Should atypia of undetermined significance be subclassified to better estimate risk of thyroid cancer?

Background

Atypia or follicular lesion of undetermined significance (AUS) is a cytologic category of thyroid aspirates with a wide range of reported malignancy. We aimed to determine whether specific cytologic features are associated with different rates of thyroid malignancy.

Methods

All thyroid fine needle aspiration biopsies with AUS from 2010 to 2012 were reanalyzed. Cytologic features were correlated with final pathology. Cytopathologists were blinded to the original cytologic interpretation and final diagnosis.

Results

Seventy-six patients had AUS; 39 (54%) underwent surgery with a malignancy rate of 18%. Specimens with moderate or large amount of thin colloid and absent or few nuclear inclusions had a >88% rate of benign disease. More than rare nuclear inclusions or grooves were associated with a higher rate of cancer (75% vs 9%, P = .005; 45% vs 7%, P = .003).

Conclusions

Patients with AUS and more than rare nuclear inclusions or grooves are at higher risk for cancer and should forego repeat fine needle aspiration biopsy and undergo thyroidectomy.     

Postoperative thyroid hormone supplementation rates following thyroid lobectomy

BackgroundThyroid lobectomy is performed for symptomatic benign nodules, indeterminate nodules, or low-risk well differentiated thyroid cancer. We aimed to determine factors associated with thyroid stimulating hormone over goal (TH) following lobectomy.MethodsWe performed a retrospective single-institution cohort study of patients undergoing thyroid lobectomy from January 2016 to December 2017. TH was defined as need for thyroid hormone in accordance with guidelines. Univariate and multivariate logistic regression analysis was performed.ResultsOne hundred patients were included and 47% developed.TH73% of those with cancer, 38% with benign pathology (p = 0.002). Patients with TH were more likely to have thyroiditis 26% versus 3.8% (p = 0.002); higher preoperativeTSHmean 1.88mIU/L (SD 1.17) versus 1.16mIU/L (SD 0.77) (p = 0.0002), and smaller remnant thyroid lobe adjusted for body surface area 2.99ml/m2 versus 3.72ml/m2 (p = 0.003).ConclusionsAfter thyroid lobectomy, TH is associated with preoperative TSH level, thyroiditis, remnant thyroid volume, and malignancy. The majority of patients with final pathology of carcinoma will require thyroid hormone supplementation to achieve TSH goal.     

The incidence of thyroid cancer by f ine needle aspiration varies by age and gender

Background

Fine needle aspiration (FNA) is the standard to evaluate thyroid nodules for malignancy. The aim of this study was to determine the influence of patient age and gender on the rate of thyroid nodule malignancy by FNA.

Methods

A database of 3981 consecutive patients who underwent thyroid FNA between 2002 and 2009 was reviewed. The percentages of benign, indeterminate, and malignant biopsies based on patient age and gender were determined. Statistical analysis was performed using SPSS (SPSS Inc, Chicago, IL).

Results

Our patient population included 2766 women (mean age ± SD, 52 ± 15.2) and 964 men (mean age ± SD, 59 ± 13.8). Of the 3722 (93.5%) patients with diagnostic FNAs, 196 (5.3%) had malignant FNA cytology. Malignant FNAs were twice as frequent in patients age ≤45 versus those >45 (8.1% versus 4.0%, P < 0.001). Overall, men had more indeterminate (10.2% versus 6.3%, P < 0.001) and malignant (6.7% versus 4.8%, P = 0.034) FNAs than women. Malignant FNAs in men were greatest in patients over age 45 (6.0% versus 3.2%, P = 0.001). The incidence of malignant FNAs for women peaked in their age 30s (10.4%), whereas the incidence of malignant FNAs for men peaked 10 y later in their age 40s (12.1%). Both men and women had the lowest incidence of malignant FNAs in their age 70s (2.3% and 1.9%, respectively).

Conclusions

The typical 5% risk of thyroid nodule malignancy on FNA varies depending on a patient’s age and gender. A patient’s age and gender should, therefore, be considered when counseling someone of his or her risk of thyroid cancer by FNA.     

超声引导下细针抽吸活检诊断不同大小甲状腺结节

目的探讨甲状腺结节大小对超声引导下细针抽吸活检(US-FNAB)诊断效能的影响。方法选取接受USFNAB且病理证实为甲状腺结节的患者125例(共143个结节),根据结节最大直径(L)分为3组:A组(L≤10mm),B组(10mmL≤15mm),C组(L15mm)。将US-FNAB细胞学诊断结果与病理结果对比,并进行统计学分析。结果143个结节中US-FNAB细胞学诊断阳性结节94个,阴性结节49个;术后病理诊断恶性结节96个,良性结节47个。良、恶性结节大小差异有统计学意义(P0.001)。3组敏感度、特异度差异均有统计学意义(P均0.05),阳性预测值、阴性预测值、假阳性率、假阴性率及准确率差异均无统计学意义(P均0.05)。与A、B组比较,C组敏感度最低(P0.05),A、B组敏感度差异无统计学意义(P0.05)。与B、C组比较,A组特异度最低(P0.05),B、C组特异度差异无统计学意义(P0.05)。结论甲状腺结节大小对US-FNAB诊断的效能无影响。     

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目的 评价扩大的患侧甲状腺切除术即患侧甲状腺全切加峡部切除术治疗孤立性甲状腺结节的合理性与安全性。方法 回顾性分析1996年1月至2002年1月间87例孤立性甲状腺结节病人行扩大的患侧甲状腺切除术的治疗效果。结果 病理证实74例为甲状腺良性病变，13例为甲状腺癌。术后均未出现甲状腺功能低下。13例甲状腺癌病人均存活，无癌复发。结论 扩大的患侧甲状腺切除术是治疗孤立性甲状腺结节的安全、有效的理想术式。     

Role of Surgeon-Performed Ultrasound in Predicting Malignancy in Patients with Indeterminate Thyroid Nodules

Background  Certain ultrasound features can predict malignancy in patients with thyroid nodules. The purpose of this study was to determine the value of surgeon-performed ultrasound (SUS) in predicting thyroid malignancy in patients with indeterminate fine-needle aspiration (FNA) cytology. Methods  477 consecutive patients with dominant thyroid nodules were referred to our institution from 2002 to 2007. Of these, 180/477(38%) were judged to have indeterminate cytology: follicular neoplasm (FN, n = 108), Hürthle neoplasm (HN, n = 29), and suspicious for papillary thyroid cancer (SPTC, n = 43). SUS characteristics for thyroid nodules were recorded in a prospective database prior to thyroidectomy. Variables analyzed included patients’ age and sex, nodule size, shape, echogenicity, consistency, borders, multiplicity/multicentricity, and presence of microcalcifications. SUS features of thyroid nodules were correlated with final pathology. The accuracy of individual SUS features as well as the presence of two or more adverse features in predicting malignancy was also examined. Results  There were 144 females and 36 males. Mean age was 52 years (range 17–87 years). Mean tumor size was 2.7 cm (range 0.65–6.6 cm). Overall, final pathology revealed cancer in 92/180 (51%) patients. Malignancy was present in 40/108 (37%) FN, 12/29 (41%) HN, and 40/43 (93%) SPTC. Nodule borders (irregular), shape (height > width), hypoechogenicity, and presence of microcalcifications were significantly associated with malignancy. The presence of 2 or ≥3 adverse SUS thyroid nodule features was associated with a ≥55% or ≥78% risk of malignancy, respectively. Conclusion  Adverse thyroid nodule features seen on SUS may predict malignancy and help determine the initial extent of thyroidectomy in patients with indeterminate FNA cytology. Presented at the 61^st Annual Cancer Symposium of the Society of Surgical Oncology, March 14, 2007.     

Prognostic significance of indeterminate lung nodules in renal cell carcinoma

ObjectivesMany patients with renal cell carcinoma (RCC) are found to have lung nodules at the time of diagnosis. The significance of these nodules is unclear. This study sought to determine whether the presence of indeterminate lung nodules affects survival for patients with early-stage RCC.Methods and materialsA retrospective review was performed of patients with stages I to III RCC at an academic hospital who underwent nephrectomy between 2001 and 2006 and had baseline imaging available for review. Presence of lung nodule(s) was determined, along with patient and disease characteristics. The time from diagnosis to last known follow-up, metastasis, and death were determined. The study follow-up period extended to July 2012. Univariate and multivariate Cox proportional hazards models assessed disease-free and overall survival.ResultsOf 548 patients, 240 met the inclusion criteria. Lung nodules were absent in 148 and present in 92 cases. Disease-free survival was associated with the presence of nodules (hazard ratio [HR] = 1.90; 95% CI: 1.04–3.46; P = 0.0362), tumor stage (stage II—HR = 5.61; 95% CI: 2.69–11.72; P<0.001 and stage III—HR = 2.49; 95% CI: 1.21–5.10; P = 0.0129) and tumor grade (HR = 2.43 for grades 3 or 4; 95% CI: 1.31–4.53; P = 0.005). The number and size of nodules were not associated with survival. Overall survival was associated with Charlson comorbidity score (HR = 1.30; 95% CI: 1.15–1.47; P<0.0001) and primary tumor size (HR = 1.29; 95% CI: 1.14–1.46; P<0.0001) but not the presence of lung nodules (HR = 1.73; 95% CI: 0.83–3.60; P = 0.1454).ConclusionsThe presence of indeterminate lung nodules had a negative effect on disease-free survival. Stage and grade were also significant. These findings underscore the importance of baseline imaging and vigilant surveillance of patients in whom nodules are identified.     

甲状腺结节钙化的临床价值

目的探讨甲状腺结节钙化在临床诊治中的意义。方法回顾性分析2002年6月至2003年8月中山大学附属第一医院收治的543例甲状腺结节病人的临床、B超扫描和病理资料。543例甲状腺结节中良性病变473例(87·1%),恶性病变70例(12·9%)。结果121例甲状腺结节有钙化,占22·3%,其中恶性肿物的钙化发生率(52·9%)明显高于良性甲状腺肿物(17·8%,P<0·05)。单发结节、伴有颈部淋巴结肿大甲状腺肿物为恶性的可能性大(P<0·05)。结论B超检查发现甲状腺结节钙化,并有结节边界模糊、形态不规则、低回声和血流信号丰富时,宜采用积极的治疗方法。     

Standard-radical vs. function-preserving surgery of benign nodular goiter—a sonographic and biochemical 10-year follow-up study

Background  The necessary extent of thyroid resection in benign nodular goiter is under debate. The aim of our study was to compare the long-term outcome of different thyroid resection modes with special interest in the incidence of recurrent nodules and the use of oral thyroid hormone medication. Materials and methods  We performed a follow-up examination of 109 patients (23 men and 86 women) having been operated for benign nodular goiter at our department 10 years ago. Unilateral resections and function-preserving resections of at least one thyroid lobe were classified as function-preserving (FP). Total thyroidectomy, Dunhill’s operation and bilateral subtotal thyroidectomy were rated as standard-radical (STR). On follow-up, we recorded current oral thyroid hormone medication, thyroid function tests and ultrasound of the neck. Results  Seventy-three patients had FP resection (67%), while 36 were STR-operated (33%). The subsequent medical treatment was performed by dedicated endocrinologists (n = 19), internists (n = 11) or primary-care physicians (n = 59). Twenty patients had no medical attendance. Recurrent nodules were found in 13 cases in the FP group (18.6%) vs. 3 cases in the STR group (2.5%; p < 0.001). In both groups, about 80% of patients used thyroid hormone medication 10 years after operation. Conclusion  There was no advantage in thyroid function tests nor lesser medication in the FP group. The risk for recurrent nodules was significantly higher in the FP than in the STR-operated patients. The data of this study have been presented in oral form at the Meeting of the German Endocrine surgeons (CAEK 2006 Duisburg) and at the German Surgical congress (Munich 2007).     

Fine-needle aspiration of the thyroid and correlation with histopathology in a contemporary series of 240 patients

BACKGROUND: False-positive, false-negative, and indeterminate fine-needle aspiration (FNA) biopsy results complicate the management of patients with thyroid nodules. METHODS: Thyroid FNA results from 240 consecutive patients (seen 1991 to 2002) were categorized into four groups: positive for malignancy, negative for malignancy, indeterminate for malignancy, and nondiagnostic. Indeterminate results included follicular neoplasm, Hürthle cell neoplasm, and suspicious for papillary carcinoma. The FNA results were compared with histopathologic analysis after thyroidectomy. RESULTS: The FNA results were 76 (32%) positive for malignancy, 53 (22%) negative for malignancy, 100 (42%) indeterminate for malignancy, and 11 (5%) nondiagnostic. There were 3 (4%) false-positive and 2 (4%) false-negative FNA results. Among the 100 indeterminate FNA results, carcinoma was found in 11 (15%) of 73 follicular neoplasms, 2 (20%) of 10 Hürthle cell neoplasms, and 14 (82%) of 17 suspicious for papillary carcinoma. For the 73 patients with follicular neoplasms, nodule diameter >2 cm was associated with an increased risk of malignancy (P <0.03). CONCLUSIONS: False-negative FNA results are uncommon, supporting the practice of observation in most of these patients. Among those with indeterminate biopsy results, high-risk subgroups include patients with FNA results suspicious for papillary carcinoma and follicular neoplasms >2 cm.     

不同甲状腺癌切除术治疗甲状腺癌患者的临床疗效分析

目的 探讨甲状腺癌切除术对甲状腺癌患者炎症指标分析.方法 将2019年1月至2021年9月在宣城市仁杰医院治疗的30例甲状腺癌患者根据手术方式分为两组,对照组使用甲状腺患侧叶切除+对侧次全切除术,观察组使用甲状腺患侧叶切除术.对比两组患者各项手术指标、并发症发生率、甲状腺激素指标、甲状旁腺激素(parathyroid ...     

甲状腺结节微波热消融治疗的临床进展

甲状腺结节是临床常见疾病,其治疗方式目前主要以外科开放式手术为主,微创治疗一直是临床探索的热点。经超声引导下甲状腺结节微波热消融具有重要的临床意义。本文主要对微波热消融甲状腺结节的治疗指征、临床疗效及常见并发症进行综述。     

Thy3 cytology: what to do next?

INTRODUCTION

Cytological analysis of thyroid fine needle aspiration (FNA) is aided by the ‘Thy’ classification. However, there is often confusion surrounding the management of patients with a Thy3 classification. A subdivision of Thy3 has been created to help reduce this dilemma but its use within the UK appears to by infrequent. This paper analyses the management of patients with Thy3 cytology from FNA of a thyroid nodule in a UK case series and reviews the relevant literature. It also describes the results of a survey of selected UK ENT departments on the use of the Thy3 classification and its subdivisions.

PATIENTS AND METHODS

A retrospective analysis of a case series of patients was undertaken. In addition, a telephone survey of local/regional pathology departments was conducted to assess the utilisation of the Thy classification and to assess the awareness and usage of the Thy3 subdivisions.

RESULTS

A total of 39 Thy3 results (11 males, 28 females) were identified from 2007 to 2009. Of these, 24 patients went on to have surgery, 8 had a further FNA, 2 had a Tru-cut biopsy and 5 were lost to follow-up. Eleven (28.2%) patients were subsequently diagnosed with a thyroid malignancy. The survey identified that none of the departments had adopted the Thy3 subclassifications and only 40% were aware of them.

CONCLUSIONS

Thy3 results from thyroid FNA have a significant risk of malignancy but there remains confusion surrounding their management. This district general hospital has adopted and recommends the use of the Thy3 (i) and Thy3 (ii) subdivisions in order to assist decision-making and avoid delays in treatment or unnecessary surgery.     

热消融术在甲状腺结节微创治疗中的应用进展

目的探讨热消融技术在治疗甲状腺结节中的特点,为临床上选择合适的消融方案提供参考。 方法结合文献分析微波、射频、激光等热消融术的原理,回顾近年来相关技术的临床应用情况,明确各方式的优缺点。 结果虽然众多研究证实热消融在治疗某些甲状腺结节中疗效肯定,但随着临床应用增多其并发症也逐渐被重视,在治疗甲状腺恶性肿瘤及其转移的淋巴结方面尚有其局限性。 结论各种热消融术各有其优势和不足,故在选择热消融治疗时必须严格掌握其适应证。     

TSH水平与甲状腺乳头状微小癌之间的关系探讨

目的探讨促甲状腺激素(TSH)与甲状腺乳头状微小癌之间的关系。方法回顾性分析2006年1月至2016年2月手术治疗的341例甲状腺结节患者,根据病理结果分为两组:甲状腺乳头状微小癌组104例,良性甲状腺结节组237例,收集并比较各组临床实验资料。数据分析采用SPSS 19.0统计软件,计量资料采用(x珋±s)表示,患者在年龄、结节直径、TSH浓度、淋巴结转移与TSH关系比较使用t检验;甲状腺乳头状微小癌发生率与TSH的关系采用χ2趋势检验,以P0.05表示差异具有统计学意义。结果甲状腺乳头状微小癌组患者结节直径平均为(1.92±1.13)cm,低于良性甲状腺结节组患者的(2.82±1.44)cm(t=-5.654,P0.05);甲状腺乳头状微小癌组患者TSH平均为(3.01±1.51)μIU/ml,高于良性甲状腺结节组患者的(1.90±1.32)μIU/ml(t=6.836,P0.05),差异均有统计学意义;按照TSH水平分为0.34μIU/ml、0.34~1.00μIU/ml、1.01~2.00μIU/ml、2.01~5.60μIU/ml和5.60μIU/ml,甲状腺乳头状微小癌组发生比例分别为11.76%、14.29%、23.94%、39.06%和53.33%,检验结果显示TSH水平越高其甲状腺乳头状微小癌的发生率越高(χ2=28.783,P0.05);甲状腺乳头状微小癌伴淋巴结转移患者TSH为(5.07±1.31)μIU/ml、明显高于无淋巴结转移患者的(2.83±1.55)μIU/ml,差异比较有统计学意义(t=5.844,P0.05)。结论 TSH可作为预测甲状腺乳头状微小癌风险的指标之一,可为临床诊断提供参考依据。     

甲状腺结节内钙化与甲状腺癌的关系研究

目的 探讨超声探测到的甲状腺结节内钙化与甲状腺癌的关系.方法 收集本院5年间行甲状腺手术患者4186例,对比甲状腺结节术前彩色超声检查与术后病理诊断.结果 甲状腺癌患者甲状腺结节内钙化,微小钙化和非微小钙化的发生率明显高于良性疾病中的发生率(P＜0.05).微小钙化对于预测甲状腺癌更有意义(P＜0.01),它在≥45岁和＜45岁组问比例分别为2.4%和16.8%,差异有统计学意义(P＜0.05);钙化在不同性别问差异无统计学意义(P＞0.05);伴钙化的恶性结节在单发与多发组间比例为70.7%和49.1%,差异有统计学意义(P＜0.05).结论 超声探测到微小钙化病灶对诊断甲状腺癌的特异性高,特别是对乳头状甲状腺癌.微小钙化对诊断微小乳头状癌有重要临床意义.