ECE2018 Poster Presentations: Thyroid Thyroid cancer (88 abstracts)
Malignancy risk stratification of thyroid nodules with cytological diagnosis of folicular neoplasm (Bethesda IV), according to the ultrasound sonographic patterns proposed by the American Thyroid Association (ATA)
José Javier Pineda 1, , Ander Ernaga 1, , Emma Anda 1, , Marta Toni 1, , Juan Pablo Martinez 1 , Patricia Munarriz 1 , Jorge Rojo 1 , Dolores Ollero 1, & María Diaz 1
1Thyroid Pathology Unit of Complejo Hospitalario de Navarra, Pamplona, Spain; 2IdiSNA: Instituto de investigación sanitaria de Navarra, Pamplona, Spain.
Background: The main limitation of fine-needle aspiration (FNA) is represented by indeterminate category (Bethesda III and IV) in which the risk of malignancy is between 5-30%. Given this result, surgical treatment is necessary in many cases. The aim of our study is to assess whether the ultrasound patterns proposed by the ATA, help us to stratify the risk of malignancy in nodules with Bethesda IV cytology result.
Methods: From January 2011 to June 2017 we selected all thyroid nodules referred to our Thyroid Unit, with cytological diagnosis of follicular neoplasia (Bethesda IV). All patients underwent surgical treatment. We retrospectively analyzed the clinical data (computerized clinical history) and ultrasound images. (All images were reviewed and classified in different ultrasound patterns by two endocrinologists with at least 5 years of experience in thyroid ultrasound.).
Results: A total of 263 nodules were selected with the following characteristics: Mean age ±S.D.: 52.1±15.1 years; sex: F/M (4/1); mean size of nodules 30.6±13.3 mm; TSH: 2.5 mU/L±8.6; thyroid autoimmunity 27.8%. The malignancy risk of the following ultrasound patterns is: Very low suspicion (0%), Low suspicion (16.7%), Intermediate Suspicion (27.9%) and High Suspicion (63.4%). 15 Nodules (5.7%) could not be classified within a specific pattern, presenting a risk of malignancy of 26.7%. Of the 263 nodules 68 were malignant (25.9%). 44 malignant nodules (64.7%) were papillary carcinomas, being the follicular variant the most frequent histologic type.
Conclusions: Ultrasound patterns proposed by the ATA, allow an adequate stratification of the malignancy risk, in nodules with Bethesda IV cytological results. This information may have clinical utility to decide the most appropriate surgical approach. However, 5.7% of the nodules could not be classified properly, presenting a risk of malignancy similar to those of Intermediate Suspicion.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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