Frequencies and malignancy rates of 6-tiered Bethesda categories of thyroid nodules according to ultrasound assessment and nodule size

Head & Neck ◽  
2018 ◽  
Vol 40 (9) ◽  
pp. 1947-1954 ◽  
Author(s):  
Vivian Youngjean Park ◽  
Hye Sun Lee ◽  
Eun-Kyung Kim ◽  
Jin Young Kwak ◽  
Jung Hyun Yoon ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Nodule Size ◽  
Ultrasound Assessment

scholarly journals Follow-up of Benign Thyroid Nodules—Can We Do Less?

2019 ◽  
Vol 70 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Manijeh Mohammadi ◽  
Carrie Betel ◽  
Kirsteen Rennie Burton ◽  
Kevin McLughlin Higgins ◽  
Zeina Ghorab ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Descriptive Study ◽  
Needle Aspiration ◽  
Thyroid Malignancy ◽  
Fine Needle ◽  
Nodule Size ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Objective To determine the incidence of malignancy, follow-up ultrasound (US), and repeat fine needle aspiration (FNA) in thyroid nodules that have been previously biopsied as benign. Methods This is a retrospective, descriptive study of benign thyroid nodules evaluated by US between 2010-2011. We determined the frequency of follow-up ultrasounds and FNAs, mean years of follow-up, interval between follow-up US, change in nodule size, reasons for repeat FNA (rFNA), frequency of thyroidectomy, and thyroid malignancy during 5 years of follow-up. Results A total of 733 benign thyroid nodules were reviewed in 615 patients. Mean years of US follow-up was 3.47 ± 1.65 years; 275 (37.5%) had no follow-up US; 109 (14.9%) had 1 follow-up US; 93 (12.7%) had 2 follow-up US; and 256 (34.9%) had 3 or more follow-up US. Assessment of thyroid nodule size showed that 215 (28.8%) nodules decreased in size, 145 (19.4%) increased in size by less than 50%, and 91 (12.1%) increased in size by more than 50%. Of the 733 nodules, 17 nodules (2.3%) underwent thyroidectomy for which the pathology result of 9 (1.2%) showed malignancy, and 65 (8.9%) thyroid nodules underwent rFNA. When applying the 2015 recommendations for repeat FNA, 35% were done unnecessarily. Conclusion In our sample of initially benign thyroid nodules, only 9 patients (1.2%) had pathology-proven malignancy after a mean follow-up of 3.5 years. Over 30% of patients had more than 3 rUSs. Decreased interval and frequency of rUS should be considered in future guidelines for thyroid management.

Application of Thyroid Imaging Reporting and Data System in the Ultrasound Assessment of Thyroid Nodules According to Physician Experience

2016 ◽  
Vol 32 (2) ◽  
pp. 126-131 ◽  
Author(s):  
Su Yeon Ko ◽  
Eun-Kyung Kim ◽  
Hee Jung Moon ◽  
Jung Hyun Yoon ◽  
Ha Yan Kim ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Data System ◽  
Thyroid Imaging ◽  
Ultrasound Assessment

scholarly journals Possibilities of nontoxic autonomous thyroid nodules treatment by percutaneous ethanol injection

2011 ◽  
Vol 68 (9) ◽  
pp. 767-773 ◽  
Author(s):  
Zoran Andjelkovic ◽  
Snezana Kuzmic-Jankovic ◽  
Dragan Pucar ◽  
Ivan Tavcar ◽  
Tamara Dragovic
Keyword(s):  
Thyroid Nodules ◽  
Soft Tissues ◽  
Percutaneous Ethanol Injection ◽  
Thyroid Stimulating Hormone ◽  
Ultrasound Guided ◽  
Percutaneous Injection ◽  
Ethanol Injection ◽  
Nodule Size ◽  
Starting Point ◽  
Average Size

Background/Aim. According to the current principles, autonomous functional thyroid nodules are treated by surgery or by radioiodin therapy. Ultrasound guided percutaneous ethanol injection into solid tumors of the soft tissues was a starting point in attempts to treat the thyroid nodules by the same method. The aim of the study was to assess the efficiency of percutaneous injection in treating solitary, nontoxic, autonomous thyroid nodules of up to 15 mL volume. Methods. In 25 patients with solitary nontoxic autonomous thyroid nodules diagnosed by tehnetium-99m scanning as an intensive area having a complete supremacy in the paranodal tissue, an ultrasound guided percutaneous ethanol injection was applied. The procedure was carried out repeatedly once a week until the reduction in nodule size to 50% of the initial size was achieved. Results. An average size of the nodule before curing was 9.68 ? 5.01 mL. An average quantity of the injected ethanol was 9.52 ? 5.08 mL, ie 1.06 ? 0.48 mL/mg of the tissue. The regression of the nodule size in the successfully (?vol% u = - 57.09 ? 13.75%, p < 0.001) and partly successfully cured (?vol du = -48.45 ? 14.35%, p < 0.05) was statistically significant compared to the size before the treatment. After ceasing ethanol injection, 18 months later, a further size regression (?vol% = -79.20 ? 9.89%) compared to the initial one (p < 0.001) was noticed. Soon, after the procedure was finished, a statistically significant concentration increase of Thyroid Stimulating Hormone (TSH) was noticed compared to the initial values (0.18 ? 0.16 vs 0.34 ? 0.31 mU/L, p < 0.01). According to the given criteria, in two female patients satisfactory results were not achieved, but, a year later, in one of them the nodule was not seen by repeated scintigram. The number and frequency of side effects were insignificant. Conclusion. Repeated percutaneous ethanol injections into nontoxic solitary autonomous thyroid nodules result in disappearing of authonomy. The regression of the nodule size of more than 50% compared to its initial volume, as well as the increase in concentration of TSH for more than 50% are the signs of a successful treatment.

scholarly journals Ultrasound Assessment of Autonomous Thyroid Nodules before and after Radioiodine Therapy Using Thyroid Imaging Reporting and Data System (TIRADS)

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1038
Author(s):  
Simone Agnes Schenke ◽  
Jan Wuestemann ◽  
Michael Zimny ◽  
Michael Christoph Kreissl
Keyword(s):  
High Risk ◽  
Thyroid Nodules ◽  
Radioiodine Therapy ◽  
Diagnostic Procedures ◽  
Low Risk ◽  
Therapeutic Interventions ◽  
Thyroid Imaging ◽  
Before And After ◽  
Autonomously Functioning Thyroid Nodules ◽  
Ultrasound Assessment

The Thyroid Imaging and Reporting System (TIRADS) allows a sonographic assessment of the malignancy risk of thyroid nodules (TNs). To date, there is a lack of systematic data about the change in ultrasound (US) features after therapeutic interventions. The aim of this study was to characterize the changes in autonomously functioning thyroid nodules (AFTNs) after radioiodine therapy (RIT) by using TIRADS. We retrospectively assessed data from 68 patients with AFTNs treated with RIT between 2016 and 2018 who had available first and second follow-up US imaging. Before RIT, 69.1% of the AFTNs were classified as low-risk TNs when applying Kwak TIRADS (EU-TIRADS 52.9%), 22.1% were intermediate-risk TNs (EU-TIRADS 19.1%), and 8.8% were high-risk TNs (EU-TIRADS 27.9%). Twelve months after RIT, 22.1% of the AFTNs showed features of high-risk TNs according to Kwak TIRADS (EU-TIRADS 45.6%). The proportion of intermediate TNs also increased to 36.8% (EU-TIRADS 29.4%), and 41.2% were low-risk TNs (EU-TIRADS 25%). A significant percentage of AFTNs presented with features suspicious for malignancy according to TIRADS before RIT, and this number increased significantly after therapy. Therefore, before thyroid US, thorough anamnesis regarding prior radioiodine treatment is necessary to prevent unneeded diagnostic procedures.

scholarly journals Clinicopathologic Characteristics of Thyroid Nodules Positive for PTEN Mutations on Preoperative Molecular Testing

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A1013-A1014
Author(s):  
Jacob Quaytman ◽  
Yuri E Nikiforov ◽  
Marina Nikiforova ◽  
Elena Morariu
Keyword(s):  
Thyroid Nodules ◽  
Follicular Carcinoma ◽  
Retrospective Chart Review ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Molecular Testing ◽  
Nras Mutation ◽  
Clinicopathologic Characteristics ◽  
Nodule Size

Abstract Somatic and germline mutations of PTEN tumor suppressor gene are associated with follicular-pattern thyroid tumors and PTEN Hamartoma Tumor Syndrome (PHTS). The incidence of cancer in thyroid nodules positive for PTEN mutations on fine-needle aspiration (FNA) is not well defined. The aim of this study was to characterize diagnostic and phenotypic features of thyroid nodules with preoperatively detected PTEN mutations and their impact on management. Thyroid nodules with PTEN mutations on ThyroSeq v3 GC testing of FNA and core needle biopsy specimens from November 2017 to July 2020 were identified from the ThyroSeq Molecular Database. Demographic and clinicopathologic data were obtained through retrospective chart review. We identified 49 PTEN mutation-positive nodules from 48 patients. Patients were 57 years old on average (range 14-88) and 80% female. Cytology was predominantly indeterminate (73% atypia of undermined significance, 18% follicular neoplasm). There were 18 (29%) frameshift, 6 (10%) splice site, and 39 (62%) single nucleotide variant PTEN mutations. Fourteen (29%) nodules had two PTEN mutations, 5 (10%) had copy number alterations, and single cases had concurrent BRAF K601N, EZH1, and NRAS mutations. Surveillance was pursued for 27 (56%) and surgery for 21 (44%) patients (16 lobectomies, 5 total thyroidectomies). There were 14 follicular adenomas (FA), 4 oncocytic FA’s, 1 oncocytic hyperplastic nodule, and 1 encapsulated follicular variant papillary thyroid carcinoma (EFVPTC). The EFVPTC had two low-frequency PTEN mutations, PTEN locus loss, an NRAS mutation, and was a low-risk tumor with capsular but no angiolymphatic invasion. Four (8.3%) patients had confirmed or suspected PHTS, all with multiple nodules. Two had surgery finding no malignancies (2 FA). One PHTS patient had a prior thyroidectomy for a MET mutation-positive nodule that was follicular carcinoma. On US, the mean nodule size of patients who had surgery was larger than the surveillance group (3.2 cm vs. 2.3 cm, p=0.02) but there was no difference in TI-RADS level (p=0.54). There was no difference in mean nodule size (3.5 cm vs. 2.6 cm, p=0.35) or TI-RADS level (p=0.81) between PHTS and non-PHTS patients. Among surveillance patients, follow-up US was done at 1 year in 13/19 (68%) and 2 years in 3/6 (50%) of eligible cases. Only 1/19 (5%) underwent repeat FNA for increased nodule size. No thyroid malignancy was found with a mean of 1.75 years of follow-up (range 1.00-2.78). The EFVPTC patient had no recurrence after 1.05 years of follow-up. In summary, thyroid nodules with isolated somatic PTEN mutations are primarily benign and can be safely followed with serial imaging. Nodules with multiple PTEN mutations were only associated with malignancy when accompanied by an additional NRAS mutation. About 8% of patients with PTEN mutations may be PHTS patients who may be at greater risk for malignancy.

scholarly journals OR21-02 Impact of Nodule Size on the Probability of Hurthle Cell Carcinoma and Other Cancers in Thyroid Nodules with Multiple Chromosomal Copy Number Alterations

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Marina N Nikiforova ◽  
Alyaksandr Nikitski ◽  
Jessica Tebbets ◽  
Lindsey Tolino ◽  
Pooja Manroa ◽  
...  
Keyword(s):  
Copy Number ◽  
Thyroid Nodules ◽  
Surgical Pathology ◽  
Copy Number Alterations ◽  
Nodule Size ◽  
Thyroid Carcinomas ◽  
Hürthle Cell ◽  
Chromosomal Copy Number ◽  
Chromosomal Copy ◽  
Probability Of Cancer

Abstract Fine-needle aspiration (FNA) of thyroid nodules yields indeterminate cytological diagnosis in ~20% of cases, confounding patient management. This includes Hurthle cell nodules, which typically yield Bethesda IV and III cytology. Chromosomal copy number alterations (CNA) are known to occur in thyroid tumors, particularly in Hurthle cell carcinomas (HCC) as well as in other typically follicular-patterned tumors including papillary thyroid carcinomas (PTC) and poorly differentiated thyroid carcinomas (PDTC). The aim of this study was to evaluate thyroid nodules tested positive for CNA but negative for all other genomic alterations using ThyroSeq v3 NGS assay in order to establish the probability of cancer in these nodules and find whether it is influenced by the pattern of CNA and nodule size. We evaluated 111 nodules with multiple CNA detected by ThyroSeq in FNA samples and available surgical pathology outcome. Of those, 69 (62%) nodules showed CNA changes consistent with genome near-haploidization (GNH) whereas 42 (38%) nodules had multiple chromosomal losses and gains (CLG). Nodule size ranged from 0.5-10.2 cm; cytology was Bethesda III in 54%, Bethesda IV in 43%, and Bethesda V-VI in 3% of cases, with Hurthle cells mentioned in the cytology report in 64% of cases. On surgical pathology, 38 (34%) of these nodules were malignant (including 24 HCC, 8 PTC, and 5 oncocytic PDTC) and 73 (66%) were benign (including 43 Hurthle cell and 18 follicular adenomas). No significant difference was observed in probability of malignancy between the two patterns of CNA (p=0.41). However, a significant correlation between the nodule size and probability of cancer was found (p=0.006). In specific CNA groups, correlation between cancer and nodule size remained significant for nodules with GNH pattern (P=0.0002), but not with CLG pattern (p=0.449). Specifically, cancer probability in nodules with GNH pattern and &lt;2 cm in size was 14% (all cancers minimally-invasive), 2.0-2.9 cm was 33%, 3.0-3.9 cm was 50%, 4-4.9 cm was 67%, and ≥5 cm was 80%. Among high-risk cancers (widely-invasive or angioinvasive HCC, PDTC), all 10 tumors had the GNH pattern (p=0.01) and average nodule size of 4.9 cm (range, 2.1-8.5 cm). These findings suggest that CNA of both types are frequently found in Hurthle cell tumors, and probability of cancer in nodules with CNA and no other mutations increases with larger nodule size. This may help to refine the pre-operative assessment of cancer probability and risk of more aggressive disease and offer more tailored management to these patients.

scholarly journals Predicting the Size of Benign Thyroid Nodules and Analysis of Associated Factors That Affect Nodule Size

2015 ◽  
Vol 51 (2) ◽  
pp. 97 ◽  
Author(s):  
Seok Ho Seo ◽  
Tae Hyun Kim ◽  
Soon Ho Kim ◽  
Seung Hyun Lee ◽  
Jong Taek Kim ◽  
...  
Keyword(s):  
Associated Factors ◽  
Thyroid Nodules ◽  
Nodule Size ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid
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