Cargando…

Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?

BACKGROUND: Identification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians. This study investigates the ability of clinical, cytological and sonographic data to predict malignancy in indeterminate nodules with the scope of determining the ne...

Descripción completa

Detalles Bibliográficos
Autores principales: Calò, Pietro Giorgio, Medas, Fabio, Santa Cruz, Rosa, Podda, Francesco, Erdas, Enrico, Pisano, Giuseppe, Nicolosi, Angelo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946766/
https://www.ncbi.nlm.nih.gov/pubmed/24597765
http://dx.doi.org/10.1186/1471-2482-14-12
_version_ 1782306687024103424
author Calò, Pietro Giorgio
Medas, Fabio
Santa Cruz, Rosa
Podda, Francesco
Erdas, Enrico
Pisano, Giuseppe
Nicolosi, Angelo
author_facet Calò, Pietro Giorgio
Medas, Fabio
Santa Cruz, Rosa
Podda, Francesco
Erdas, Enrico
Pisano, Giuseppe
Nicolosi, Angelo
author_sort Calò, Pietro Giorgio
collection PubMed
description BACKGROUND: Identification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians. This study investigates the ability of clinical, cytological and sonographic data to predict malignancy in indeterminate nodules with the scope of determining the need for total thyroidectomy in these patients. METHODS: The study population consisted of 249 cases presenting indeterminate nodules (Thy3): 198 females (79.5%) and 51 males (20.5%) with a mean age of 52.43 ± 13.68 years. All patients underwent total thyroidectomy. RESULTS: Malignancy was diagnosed in 87/249 patients (34.9%); thyroiditis co-existed in 119/249 cases (47.79%) and was associated with cancer in 40 cases (40/87; 45.98%). Of the sonographic characteristics, only echogenicity and the presence of irregular margins were identified as being statistically significant predictors of malignancy. 52/162 benign lesions (32.1%) and 54/87 malignant were hypoechoic (62.07%); irregular margins were present in 13/162 benign lesions (8.02%), and in 60/87 malignant lesions (68.97%). None of the clinical or cytological features, on the other hand, including age, gender, nodule size, the presence of microcalcifications or type 3 vascularization, were significantly associated with malignancy. CONCLUSIONS: The rate of malignancy in cytologically indeterminate lesions was high in the present study sample compared to other reported rates, and in a significant number of cases Hashimoto’s thyroiditis was also detected. Thus, considering the fact that clinical and cytological features were found to be inaccurate predictors of malignancy, it is our opinion that surgery should always be recommended. Moreover, total thyroidectomy is advisable, being the most suitable procedure in cases of multiple lesions, hyperplastic nodular goiter, or thyroiditis; the high incidence of malignancy and the unreliability of intraoperative frozen section examination also support this preference for total over hemi-thyroidectomy.
format Online
Article
Text
id pubmed-3946766
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-39467662014-03-09 Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option? Calò, Pietro Giorgio Medas, Fabio Santa Cruz, Rosa Podda, Francesco Erdas, Enrico Pisano, Giuseppe Nicolosi, Angelo BMC Surg Research Article BACKGROUND: Identification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians. This study investigates the ability of clinical, cytological and sonographic data to predict malignancy in indeterminate nodules with the scope of determining the need for total thyroidectomy in these patients. METHODS: The study population consisted of 249 cases presenting indeterminate nodules (Thy3): 198 females (79.5%) and 51 males (20.5%) with a mean age of 52.43 ± 13.68 years. All patients underwent total thyroidectomy. RESULTS: Malignancy was diagnosed in 87/249 patients (34.9%); thyroiditis co-existed in 119/249 cases (47.79%) and was associated with cancer in 40 cases (40/87; 45.98%). Of the sonographic characteristics, only echogenicity and the presence of irregular margins were identified as being statistically significant predictors of malignancy. 52/162 benign lesions (32.1%) and 54/87 malignant were hypoechoic (62.07%); irregular margins were present in 13/162 benign lesions (8.02%), and in 60/87 malignant lesions (68.97%). None of the clinical or cytological features, on the other hand, including age, gender, nodule size, the presence of microcalcifications or type 3 vascularization, were significantly associated with malignancy. CONCLUSIONS: The rate of malignancy in cytologically indeterminate lesions was high in the present study sample compared to other reported rates, and in a significant number of cases Hashimoto’s thyroiditis was also detected. Thus, considering the fact that clinical and cytological features were found to be inaccurate predictors of malignancy, it is our opinion that surgery should always be recommended. Moreover, total thyroidectomy is advisable, being the most suitable procedure in cases of multiple lesions, hyperplastic nodular goiter, or thyroiditis; the high incidence of malignancy and the unreliability of intraoperative frozen section examination also support this preference for total over hemi-thyroidectomy. BioMed Central 2014-03-06 /pmc/articles/PMC3946766/ /pubmed/24597765 http://dx.doi.org/10.1186/1471-2482-14-12 Text en Copyright © 2014 Calò et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Calò, Pietro Giorgio
Medas, Fabio
Santa Cruz, Rosa
Podda, Francesco
Erdas, Enrico
Pisano, Giuseppe
Nicolosi, Angelo
Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?
title Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?
title_full Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?
title_fullStr Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?
title_full_unstemmed Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?
title_short Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?
title_sort follicular nodules (thy3) of the thyroid: is total thyroidectomy the best option?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946766/
https://www.ncbi.nlm.nih.gov/pubmed/24597765
http://dx.doi.org/10.1186/1471-2482-14-12
work_keys_str_mv AT calopietrogiorgio follicularnodulesthy3ofthethyroidistotalthyroidectomythebestoption
AT medasfabio follicularnodulesthy3ofthethyroidistotalthyroidectomythebestoption
AT santacruzrosa follicularnodulesthy3ofthethyroidistotalthyroidectomythebestoption
AT poddafrancesco follicularnodulesthy3ofthethyroidistotalthyroidectomythebestoption
AT erdasenrico follicularnodulesthy3ofthethyroidistotalthyroidectomythebestoption
AT pisanogiuseppe follicularnodulesthy3ofthethyroidistotalthyroidectomythebestoption
AT nicolosiangelo follicularnodulesthy3ofthethyroidistotalthyroidectomythebestoption