Clinicopathological Features of Indeterminate Thyroid Nodules: A Single-center Cross-sectional Study
Abstract
Introduction
Due to indeterminate cytology, Bethesda III is the most controversial category within the Bethesda System for Reporting Thyroid Cytopathology. This study examines the characteristics and malignancy rates of thyroid nodules (TNs) classified as Bethesda III.
Methods
Data were collected by reviewing electronic medical records, encompassing demographic details, medical history, chief complaint, laboratory tests (including thyroid function tests), preoperative imaging, cytology results, management, and histopathology diagnosis.
Results
The majority of the cases were female (84.7%). Patients’ ages ranged from 15 to 71 years, with a mean of 42.9 ± 10.5 years. Regarding goiter grading, 37 cases (21.8%) were classified as G0, 62 (36.5%) as G1, 55 (32.3%) as G2, and seven (4.1%) as G3. Thyroid Imaging Reporting and Data Systems scoring categorized the nodules as TI-RADS 2 (5.3%), TI-RADS 3 (40%), TI-RADS 4 (38.2%) and TI-RADS 5 (9.4%). The size of TNs on ultrasound ranged from 0.3 cm to 7.8 cm, with a mean size of 2.06 ± 1.3 cm. Adenoma was the most common diagnosis (40%), followed by thyroiditis (16.5%), papillary thyroid carcinoma (15.9%), and papillary thyroid microcarcinoma (15.9%). The nodules were predominantly benign (64.7%), while 35.3% were malignant. Patients with malignant nodules were younger than those with benign nodules (p=0.044). Benign nodules were significantly larger than malignant ones (p-value = 0.003).
Conclusion
One of three TNs with indeterminate cytology may be malignant. Patients with malignant nodules tend to be younger than those with benign nodules, and benign nodules are likely larger than malignant ones.
References
- nodules with indeterminate cytology: Association between nodule size, histopathological characteristics and clinical outcome in differentiated thyroid carcinomas—A multicenter retrospective cohort study on 761 patients. Updates in Surgery. 2021;73(5):1923-30. doi:10.1007/s13304-021-01096-2
- Naidu K, Saksenberg V, Mahyoodeen NG. Clinical and ultrasound characteristics distinguishing benign and malignant thyroid nodules in Johannesburg, South Africa. Journal of Endocrinology, Metabolism and Diabetes in South Africa. 2023;28(2):62-8. doi:10.1080/16089677.2023.2178274
- Dimitriadis PA, Moinie A, Michaels J, Bance R, Vijendren A, Mochloulis G. Indeterminate thyroid nodules (Thy3): malignancy rate and characteristics in a study of 118 patients. The Annals of The Royal College of Surgeons of England. 2023;105(6):568-71. doi:10.1308/rcsann.2022.0163
- Chen D, Hu J, Zhu M, Tang N, Yang Y, Feng Y. Diagnosis of thyroid nodules for ultrasonographic characteristics indicative of malignancy using random forest. BioData mining. 2020; 13:1-21. doi:10.1186/s13040-020-00223-w
- Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341-6. doi:10.1089/thy.2017.0500
- Kakamad FH, Abdalla BA, Abdullah HO, Omar SS, Mohammed SH, Ahmed SM, et al. Lists of predatory journals and publishers: a review for future refinement. European Science Editing. 2024;50: e118119. doi:10.3897/ese.2024.e118119
- Luo W, Yang X, Yuan J, Pang L, Zhang P, Ding L, et al. Evaluation of characteristics of thyroid nodules on contrast-enhanced ultrasonography: a retrospective analysis of 252 cases. Medical Ultrasonography. 2020;22(2):164-70. doi:10.11152/mu-2252
- Rano E, Lin L, Molinie V, Sulpicy C, Dorival MJ, Drak Alsibai K, et al.Epidemiological, Clinical, Ultrasonographic and Cytological Characteristics of Thyroid Nodules in an Afro-Caribbean Population: A Series of 420 Patients. Cancers. 2022;14(10): 2365. doi:10.3390/cancers14102365
- Bessey LJ, Lai NB, Coorough NE, Chen H, Sippel RS. The incidence of thyroid cancer by fine needle aspiration varies by age and gender. Journal of Surgical Research. 2013;184(2):761-5. doi:10.1016/j.jss.2013.03.086.
- Rago T, Scutari M, Latrofa F, Loiacono V, Piaggi P, Marchetti I, et al. The large majority of 1520 patients with indeterminate thyroid nodule at cytology have a favorable outcome, and a clinical risk score has a high negative predictive value for a more cumbersome cancer disease. The Journal of Clinical Endocrinology & Metabolism. 2014;99(10):3700-7. doi:10.1210/jc.2013-4401.
- Mitchell AL, Gandhi A, Scott-Coombes D, Perros P. Management of thyroid cancer: United Kingdom national multidisciplinary guidelines. The Journal of Laryngology & Otology. 2016;130(S2):S150-60. doi:10.1017/S0022215116000578.
- Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Thyroid. 2009 ;19(11):1167-214. doi:10.1089/thy.2009.0110.
- Kiernan CM, Solórzano CC. Bethesda category III, IV, and V thyroid nodules: can nodule size help predict malignancy? Journal of the American College of Surgeons. 2017;225(1):77-82. doi:10.1016/j.jamcollsurg.2017.02.002.
- Talmor G, Badash I, Zhou S, Kim YJ, Kokot NC, Hsueh W, et al. Association of patient characteristics, ultrasound features, and molecular testing with malignancy risk in Bethesda III–V thyroid nodules. Laryngoscope Investigative Otolaryngology. 2022;7(4):1243-50. doi:10.1002/lio2.847.
- Mihai R, Parker AJ, Roskell D, Sadler GP. One in four patients with follicular thyroid cytology (THY3) has a thyroid carcinoma. Thyroid. 2009;19(1): 33-7. doi:10.1089/thy.2008.0200
- Cavallo A, Johnson DN, White MG, Siddiqui S, Antic T, Mathew M, et al. Thyroid nodule size at ultrasound as a predictor of malignancy and final pathologic size. Thyroid. 2017;27(5):641-50. doi:10.1089/thy.2016.0336.
- Chadwick D, Kinsman R, Walton P. Fifth National audit report. British Association of Endocrine and Thyroid Surgeons, Henley-on-Thames: Dendrite Clinical Systems. 2017. https://www.baets.org.uk/wp-content/uploads/BAETS-Audit-National-Report-2017.pdf.
- Poller DN, Bongiovanni M, Trimboli P. Risk of malignancy in the various categories of the UK Royal College of Pathologists Thy terminology for thyroid FNA cytology: A systematic review and meta‐analysis. Cancer cytopathology. 2020;128(1):36-42. doi:10.1002/cncy.22201
- Calò PG, Medas F, Santa Cruz R, Podda F, Erdas E, Pisano G, et al. Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option? BMC surgery. 2014; 14:1-7. doi:10.1186/1471-2482-14-12
- Bresler A, Mehta V, Schiff BA, Smith RV, Khader S, Ramos‐Rivera G, et al. Comparison of Bethesda cytopathology classification to surgical pathology across racial‐ethnic groups. Head & Neck. 2019;41(7):2340-5. doi:10.1002/hed.25707.
- Finlayson A, Barnes I, Sayeed S, McIver B, Beral V, Ali R. Incidence of thyroid cancer in England by ethnic group, 2001–2007. British journal of cancer. 2014;110(5):1322-7. doi:10.1038/bjc.2014.4.
- Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1-33. doi:10.1089/thy.2015.0020.
- Salih AM, Muhialdeen AS, Ismaeil DA, Saeed YA, Dhahir HM, Baba HO, et al. Thyroid nodulectomy: A promising approach to the management of solitary thyroid nodules. Biomedical Reports. 2024;21(2):1-6. doi:10.3892/br.2024.1805.
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