Abstract
To analyze the association of clinical, anatomical, and ultrasound (US) characteristics of malignancies in Bethesda III or IV (III-B or IV-B) thyroid nodules. The association between malignancies and the following variables were analyzed: III-B or IV-B, age < 55 years and ≥ 55 years, sex, family history of thyroid cancer, history of irradiation, nodule size, and ACR TI-RADS classification in 62 participants who underwent thyroidectomy. Of the 62 participants, 87.1% (54/62) were women, 74.2% were < 55 years old, 95.2% had no family history of thyroid cancer, 56.5% had nodules < 2 cm in size, 62.9% were IV-B, and 69.4% were ACR TI-RADS 4. Thirty-two patients had thyroid carcinoma, and 30 had benign histology. Among all factors associated with malignancy, only ACR TI-RADS 5 classification on US was found to be statistically significant (p = 0.014), while III-B with architectural atypia cytological classification was the only one significantly associated with benign status (p = 0.004). Only a high risk of malignancy as assessed using US was able to refine the indication for molecular tests in a group of patients with indeterminate nodules. We found 85% (53/62) of III-B or IV-B thyroid nodules would benefit from available molecular diagnostic tests.
Highlights
The detection of thyroid nodules has increased considerably in recent decades, and most present with benign histology
These subtypes were described in the latest edition of the Bethesda classification published in 2017 as nuclear atypia due to the presence of enlarged and prominent nuclei with pale chromatin, in addition to rare pseudoinclusions in the AUS/ FLUS [11] classification and that in these groups with nuclear atypia there was a 2.6-fold risk in relation to the group that presented with architectural changes only [1,14]
There was a reduction in the p-value (0.0040 to 0.0014), suggesting a greater statistical association with malignancy when simplifying the analysis to III-B with nuclear atypia vs. IV-B (Table 2)
Summary
The detection of thyroid nodules has increased considerably in recent decades, and most present with benign histology. The focus of this study is III-B and IV-B, with each found in approximately 10% of all FNABs, since V-B already presents with a high risk of malignancy, which is sufficient surgical indication in most cases (high pre-test probability) In this scenario, the use of molecular tests has gained importance [15], since it is necessary to use tools to assist in the preoperative diagnostic definition of thyroid nodules that are not highly suspected of being malignant or benign because of the characteristics available at this stage of the investigation (US, cytological, risk factors for thyroid carcinoma). Risk factors for thyroid cancer were prospectively analyzed [33,34,35], including a positive family history of thyroid cancer, age, sex, and nodule size, in addition to Bethesda cytological and US ACR TI-RADS classifications, to determine which anatomical, clinical, and US characteristics, alone or considered together, would be able to predict the malignancy or benignity of III-B or IV-B nodules, in the preoperative period, to dispense with the use of molecular panels
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
