Abstract
BackgroundIdentification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians. This study investigates the ability of clinical, cytological and sonographic data to predict malignancy in indeterminate nodules with the scope of determining the need for total thyroidectomy in these patients.MethodsThe study population consisted of 249 cases presenting indeterminate nodules (Thy3): 198 females (79.5%) and 51 males (20.5%) with a mean age of 52.43 ± 13.68 years. All patients underwent total thyroidectomy.ResultsMalignancy was diagnosed in 87/249 patients (34.9%); thyroiditis co-existed in 119/249 cases (47.79%) and was associated with cancer in 40 cases (40/87; 45.98%). Of the sonographic characteristics, only echogenicity and the presence of irregular margins were identified as being statistically significant predictors of malignancy. 52/162 benign lesions (32.1%) and 54/87 malignant were hypoechoic (62.07%); irregular margins were present in 13/162 benign lesions (8.02%), and in 60/87 malignant lesions (68.97%). None of the clinical or cytological features, on the other hand, including age, gender, nodule size, the presence of microcalcifications or type 3 vascularization, were significantly associated with malignancy.ConclusionsThe rate of malignancy in cytologically indeterminate lesions was high in the present study sample compared to other reported rates, and in a significant number of cases Hashimoto’s thyroiditis was also detected. Thus, considering the fact that clinical and cytological features were found to be inaccurate predictors of malignancy, it is our opinion that surgery should always be recommended. Moreover, total thyroidectomy is advisable, being the most suitable procedure in cases of multiple lesions, hyperplastic nodular goiter, or thyroiditis; the high incidence of malignancy and the unreliability of intraoperative frozen section examination also support this preference for total over hemi-thyroidectomy.
Highlights
Identification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians
All patients with Thy3 nodules underwent total thyroidectomy (TT), as routinely practiced in this Institute; intraoperative frozen section examination was not used as a means of diagnosing thyroid cancer and to determine the extent of thyroidectomy since our pathologists consider the usefulness of this procedure to be very limited with little benefit in terms of patient outcome
Clinical data and histological diagnosis Thyroiditis co-existed in 119/249 patients (47.79%); it was associated with cancer in 40 patients (40/87; 45.98%) and with benign pathology in 79/162 patients (48.77%: in 52 cases with a hyperplastic nodular goiter and in 27 with a follicular adenoma)
Summary
Identification of the best management strategy for nodules with Thy cytology presents particular problems for clinicians. Ultrasound-detectable nodules, may be present in 30-50% of the population [3,5] They are usually benign [1,2,6,7,8]; 5-15% prove to be malignant [1,2,4,5,7,9]. In 2007, the ‘Thy’ classification system was introduced by the British Thyroid Association (BTA) to guide the management of the thyroid nodules based on FNAC analysis of the thyroid. They suggested a management plan for each of the five diagnostic categories obtained (Thy to Thy5) [2]
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