Institution-specific risk of papillary thyroid carcinoma in atypia/follicular lesion of undetermined significance

Head & Neck ◽  
2015 ◽  
Vol 38 (S1) ◽  
pp. E1210-E1215 ◽  
Author(s):  
Jonathan M. Bernstein ◽  
Manish Shah ◽  
Christina MacMillan ◽  
Jeremy L. Freeman
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Papillary Thyroid ◽  
Specific Risk ◽  
Undetermined Significance

scholarly journals Evaluation of thyroid nodules classified as Bethesda category III on cytology and their malignancy rate: An institutional experience

CytoJournal ◽  
2019 ◽  
Vol 16 ◽  
pp. 18 ◽  
Author(s):  
Sayed Ali Almahari ◽  
Zainab Harb ◽  
Safa Alshaikh
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Multinodular Goiter ◽  
Thyroid Nodules ◽  
Follicular Adenoma ◽  
Hashimoto Thyroiditis ◽  
International Standards ◽  
Papillary Thyroid ◽  
Institutional Experience ◽  
Undetermined Significance

Background: Thyroid gland nodules are common and fine-needle aspiration (FNA) is the gold standard for screening those nodules. The Bethesda system for reporting thyroid cytolopathology standardized reporting thyroid nodules aspirations, but atypia of undetermined significance or follicular lesion of undetermined significance (Bethesda category III) was the most controversial category. The aim of our study is to review our institutional experience and analyze the clinical implications of making a diagnosis of AUS/FLUS (Bethesda category III). Methods: This is a retrospective study of an 889 thyroid FNAs from 825 patients in Salmaniya Medical Complex, during (January 2013–December 2017). Results: The most common cause for designating cases as AUS/FLUS (Bethesda category III) was the presence of features suggestive of papillary thyroid carcinoma, but not quite fulfilling the criteria for such diagnosis. Ninety-six cases were diagnosed as AUS/FLUS (10.7%), in which 26 (27%) patients underwent surgery without repeating the FNA, 25 (26%) underwent a second FNA and 43 (44.7%) patients were followed up by ultrasound. On repeating the FNA, 1 (4%) was unsatisfactory, 13 (52%) were benign, 10 (40%) were AUS/FLUS, and only 1 (4%) was categorized as malignant. Thirty cases were surgically excised, in which 4 (13.3%) were diagnosed as follicular adenoma, 2 (6.6%) as Hurthle cell adenoma, 9 (30%) as multinodular goiter, 5 (16.6%) as multinodular goiter with Hashimoto thyroiditis, 1 (3.3%) as colloid nodule with Hashimoto thyroiditis, and 9 (30%) as papillary thyroid carcinoma. Among all the cases diagnosed initially as AUS/FLUS (Bethesda category III), 9 (9.3%) cases were diagnosed as papillary thyroid carcinoma. Conclusion: Diagnostically, we almost meet the international standards of designating cases with AUS/FLUS (Bethesda category III) and approximate the risk of malignancy. However, the clinical management's guidelines should be followed to decrease the risk of unnecessary surgeries and their complications. There is a statistically significant correlation between the age and gender with the final histopathology report, respectively.

scholarly journals MON-484 Thyroid Nodules: Not so Simple to Manage

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Alegyari Figueroa Cruz ◽  
Yineli Ortiz Torres ◽  
Victor J Carlo Chévere ◽  
Jose M Garcia-Mateo
Keyword(s):  
Decision Making ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Papillary Thyroid ◽  
Risk Of Malignancy ◽  
History Of ◽  
Bethesda System ◽  
Undetermined Significance

Abstract Thyroid Nodules: Not So Simple to Manage Thyroid nodules diagnosis and malignancy risk stratification remains a challenge for decision making between conservative vs invasive management. The development of the clinical guidelines provides alternatives for evaluation and management for thyroid nodules, but can be used for all patients? A 43 y/o female without known past medical history is referred to the endocrine service by her primary care physician for evaluation of a thyroid nodule. She was presenting with 1 month history of mild discomfort on the neck and was evaluated with thyroid US that was relevant for multiple bilateral solid nodules measuring <1.0cm and a one spongiform measuring 1.7 x 1.2 x 1.3cm in the right lobe extending minimally to the capsule laterally and to the carotid artery wall. Patient denies cough, hoarseness, odynophagia, shortness of breath, family history of thyroid cancer or radiation exposure. On examination there were no goiter nor palpable thyroid nodules, as well as no clinical signs and symptoms of thyroid disease. Patient is clinically and biochemically euthyroid with a very low suspicion thyroid nodule (3% estimated malignancy risk). Despite nodule is below the 2.0cm cutoff point for fine needle aspiration biopsy (FNAB) according to American Association of Clinical Endocrinologist (AACE) and American Thyroid Association (ATA) guidelines, it was done based on additional suspicious sonographic features detect by the endocrinologist on evaluation of ultrasound images. FNAB was performed and reveals Atypia of undetermined significance/Follicular Lesion of undetermined significance (AUS/FLUS) Bethesda system category III with a risk of malignancy of 5–15%. Patient was reluctant to surgery given the very low risk nodule and biopsy results of AUS/FLUS. In order to further manage this patient with undetermined significance thyroid nodule, Gene Expression Classifier (GEC) Molecular Analysis (AFIRMA) was performed. AFIRMA test was done with a second FNAB that also reveals AUS/FLUS but was found positive for BRAFv600, Bethesda system category IV: Suspicious of Papillary Thyroid Carcinoma. BRAFv600 is the only mutation that have high specificity (99%) for papillary thyroid carcinoma and is associated with increased disease-specific mortality, aggressive histologic phenotypes, lymph node metastases, extrathyroidal extension and risk of recurrence. Based on this data patient now have 95% risk of malignancy and requires surgical therapy. Patient preferred total thyroidectomy over lobectomy; pathology results shows 2.0cm Papillary Thyroid Carcinoma Stage I (T1N0M0). Despite very low risk nodule finding, malignancy was diagnosed. As depicted in this case, thyroid nodules aren’t so simple to manage, and their management should involve imaging and pathology findings along with clinical judgement and patient individualization in decision making process.

Papillary Thyroid Carcinoma: How Radical Lymphadenectomy Should be Performed?

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 63-68
Author(s):  
Schweizer ◽  
Seifert ◽  
Gemsenjäger
Keyword(s):  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Sentinel Nodes ◽  
Fand Sich ◽  
Radical Lymphadenectomy ◽  
N Status

Fragestellung: Die Bedeutung von Lymphknotenbefall bei papillärem Schilddrüsenkarzinom und die optimale Lymphknotenchirurgie werden kontrovers beurteilt. Methodik: Retrospektive Langzeitstudie eines Operateurs (n = 159), prospektive Dokumentation, Nachkontrolle 1-27 (x = 8) Jahre, Untersuchung mit Bezug auf Lymphknotenbefall. Resultate: Staging. Bei 42 Patienten wurde wegen makroskopischem Lymphknotenbefall (cN1) eine therapeutische Lymphadenektomie durchgeführt, mit pN1 Status bei 41 (98%) Patienten. Unter 117 Patienten ohne Anhalt für Lymphknotenbefall (cN0) fand sich okkulter Befall bei 5/29 (17%) Patienten mit elektiver (prophylaktischer) Lymphadenektomie, und bei 2/88 (2.3%) Patienten ohne Lymphadenektomie (metachroner Befall) (p < 0.005). Lymphknotenrezidive traten (1-5 Jahre nach kurativer Primärtherapie) bei 5/42 (12%) pN1 und bei 3/114 (2.6%) cN0, pN0 Tumoren auf (p = 0009). Das 20-Jahres-Überleben war bei TNM I + II (low risk) Patienten 100%, d.h. unabhängig vom N Status; pN1 vs. pN0, cN0 beeinflusste das Überleben ungünstig bei high risk (>= 45-jährige) Patienten (50% vs. 86%; p = 0.03). Diskussion: Der makroskopische intraoperative Lymphknotenbefund (cN) hat Bedeutung: - Befall ist meistens richtig positiv (pN1) und erfordert eine ausreichend radikale, d.h. systematische, kompartiment-orientierte Lymphadenektomie (Mikrodissektion) zur Verhütung von - kurablem oder gefährlichem - Rezidiv. - Okkulter Befall bei unauffälligen Lymphknoten führt selten zum klinischen Rezidiv und beeinflusst das Überleben nicht. Wir empfehlen eine weniger radikale (sampling), nur zentrale prophylaktische Lymphadenektomie, ohne Risiko von chirurgischer Morbidität. Ein empfindlicherer Nachweis von okkultem Befund (Immunhistochemie, Schnellschnitt von sampling Gewebe oder sentinel nodes) erscheint nicht rational. Bei pN0, cN0 Befund kommen Verzicht auf 131I Prophylaxe und eine weniger intensive Nachsorge in Frage.

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