Abstract
We assess the role of thyroid fine needle aspiration cytology(FNAC) in our series of elderly patients. The growing subset of people aged older than 70 years has shown an increased incidence of thyroid diseases which need to be studied in order to reduce the percentage of surgical treatments in patients with higher likelihood of co-morbidities and associated life risk. We compared Follicular/Indeterminate Neoplasms(FN) and suspicious of malignancy(SM) with pediatric and adult cohorts. We discussed the role of immunocytochemistry-ICC to refine diagnoses. Four hundred and eighty out of 3539FNACs(13.5%) in elderly patients, were surgical followed-up. They included: 35Inadequate, 188benign(BL), 164FN/AUS, 49SM and 44positive for malignancy (PM). All PM and 95.7%BL were histological confirmed. The malignant rate was 24.3% mostly diagnosed as papillary thyroid carcinomas. An ICC panel (HBME-1 and Galectin-3) was carried out on liquid based cytology (LBC) and performed on FN/AUS, SM and PM. We found concordant positive ICC in 69.3%malignancies and concordant negative ICC in 97.6%benign follicular adenomas. Among FNs, 42.9%malignant histologic cases had concordant positivity whilst 97.4%benign histology had negative panel. Thyroid FNAC shows high feasibility in elderly patients. ICC helps in reducing the number of useless thyroidectomies and providing a more adequate clinical and/or surgical selection in elderly patients.
Highlights
Thyroid nodules are a common finding with up to 50% of the patients with at least one thyroid nodule characterized by an average and estimate risk of malignancy at about 5% [1,2]
Based on our previous experiences with ICC in adult and pediatric thyroid series [1,2,20], we evaluated whether the application of the same immunopanel comprised of Hector Battifora mesothelial cell-1 (HBME-1) and Galectin-3 might avoid unnecessary surgery in these elderly patients frequently affected by co-morbidities and disease burden
We found a total of 59 papillary thyroid cancers (PTC) with the majority of the cases (76%) within the suspicious for malignancy (SM) (13 cases) and positive for malignancy (PM) (32 cases) categories; 37 follicular variant of PTC (FVPC) with a strong prevalence (73%) between the FN/AUS (14 cases) and the SM (13 cases) categories; 5 follicular thyroid cancers (FTC) and 6 Hurtle cells carcinomas (HCC) almost all in the FN/AUS category, whereas most of the 6 medullary carcinoma (MTC) and all the 3 anaplastic carcinoma (ATC) were found in the PM category
Summary
Thyroid nodules are a common finding with up to 50% of the patients with at least one thyroid nodule characterized by an average and estimate risk of malignancy at about 5% [1,2]. Whilst no single clinical and radiological test has proven to show 100% sensitivity and specificity, fine-needle aspiration cytology (FNAC) is likely to be considered as the most important and primary diagnostic tool for the evaluation and diagnosis of thyroid lesions regardless of patient age. It has worldwide application because of its simplicity, safety, and cost-effectiveness [6,7,8,9,10,11,12,13]. All the different classification systems currently in use for reporting thyroid cytopathology do not include any specific criteria for the elderly subset of patients affected more than other categories of the different impact of the clinical and/or surgical management [14-
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