Endocrine Abstracts

Objective

The aim of the study was to evaluate the overall malignancy rate on final histopathology in nodules with Bethesda III or IV surgically excised and review the ultrasound and cytological features given

Material and methods

Is a retrospective analysis of patients referred to our outpatient clinical of endocrinology after thyroid surgery with a previous thyroid nodule FNA cytology in Bethesda III or IV category. We also reviewed the information given in the ultrasound (echogenicity, margins, presence and type of calcifications, shape if taller than wide, vascularity and the presence or absence of any suspicious cervical lymph nodes in the central or lateral compartments) and cytopathology (architectural and/or nuclear atypia) reports

Results

Of the 50 patients: 72% underwent a total thyroidectomy and 28% hemithyroidectomy. In Bethesda III nodules 77.41% total vs 22.58% hemithyroidectomy and in Bethesda IV nodules 63.15% total vs 36.48%. The overall malignancy rate was 42%; in Bethesda III 35.48% and in Bethesda IV 47.36%. Papillary thyroid cancer represents 10%, follicular thyroid cancer 8%, incidentally thyroid microcarcinoma (<5 mm) 16% and NIFTP 6%. The US report inform about echogenicity and cervical lymph nodes in 62%, size in three diameters in 50%, vascularity in 36%, calcifications in 24%, margins in 22% and no one taller than wide. Only 20% of cytopathology reports information about cytologic or architectural atypia. In those with cytologic atypia the malignancy rate was 50%. Only in 16% the FNA was repited. The medium nodule size was 2.84 cm

Conclusions

Our malignancy rate (42%) was higher than estimated risk of malignancy predicted by Bethesda system. However more than a half correspond with incidentally thyroid carcinomas <5mm and NIFTP. The high rate of thyroidectomies is possibly related to the limited information obtained in the reports. Both of them are remarkable