples and subclassified them into five subcategories: architectural atypia, cytologic atypia, cytologic and architectural atypia, and Hürthle cell AUS/FLUS, and atypia, which was not specified. Based on the suspicious ultrasound features, an appropriate ACR TI-RADS score was allocated to each nodule. Finally, the malignancy rate, surgical outcomes, and ACR TI-RADS scores were evaluated among Bethesda category III nodules. Results Among the 70 evaluated nodules, 28 (40%) were subclassified as Hürthle cell AUS/FLUS, 22 (31.42%) as cytologic and architectural atypia, 8 (11.42%) as architectural atypia, 7 (10%) as cytologic atypia, and 5 (7.14%) as atypia which was not specified. The overall malignancy rate was 34.28%, and the architectural atypia and Hürthle cell nodules displayed lower malignancy compared to other groups (P-Value<0.05). Utilizing ACR TI-RADS scores showed no statistical significance between Bethesda III subcategorization and ACR TI-RADS scores. However, ACR TI-RADS can be a reliable predictor for Hürthle cell AUS/FLU nodules. Conclusion ACR TI-RADS helps evaluate malignancy only in the Hürthle cell AUS/FLUS subcategory of AUS/FLUS. Besides, cytopathological reporting based on the suggested AUS/FLUS subclassification could help clinicians take appropriate measures to manage thyroid nodules.
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Affiliation(s)
- Amirhesam Babajani
- Oncopathology Research Center, Department of Molecular Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Pathology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Rahmani
- Oncopathology Research Center, Department of Molecular Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Pathology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoomeh Raoufi
- Department of Radiology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Shaarbaf Eidgahi
- Kidney Transplantation Complication Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Poya Behfarnia
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shayesteh Khalili
- Department of Internal Medicine, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Noushin Afshar Moghaddam
- Department of Pathology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rastegar H, Torshizian A, Yaghoubi MA, Khoshhal N, Asadi M, Morovatdar N, Mohebbi M. Accuracy of fine-needle aspiration cytopathology to differentiate malignant and benign thyroid nodules with ≥4 cm diameter: A retrospective study. Diagn Cytopathol 2023; 51:263-269. [PMID: 36585850 DOI: 10.1002/dc.25096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/28/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Thyroid nodules (TN) are commonly present in the general population and are usually pathologically benign. An initial diagnosis with fine-needle aspiration (FNA) cytopathology could help clinical decision-making with fewer complications. As the previous studies suggest surgical procedures for >4 cm TNs, we aimed to investigate the accuracy of preoperative FNA cytology to predict malignancy risk in these nodules in a sample of the Iranian population. METHODS Patients with ≥4 cm TNs who had preoperative FNA cytology, underwent nodulectomy and had a histopathological report were included. Each patient's preoperative demographic, ultrasonographic, and cytology data were gathered. After surgery, resected samples were assessed pathologically and diagnosed as benign or malignant. Finally, data were analyzed to evaluate the presurgical accuracy of the FNA cytology. RESULTS We identified 41 (51.25%) patients with malignant legions among our study population (N = 80). The pathology reports were indeterminate in 3 patients with follicular neoplasm. Bethesda scores were substantially higher in patients with malignancy. The sensitivity, specificity, and false-negative rate of FNA cytology reports using the Bethesda system were 73.7%, 74.2%, and 26.3%, respectively. There was no association between malignancy and TNs' size, neither their volume nor their highest diameter. CONCLUSION FNA cytology is not as sensitive and specific in nodules>4 cm as in smaller ones. However, it can still be used alongside other diagnostic procedures in malignancy screening. Clinicians should make more complex decisions considering various influential factors to avoid missing malignant lesions and reduce diverse probable complications of highly invasive diagnostic surgery. Further prospective research on >4 cm TNs and their multiple features' association with malignancy is required for more precise judgment.
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Affiliation(s)
- Houra Rastegar
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ashkan Torshizian
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Ali Yaghoubi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nastaran Khoshhal
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Asadi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Mohebbi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Boers T, Braak SJ, Rikken NET, Versluis M, Manohar S. Ultrasound imaging in thyroid nodule diagnosis, therapy, and follow-up: Current status and future trends. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023. [PMID: 36655705 DOI: 10.1002/jcu.23430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Ultrasound, the primary imaging modality in thyroid nodule management, suffers from drawbacks including: high inter- and intra-observer variability, limited field-of-view and limited functional imaging. Developments in ultrasound technologies are taking place to overcome these limitations, including three-dimensional-Doppler, -elastography, -nodule characteristics-extraction, and novel machine-learning algorithms. For thyroid ablative treatments and biopsies, perioperative use of three-dimensional ultrasound opens a new field of research. This review provides an overview of the current and future applications of ultrasound, and discusses the potential of new developments and trends that may improve the diagnosis, therapy, and follow-up of thyroid nodules.
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Affiliation(s)
- Tim Boers
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Sicco J Braak
- Department of Radiology, Ziekenhuisgroep Twente, Hengelo, the Netherlands
| | - Nicole E T Rikken
- Department of Endocrinology, Ziekenhuisgroep Twente, Hengelo, the Netherlands
| | - Michel Versluis
- Physics of Fluids Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Srirang Manohar
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
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Abstract
Benign or malignant thyroid nodules are common in adults. Fine needle aspiration biopsy is the gold standard for diagnosis. Most thyroid nodules are benign. Ultrasound imaging is the optimal noninvasive imaging modality to determine which nodules demonstrate malignant features. The American College of Radiology Thyroid Imaging Reporting and Data System committee published a standardized approach to classifying nodules on ultrasound. The ultrasound features in this system are categorized as benign, minimally suspicious, moderately suspicious, or highly suspicious for malignancy. Applying the Thyroid Imaging Reporting and Data System results in a meaningful decrease in the number of thyroid nodules biopsied.
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Chen Z, Mosha SS, Zhang T, Xu M, Li Y, Hu Z, Liang W, Deng X, Ou T, Li L, Li W. Incidence of microcarcinoma and non-microcarcinoma in ultrasound-found thyroid nodules. BMC Endocr Disord 2021; 21:38. [PMID: 33663475 PMCID: PMC7934238 DOI: 10.1186/s12902-021-00700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/16/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUNDS The incidence of thyroid nodules is increasing year by year around the world. However, ultrasound is not recommended as a screening test for the general population or patients with a normal thyroid on palpation by the American Association of Clinical Endocrinologists (AACE). In practice, some individuals with normal thyroid palpation have nodules that can just be found out by ultrasound. No studies have directly described the risk of nodules found by ultrasound or by palpation up to now. More evidence is needed to carry out for helping us balance the over diagnosis and missed diagnosis of malignant lesions. Therefore, we carried out a retrospective study to investigate the incidence of malignant lesions in ultrasound-found nodules in a large cohort. METHODS We conducted a retrospective analysis involving 2957 patients who underwent thyroid ultrasound evaluation and fine-needle aspiration (FNA) between Jan 2013 and Dec 2019. The cytologic examinations were analyzed based on the Bethesda system. For nodules suspected to be follicular neoplasm or other malignant tumors by cytological tests, patients were recommended for surgery and histopathology examinations. RESULTS Compared with palpation-found nodules, ultrasound-found nodules were presenting less as purely cystic nodules (10.1 % vs. 39.9 %, x2 = 355.69, p = 0.000), smaller size (17.5 ± 9.9 mm vs. 28.0 ± 12.5 mm, t = 23.876 p = 0.000), and higher TI-RADS score (5.5 ± 2.9 vs. 3.4 ± 3.3, t = 18.084, p = 0.000), respectively. More ultrasound-found nodules were diagnosed as carcinoma by histology examinations [136 (11.2 %) nodules found by ultrasound vs. 68 (3.9 %) by palpation, x2 = 59.737, p = 0.000], and 88 (64.7 %) nodules found by ultrasound were non-microcarcinoma. Among the malignant nodules confirmed by histopathology, a higher proportion of microcarcinoma was detected in ultrasound-found nodules [35.3 % (48/136) vs. 16.2 % (11/68), x2 = 8.183, p = 0.004]. CONCLUSIONS In view of the results observed in our research, malignant nodules were more common in nodules screened out by ultrasound, and nearly two thirds of them were non-microcarcinoma. We suggest the recommendation against screening thyroid nodules by ultrasound needs to be re-evaluated.
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Affiliation(s)
- Zhi Chen
- Department of Endocrinology, The Third Affiliated Hospital, Southern Medical University, No.183 Zhongshan Avenue West, Tianhe District, 510630, Guangzhou, China
| | - Singla Sethiel Mosha
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China
| | - Tong Zhang
- Department of Endocrinology, The Third Affiliated Hospital, Southern Medical University, No.183 Zhongshan Avenue West, Tianhe District, 510630, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasound, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China
| | - Yanli Li
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China
| | - Zhuoqing Hu
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China
| | - Weiqiang Liang
- Department of Endocrinology, Affiliated Nanhai Hospital of Southern Medical University, No.40 Foping Road, Nanhai District, 528200, Foshan, China
| | - Xiaoyi Deng
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China
| | - Tingting Ou
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China
| | - Ling Li
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China.
| | - Wangen Li
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, No.250 Changgang Road East, Haizhu District, 510260, Guangzhou, China.
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