ECE2023 Eposter Presentations Thyroid (128 abstracts)
What are we going to do with Bethesda IV nodes in future? Do we need molecular testing for all of them?
Arseny Semenov 1 , Dmitry Buzanakov 1 , Roman Chernikov 1 , Iliya Sleptsov 1 , Viktor Makarin 1 , Anna Uspenskaya 1 , Nataliya Timofeeva 1 , Nataliya Gorskaya 1 , Sergey Vorobyev 2 , Konstantin Novokshonov 1 , Yuliya Karelina 1 , Igor Chinchuk 1 , Elisey Fedorov 1 , Dina Rebrova 1 , Iliya Sablin 1 , Anna Zolotukho 1 , Svetlana Alekseeva 1 , Kseniya Gerasimova 1 , Alexander Puskaruk 1 , Nataliia Levchenko 3 & Shamil Shihmagomedov 1
1SPbU Hospital, Endocrine Surgery, Sankt-Peterburg, Russia, 2National Center for Clinical Morphological Diagnostics, Sankt-Peterburg, Russia, 3SPBU, Medical Faculty, Saint Petersburg, Russia
Background: Bethesda IV is the most common indication for thyroid surgery. As histological verification is the only 100% certain method of confirming malignancy, surgery remains the gold standard for FN treatment. Most cases of FN malignancy are variants of papillary thyroid cancer that require active surveillance alone in nodules sized less than 2 cm.
Materials: A continuous cohort of 4399 patients who underwent surgery at SPbU_Hospital in the years 2020-2021 with Bethesda IV cytology obtained by FNAB with MG staining.
Results: In 1296 (29,5%) patients malignant thyroid nodules were identified by final histological examination. However, in 406 of those patients (31,3%) malignancy was found in non-punctured minor nodules. Of 980 cases of FN found to be malignant 46% were NIFTP or minimally invasive follicular thyroid cancer and only in 185 (8,8%) cases invasion of at least the nodules’ capsule was reported. 39 cases involved an invasion of the gland’s capsule (4%). 29 (3,6%) cases had vascular invasion or were suspicious for vascular invasion. 3066 patients had nodules of ≤2 cm. Of those patients 578 had malignant nodules (18,9%). In 262 patients (45,3%) the nodules were identified as NIFTP or minimally invasive follicular thyroid cancer. However, the risk of finding cancer with aggressive features in nodules of 2 cm or less was only 0,9%, as compared to 6,4% in nodules >2 cm. OR=7,4 The risk of finding aggressive cancer in any nodule sized ≤2 cm was 0,16%, while that in larger nodules was 1,5%. Most of the malignant nodules were found to be variants of thyroid cancer meeting the criteria for active surveillance. We performed ROC analysis to establish cut off size of FN and the risk of missing an aggressive thyroid cancer (AUC=0.84). Cut off nodule diameter of 3 cm showed a sensitivity of 0.8 (0.64 - 0.92), and a specificity of 0.79 (0.78 - 0.81) for the risk of aggressive cancer. For 2 cm sensitivity was 0.84 (0.68 - 0.96), while specificity was 0.6 (0.59 - 0.62). NPV was 0.9984 (0.9971 - 0.9994) for the 3 cm diameter and 0.9983 (0.9966 - 0.9996) for the 2 cm diameter.
Conclusion: It seems that patients with nodules of ≤2 cm can safely avoid surgery until the nodules grow in size even if no genetic test is performed. This may also be true for nodules of ≤3 cm, should the surveillance criteria for papillary thyroid cancer be expanded.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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