The predictive value of dominant nodules and the management of indeterminate group in multinodular goiter |
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Authors: | Engin Ac?o?lu Özgür Yi?it Nihal Seden Gülben Erdem Huq |
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Institution: | 1. Department of Otolaryngology, Istanbul Training and Research Hospital, ?rnek mah. Libadiye cad. Tahral? sitesi B1 blok, Kat:6 D:27 Usküdar, Istanbul, Turkey 2. Department of Pathology, Istanbul Training and Research Hospital, Istanbul, Turkey
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Abstract: | The objectives of this study were to determine the predictive value of dominant nodules (DNs) in multinodular goiters (MNGs),
and to stratify the risk of malignancy within the indeterminate category. The study design was retrospective study of patients
with MNG. A total of 140 patients were reviewed. Fine needle aspiration biopsy (FNAB) findings for all DNs were categorized
into four groups: (1) benign, (2) positive or suspicious for malignancy, (3) indeterminate, and (4) non-diagnostic. All FNAB
specimens of the indeterminate group were also evaluated for the presence of Hurthle cell metaplasia and were categorized
according to the presence of cytological atypia. Cytohistological comparison was then performed. Mean number and diameter
of the DNs were 1.45 and 25.6 mm, respectively. Based on final histopathology, 22.14% of the patients had thyroid malignancy
and 74.2% of thyroid carcinomas were located in DNs. The number of DNs was significantly larger in malignant thyroid glands
than in benign ones. In total, 22.6% of the indeterminate FNABs were malignant. FNABs of the indeterminate group that included
atypical cells had a statistically significant higher incidence of malignancy. The presence of Hurthle cells was not statistically
different in malignant and benign nodules upon final histological diagnosis. In conclusion, FNAB of only DNs in MNG could
determine thyroid malignancy in 75% of patients. The DN number might be required for the predictive value of malignancy. A
subclassification of the indeterminate group, based on the presence or absence of cytological atypia, is necessary to better
assess the risk of malignancy. |
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