Risk Of Thyroid Malignancy Research Articles

Could Serum TSH Levels Predict Malignancy in Euthyroid Patients Affected by Thyroid Nodules with Indeterminate Cytology?

Background Serum TSH levels in the upper-normal range were reported to be associated with increased risk of thyroid malignancy. However, measurement of TSH levels is currently not recommended for assessing the risk of malignancy in patients with newly diagnosed thyroid nodules. Objective To evaluate a possible relationship between the serum levels of TSH and the histological outcome of patients undergoing thyroidectomy for thyroid nodules with indeterminate cytology. Materials and Methods We collected the clinical data of all patients who had performed ultrasound-guided FNA of thyroid nodules with cytological diagnosis of indeterminate lesions (TIR3A and TIR3B) and serum TSH levels within the normal range. All patients had been submitted to thyroid surgery (hemi or thyroidectomy, as appropriate), and histological diagnosis had been performed. Results A histological diagnosis of thyroid malignancy was rendered in 74/378 (19.6%) nodules. Patients with histologically proven thyroid malignancy were characterized by higher serum levels of TSH as compared to patients with histologically proven benign nodules (3.03 ± 1.16 vs. 2.37 ± 1.19 mIU/L, p < 0.001). To further analyze the role of serum TSH in predicting thyroid cancer, patients were stratified in 4 groups according to quartiles of TSH concentrations. The prevalence of malignancy was 12.2% for the first quartile and 50.0% for the last quartile. ROC curve analysis identified that a serum TSH level of ≥2.7 mIU/L predicted thyroid malignancy with a sensitivity of 61% and a specificity of 65%. Conclusions TSH levels in the upper-normal range are associated with an increased risk of thyroid malignancy in patients affected by thyroid nodules with indeterminate cytology at FNA. The measurement of serum TSH levels represents an easily performed additional tool for decision-making in patients with indeterminate cytological findings.

The Diagnostic Efficiency of Ultrasound Computer-Aided Diagnosis in Differentiating Thyroid Nodules: A Systematic Review and Narrative Synthesis.

Computer-aided diagnosis (CAD) techniques have emerged to complement qualitative assessment in the diagnosis of benign and malignant thyroid nodules. The aim of this review was to summarize the current evidence on the diagnostic performance of various ultrasound CAD in characterizing thyroid nodules. PUBMED, EMBASE and Cochrane databases were searched for studies published until August 2019. The Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool was used to assess the methodological quality of the studies. Reported diagnostic performance data were analyzed and discussed. Fourteen studies with 2232 patients and 2675 thyroid nodules met the inclusion criteria. The study quality based on QUADAS-2 assessment was moderate. At best performance, grey scale CAD had a sensitivity of 96.7% while Doppler CAD was 90%. Combined techniques of qualitative grey scale features and Doppler CAD assessment resulted in overall increased sensitivity (92%) and optimal specificity (85.1%). The experience of the CAD user, nodule size and the thyroid malignancy risk stratification system used for interpretation were the main potential factors affecting diagnostic performance outcomes. The diagnostic performance of CAD of thyroid ultrasound is comparable to that of qualitative visual assessment; however, combined techniques have the potential for better optimized diagnostic accuracy.

Risk of Thyroid Cancer in 1,504 Patients Referred for Thyroid Surgery with Assumed Benign Histology

Objectives: The aims of this study were to report the risk of thyroid malignancy in cases of either benign fine-needle aspiration (FNA) or without FNA performed, and to investigate possible predictive factors for thyroid malignancy in a population with recent moderately low iodine intake. Methods: All patients referred for thyroid surgery in a tertiary cancer centre between 2000 and 2016 were included (n = 3,703). After excluding cases indicating malignant histology, we included group 1: patients with benign FNA (n = 764), and group 2: patients without FNA (n = 740), leaving 1,504 eligible for further investigation. Information on age, gender, tracheal compression or dislocation, thyroid specimen weight, scintigraphy, ultrasound, medically treated thyrotoxicosis, serum stimulating thyroid hormone, indication for surgery, TNM classification, stage, and outcome were retrieved. Results: The malignancy risk was 7.6% (58/764) in group 1 and 6.8% (50/740) in group 2. Patients with T2–4 tumours constituted 2.2% (33/1,504). In the combined groups, ultrasound verified that solitary solid tumour was predictive for malignancy (p = 0.01 by χ², and OR = 1.69, p = 0.02 in multiple logistic regression). For group 1 patients, thyrotoxicosis (which in this case was medically treated) was a significant predictive factor for malignancy (p = 0.04). Conclusions: The risk of malignancy of 7.6% and 6.8% was high, considering that patients with malignant FNA, suspicious FNA, or clinical findings indicating malignancy were excluded, and 2.2% of these malignancies were stages T2–4. In cases with solitary solid tumour on ultrasound, the risk of malignancy should not be ignored, even with benign FNA.

SUN-614 Thyroid Nodules in a Cohort of Childhood Cancer Survivors: A Single Center Experience

The aim of our study was to identify patients suffering from thyroid nodules and thyroid carcinoma in a pediatric population with previous neoplasm. Patients and methods: 44 patients (23 females; 21 males) with thyroid nodules among a single center population with a previous diagnosis of hematologic or solid tumor at a mean age 7.4 ± 4.9 years were recruited. Radiotherapy was performed in 30 patients (Total body irradiation, TBI =18; locoregional radiotherapy, RT =12). The mean age at the first thyroid nodule detection was 17.2±5 years FNAB was performed in 36/44 pts. with nodules larger than 7 mm and/or suspect sonographic findings TSH, FT4 and thyroid antibodies assays were performed in all patients Results FNAB showed: 13 Tir2 (36.1%), 14 Tir3 (38,9%), 4 Tir4 (11.1%) and 5 Tir5 (13.9%). Histological finding of PTC was demonstrated in 8 of 9 patients with Tir4 and Tir5 and in 9 out of 14 pts.with Tir3 (69,2%,). after thyroidectomy and in 1 out of 9 Tir4 and Tir5 an insular tumor was diagnosed by Core Needle Biopsy . Overall, 18 thyroid carcinomas in our population (40,9%) were detected. Among patients with malignant nodules: 11/18 (61,1%) were male and 7/18 (38,9%) were female. Radiotherapy cumulative dose was 12.2±1 Gy in 14/18 malignant nodules and 22.1±15.8 Gy in 16/26 benign nodules (P=0.016) Considering only patients submitted to TBI (18): 11/18 (61%) were malignant; 7/11 of them (63.6%) were male and 4/11 (36.4%) were female. When population was grouped according to the age at the diagnosis of the first malignancy (<8 years and ≥8 years old), a longer time between previous malignancy and thyroid nodules diagnosis was showed in the younger group (10.8±3.2 years vs 8.4±5.2 years, p=0.028. Discussion. These data show that the ultrasound imaging in this population allowed to detect small size thyroid nodules, 40.9% of them were demonstrated to be thyroid carcinomas. FNAB Tyr3 cytologic reports were demonstrated to be malignant in 69.2% at histological examination; this data differs from general population. The surgical option should be considered in this high risk population in order to better plan further therapeutical strategies. TBI was associated with high risk (61%) of malignancy. Male sex was more frequently associated with thyroid carcinoma in the entire population, as well as in TBI subgroup. Lower cumulative doses of radiotherapy were associated to increased risk of thyroid malignancy, according to previous studies.

The Accuracy of Risk Stratification System for Classifying Thyroid Nodules in FEU‐NRMF, Medical Center

BackgroundThyroid Image Reporting and Data System (TIRADS) is a risk stratification system, recently recognized in an American College of Radiology (ACR) white paper. However, there is paucity of data been reported regarding the use of TIRADS in our local setting. Although foreign studies have been done regarding TIRADS, it is important to validate it against local data to determine its applicability and usability in our local institution so as to avoid unnecessary biopsy.The aim of this study is to determine the accuracy of thyroid imaging reporting and data system in detecting thyroid malignancy in comparison to Fine needle aspiration biopsy report and also to determine the sensitivity and specificity of the ultrasound features in the prediction of malignant nodule.MethodsThis prospective cross‐section study involved 193 patients that underwent thyroid ultrasound and fine needle aspiration biopsy study in FEU‐NRMF medical center radiology department. The thyroid lesions were divided into 5 categories; TIRADS 1, 2, 3, 4a, 4b, 4c and 5 based on the ultrasound features. TIRADS 1, normal thyroid gland; TIRADS 2, benign in; TIRADS 3, probably benign; TIRADS 4A, low suspicious for malignancy; TIRADS 4B, intermediate suspicious for malignancy and TIRADS 5, high suspicious suspicious for malignancy. All thyroid nodules were characterized according to composition, echogenicity, margins, calcification and shape. Subsequently, the FNAB reports were obtained from the pathology department. Data were processed and encoded using Microsoft excel statistical analysis using SPSS. Determination of sensitivity and specificity was done using percentages of proportion. 95% confidence interval was calculated.ResultThis study revealed the presence of hypoechogenicity as the most sensitive but the least specific feature in a malignant thyroid nodule while taller than wide shape is the least sensitive but the most specific and its presence offers the highest likelihood of a nodule to be malignant. Higher TIRADS classification is found to be associated with higher risk of thyroid malignancy with a sensitivity of 97% in TIRADS 4a to 5. The risk of malignancy is in TIRADS 5 is put at 81%, therefore, TIRADS is a sensitive classification in recognizing patients with thyroid cancer and can be used as a guide in deciding the need for fine needle aspiration biopsy.Support or Funding InformationNo funding sourceThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The Impact of Hashimoto Thyroiditis on Thyroid Nodule Cytology and Risk of Thyroid Cancer.

ContextThe impact of Hashimoto thyroiditis (HT) on the risk of thyroid cancer and its accurate detection remains unclear. The presence of a chronic lymphocytic infiltration imparts a logical mechanism potentially altering neoplastic transformation, while also influencing the accuracy of diagnostic evaluation.MethodsWe performed a prospective, cohort analysis of 9851 consecutive patients with 21,397 nodules ≥1 cm who underwent nodule evaluation between 1995 and 2017. The definition of HT included (i) elevated thyroid peroxidase antibody (TPOAb) level and/or (ii) findings of diffuse heterogeneity on ultrasound, and/or (iii) the finding of diffuse lymphocytic thyroiditis on histopathology. The impact of HT on the distribution of cytology and, ultimately, on malignancy risk was determined.ResultsA total of 2651 patients (27%) were diagnosed with HT, and 3895 HT nodules and 10,168 non-HT nodules were biopsied. The prevalence of indeterminate and malignant cytology was higher in the HT vs non-HT group (indeterminate: 26.3% vs 21.8%, respectively, P < 0.001; malignant: 10.0% vs 6.4%, respectively, P < 0.001). Ultimately, the risk of any nodule proving malignant was significantly elevated in the setting of HT (relative risk, 1.6; 95% CI, 1.44 to 1.79; P < 0.001), and was maintained when patients with solitary or multiple nodules were analyzed separately (HT vs non-HT: 24.5% vs 16.3% solitary; 22.1% vs 15.4% multinodular; P < 0.01).ConclusionHT increases the risk of thyroid malignancy in any patient presenting for nodule evaluation. Diffuse sonographic heterogeneity and/or TPOAb positivity should be used for risk assessment at time of evaluation.

Risk of Thyroid Malignancy in Non-Toxic Multi-nodular Goitre: Experience in Rajshahi

Non-Toxic multi-nodular goitre is one of the common presentations of various thyroid diseases. A sizable portion of multi-nodular goitre turns into malignancy over time. This cross-sectional study was conducted in RMCH and different clinics of Rajshahi City to determine the incidence and types of various thyroid malignancies in non-toxic multi-nodular goitres. Among the total cases, 43% of the patients were in the age group of 31-40 years and majority (81%) of whom were female. 52% of the patients had a history of thyroid swelling for 1-5 years and 55% of the patients had goitre size ≤ 15 cm2. Sub-total thyroidectomy was the commonest operation performed and all the resected specimens were sent for histopathological examinations, which demonstrates that 13% of the multi-nodular goitres had malignancies with papillary and follicular carcinoma ratio 5:1. This study did not reveal any significant association of malignancies with age and sex and goitre size also not influence the presence of malignancy. However, it was observed that the mean duration of thyroid swelling in patients who developed malignancy was significantly higher (8.6 years) than that of patients who did not experience any malignant change (5.7 years).TAJ 2016; 29(2): 16-20

Thyroid incidentaloma as a "PAIN" phenomenon- does it always require surgery?

A thyroid nodule discovered during imaging study performed due to unrelated thyroid disease is known as a thyroid incidentaloma, while positron emission tomography (PET) associated incidental neoplasm of thyroid is known as a “PAIN” phenomenon.To evaluate which patients with “PAIN” phenomenon should undergo surgery in regards to cytology results.Retrospective review of 4716 patients consecutively admitted and surgically treated in tertiary surgical center. 49 (1.04%) patients with “PAIN” phenomenon were identified. All of them had ultrasound-guided fine needle aspiration biopsy (UG-FNAB) performed and cytological results were evaluated according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Patients were divided into 2 subgroups according to histopathological diagnosis: group 1 (n = 25) with benign tumor and group 2 (n = 24) with thyroid cancer.Cytology results were the significant predictors of cancer occurrence in patients with “PAIN” phenomenon (P < .0001). Logistic regression analysis confirmed that category III or higher of TBSRTC in patients with “PAIN” phenomenon significantly increased the risk of cancer (OR = 168.7, P < .0001).Patients with “PAIN” phenomenon and cytology assigned to category III or higher of the Bethesda system should undergo surgery due to significant risk of thyroid malignancy.

Is thyroid nodule location associated with malignancy risk?

PurposeNodules located in the upper pole of the thyroid may carry a greater risk for malignancy than those in the lower pole. We conducted a study to analyze the risk of malignancy of nodules depending on location.MethodsThe records of patients undergoing thyroid-nodule fine-needle aspiration cytology (FNAC) at an academic thyroid cancer unit were prospectively collected. The nodules were considered benign in cases of a benign histology or cytology report, and malignant in cases of malignant histology. Pathological findings were analyzed based on the anatomical location of the nodules, which were also scored according to five ultrasonographic classification systems.ResultsBetween November 1, 2015 and May 30, 2018, 832 nodules underwent FNAC, of which 557 had a definitive diagnosis. The prevalence of malignancy was not significantly different in the isthmus, right, or left lobe. Among the 227 nodules that had a precise longitudinal location noted (from 219 patients [155 females], aged 56.2±14.0 years), malignancy was more frequent in the middle lobe (13.2%; odds ratio [OR], 9.74; 95% confidence interval [CI], 1.95 to 48.59). This figure was confirmed in multivariate analyses that took into account nodule composition and the Thyroid Imaging, Reporting, and Data System (TIRADS) classification. Using the American College of Radiologists TIRADS, the upper pole location also demonstrated a slightly significant association with malignancy (OR, 6.92; 95% CI, 1.02 to 46.90; P=0.047).ConclusionThe risk of thyroid malignancy was found to be significantly higher for mid-lobar nodules. This observation was confirmed when suspicious ultrasonographic features were included in a multivariate model, suggesting that the longitudinal location in the lobe may be a risk factor independently of ultrasonographic appearance.

Both Ultrasound Features and Nuclear Atypia are Associated with Malignancy in Thyroid Nodules with Atypia of Undetermined Significance.

The optimal management of thyroid nodules that undergo fine-needle aspiration (FNA) with findings of atypia of undetermined significance (AUS) is unclear. Categorizing nodules by AUS subtype and ultrasound characteristics may improve risk stratification. Therefore, the purpose of this study is to evaluate the association between AUS subtype and ultrasound features on risk of malignancy (ROM). We performed a review of all patients with a thyroid nodule who underwent an FNA at our institution between January 2010 and November 2015. Patients with AUS were divided into groups with (1) nuclear atypia, (2) architectural atypia, or (3) Hurthle cell atypia. Their ultrasound features were assessed using the American Thyroid Association (ATA) thyroid nodule sonographic patterns. We conducted a univariate and multivariable analysis to determine the association between AUS subtype and other variables of interest with ROM. Of the 3428 thyroid nodules that underwent FNA, 237 (6.9%) had AUS. Of the 97 surgically resected nodules, 67 (69%) were benign and 30 (31%) were malignant. On univariate analysis nuclear atypia (p < 0.01) was associated with a thyroid malignancy. On multivariable analysis, both ATA high-risk ultrasound features (p = 0.04, odds ratio [OR] 3.68) and nuclear atypia (p < 0.01, OR 11.8) were independently associated with a final diagnosis of thyroid carcinoma. Nuclear atypia and ATA high-risk ultrasound features are useful in identifying patients with AUS that are at a higher risk of thyroid malignancy. Surgeons should take these factors into consideration when evaluating patients with AUS.

The Frequency of Focal Thyroid Incidental Findings and Risk of Malignancy Detected by 18F-Fluorodeoxyglucose Positron Emission Tomography in an Iodine Deficient Population.

Incidental focal uptake of 18F-fluorodeoxyglucose (FDG) in the thyroid on positron emission tomography (PET/CT) is rare but often associated with malignancy. The epidemiology of thyroid incidentalomas has only to some extent been described in countries with iodine deficiency. Here we report data from Denmark, a country with known iodine deficiency and wide access to PET/CT. All FDG PET/CT comprising the head and neck region, during 2014, were retrospectively reviewed, and patients with focal FDG uptake in the thyroid gland were identified. A total of 2451 patients had an FDG PET/CT of which 59 (2.4%) patients presented with FDG-avid focal lesions in the thyroid gland. Among the 59 patients with FDG-avid lesions, 33 patients (56%) received work up with ultrasound, thyroid technetium scintigraphy, fine needle aspiration, and/or histology of which 20 patients had a conclusive pathology report. Ten patients with FDG-avid lesions were identified with thyroid malignancy. The risk of thyroid malignancy was 16.9% among patient with incidental FDG-avid thyroid lesions. Our findings indicated a similar frequency of FDG thyroid incidentalomas and malignancy rates in an iodine deficient population compared to summary data from prior studies, studies mostly performed in geographical areas of normal or excess iodine supplementation.

Risk of thyroid malignancy in large thyroid nodules greater than 4 cm

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Subclassification of Bethesda Atypical and Follicular Neoplasm Categories According to Nuclear and Architectural Atypia Improves Discrimination of Thyroid Malignancy Risk.

Although The Bethesda System for Reporting Thyroid Cytopathology has provided clinicians with a standardized classification scheme for the diagnosis of thyroid fine-needle aspiration cytology (FNAC) specimens, the indeterminate categories of Bethesda III (B3)-atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS)-and Bethesda IV (B4)-follicular neoplasm/suspicious for follicular neoplasm (FN/SFN)-continue to pose challenges with regards to ideal diagnostic and therapeutic management. Having previously demonstrated the presence of nuclear atypia as a high-risk subgroup in B3, the objective of this study was to evaluate the malignancy rates in the B4 subgroup with nuclear atypia. A retrospective review of all thyroid FNACs diagnosed as B4 (FN/SFN) between 2008 and 2015 was conducted at a tertiary referral center in Singapore. Data on patient demographics, sonographic features, and final histological diagnosis were collected. This was compared to data from a previous analysis on all nodules diagnosed as B3 (AUS/FLUS) over a similar period. A total of 137/309 (44.3%) and 88/111 (79.3%) FNACs diagnosed as B3 and B4, respectively, underwent surgical excision yielding final histopathological diagnoses. The malignancy rate of B4 was 31/88 (35.2%) compared to B3, which was 37/137 (27.0%). Subclassification based on the presence of architectural versus nuclear atypia showed significantly higher malignancy rates in B4 nodules with nuclear atypia (21.8% vs. 57.6%; p < 0.01). These findings corroborate previous results within the B3 category (malignancy rate of 14.7% vs. 36.8%; p < 0.01). The only sonographic features predictive of malignancy were the presence of macrocalcifications in B4 compared to irregularity of margins in B3. The presence of nuclear atypia identifies subgroups with significant differential malignancy risks within both the B3 and B4 categories. This supports the notion that subclassification is a useful risk stratification tool that can guide diagnostic and therapeutic management of indeterminate thyroid nodules with heterogenous risk profiles.

Increased Cancer Risk in Younger Patients with Thyroid Nodules Diagnosed as Atypia of Undetermined Significance.

Background: The objective of this study was to determine if patient age and/or gender significantly alter the risk of thyroid malignancy in the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) diagnostic categories.Methods: A retrospective review of 291 sequential patients that underwent thyroid nodule fine needle aspiration biopsy (FNAB) and subsequent surgery at a single center was carried out. Cases were grouped according to age (55 years and older versus younger than 55 years) and gender. The cancer risk was calculated for each BSRTC diagnostic group. A p-value <0.05 was not considered statistically significant.Results: The study population was composed of 291 patients (227 females and 64 males). Histopathology diagnosed cancer in 113 cases (39%). The cancer risk was significantly increased in cases with a BSRTC diagnosis of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in patients younger than 55 years of age (36.8% vs 7.4%, p=0.0082).Conclusions: Though thyroid cancer was significantly more common in males (p=0.021), gender did not significantly influence specific BRSTC diagnostic category cancer risk estimation. A BSRTC AUS/FLUS diagnosis is associated with an increased cancer risk in younger patients.

Association between Obesity and Tumor Size in Patients with Papillary Thyroid Cancer

Purpose: Many observational studies have reported a correlation between obesity and increased risk of thyroid malignancy. However, the relationship of...

Is Diagnostic Performance of Quantitative 2D-Shear Wave Elastography Optimal for Clinical Classification of Benign and Malignant Thyroid Nodules?: A Systematic Review and Meta-analysis

This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules. PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve. After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64-0.69), 0.78 (CI: 0.76-0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80-18.43), 0.31 (CI: 0.22-0.44), and 3.87 (CI: 2.83-5.29), respectively. Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence.

Thyroid Imaging Reporting and Data System (TIRADS) in Stratifying Risk of Thyroid Malignancy at The Medical City.

ObjectiveTo determine the accuracy of Thyroid Imaging Reporting and Data System (TIRADS) in detecting thyroid malignancy, determine risk of malignancy in each TIRADS category and determine the ultrasound characteristics associated with malignancy.MethodologyThis is a retrospective cross-sectional study involving patients who underwent ultrasound, thyroid fine needle aspiration biopsy (FNAB) and thyroidectomy at The Medical City from January 2014 to December 2015. Ultrasound reports were retrieved and reviewed by two radiologists on separate occasions who were blinded to the cytopathology and histopathology results. The histopathology reports were correlated with ultrasound features to determine features associated with malignancy. Stata SE 12 was used for data analysis. TIRADS sensitivity, specificity, positive predictive values and negative predictive values and accuracy were calculated.Results149 patients with thyroid nodules were included. Solid composition is the ultrasound feature predictive of malignancy with adjusted OR 4.912 (95% Cl 1.3257 to 18.2011, p=0.017). The risk of malignancy for TIRADS categories 3, 4a, 4b, 4c and 5 were 12.50%, 12.82%, 26.19%, 53.70% and 66.67%, respectively. The Crude OR (95% CI) for TIRADS 4a, 4b, 4c and 5 were 1.03 (0.10 to 10.23), 2.48 (0.27 to 22.54), 8.12 (0.93 to 70.59) and 14.0 (0.94 to 207.60), respectively. The sensitivity, specificity, PPV, NPV and accuracy of TIRADS in relation to surgical histopathology report were 98.00%, 7.07%, 34.75%, 87.50%, and 53% respectively in TIRADS categories 4 and 5.ConclusionThis study showed that a solid nodule is the most frequent ultrasound feature predictive of thyroid malignancy. Higher TIRADS classification is associated with higher risk of thyroid malignancy. TIRADS is a sensitive classification in recognizing patients with thyroid cancer.

Thyroid Imaging Reporting and Data System (TIRADS) in Stratifying Risk of Thyroid Malignancy at The Medical City

Thyroid Imaging Reporting and Data System (TIRADS) in Stratifying Risk of Thyroid Malignancy at The Medical City

Thyroid neoplasms: incidental findings on extent of disease evaluation CT for other pediatric malignancies

PurposeWe performed a retrospective analysis to evaluate the risk of thyroid cancer in incidental thyroid nodules (ITNs) discovered on CT in patients with a history of pediatric cancer. MethodsWith IRB approval we reviewed the records of pediatric oncology patients age ≤21y with newly detected thyroid nodules on surveillance CT of the neck, chest, chest/abdomen/pelvis, or PET/CT performed between April 2008 and March 2015. Patients with <6months of follow-up after incidental findings, a history of primary thyroid malignancy, or incomplete records were excluded. ResultsThe final cohort (N=68) included 35 females and 33 males (mean age 16.0±4.3[SD] years) with a mean follow-up time of 3.7±1.9[SD] years after CT detection of ITN(s). Twenty patients (29.4%) received a follow-up thyroid ultrasound, eleven (16.2%) of whom underwent fine needle aspiration (FNA) for cytopathologic diagnosis. Among these, six (8.8%) underwent thyroid resection, with final pathology demonstrating papillary carcinoma in five (7.4%) and benign pathology in one. ConclusionsDespite the low incidence of thyroid nodules and low risk of thyroid malignancy in the general pediatric population, we found a significant rate of malignancy in CT-detected ITNs in our pediatric oncology patients, and recommend ultrasound and FNA of these nodules in this high-risk population. Level of evidenceLevel IV, retrospective study with no comparison group.

Thyroid malignancy risk in different clinical thyroid diseases

Background/aim: To evaluate the malignancy risk of thyroid nodules in different clinical thyroid diseases. Materials and methods: Patients who underwent thyroidectomy between 2007 and 2014 were grouped as euthyroid, hypothyroid, and hyperthyroid. Further classification was made depending on the presence of solitary/multiple thyroid nodules. Results: Among 2870 patients, 1719 (59.9%) were euthyroid, 962 (33.5%) were hyperthyroid, and 189 (6.6%) were hypothyroid. Overall malignancy was detected in 980 (34.1%) patients. Malignancy rates were 42.1%, 42.9%, and 18.3% in the euthyroid, hypothyroid, and hyperthyroid groups, respectively (P < 0.001). A total 41.4% of patients with euthyroid nodular goiter (ENG) and 46.3% of patients with euthyroid multinodular goiter (EMNG) had thyroid malignancy (P = 0.169). Mean tumor size and capsular and vascular invasion were significantly lower in EMNG than in ENG. Among hypothyroid patients, 45.7% with solitary and 42.2% with multiple nodules were malignant (P = 0.705). When toxic nodular goiter and toxic multinodular goiter were analyzed together, malignancy rate was 24.7% (104/421), and when Graves with nodule/nodules was considered, it was 19.7% (59/299). Conclusion: In hypothyroid or euthyroid patients who underwent thyroidectomy, malignancy rate was higher than 40%, and was lower in hyperthyroid patients. Patients with multiple nodules carry a similar risk of malignancy as patients with solitary nodules, independent of the functional status.