Focal Lymphocytic Thyroiditis Nodules Share the Features of Papillary Thyroid Cancer on Ultrasound.
10.3349/ymj.2015.56.5.1338
- Author:
Sena HWANG
1
;
Dong Yeob SHIN
;
Eun Kyung KIM
;
Woo Ick YANG
;
Jung Woo BYUN
;
Su Jin LEE
;
Gyuri KIM
;
Soo Jung IM
;
Eun Jig LEE
Author Information
1. Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. ejlee423@yuhs.ac
- Publication Type:Original Article
- Keywords:
Differential diagnosis;
focal lymphocytic thyroiditis;
papillary thyroid cancer
- MeSH:
Aged;
Aged, 80 and over;
Autoantibodies;
Biopsy, Fine-Needle/*methods;
Calcinosis;
Carcinoma/*pathology;
Female;
Hashimoto Disease;
Humans;
Hyperplasia/*pathology;
Male;
Middle Aged;
Multivariate Analysis;
Predictive Value of Tests;
Retrospective Studies;
Sensitivity and Specificity;
Thyroglobulin/blood;
Thyroid Diseases;
Thyroid Neoplasms/*pathology;
Thyroid Nodule/*pathology;
Thyroiditis, Autoimmune/*pathology;
Thyrotropin/blood
- From:Yonsei Medical Journal
2015;56(5):1338-1344
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: It is often difficult to discriminate focal lymphocytic thyroiditis (FLT) or adenomatous hyperplasia (AH) from thyroid cancer if they both have suspicious ultrasound (US) findings. We aimed to make a predictive model of FLT from papillary thyroid cancer (PTC) in suspicious nodules with benign cytologic results. MATERIALS AND METHODS: We evaluated 214 patients who had undergone fine-needle aspiration biopsy (FNAB) and had shown thyroid nodules with suspicious US features. PTC was confirmed by surgical pathology. FLT and AH were confirmed through more than two separate FNABs. Clinical and biochemical findings, as well as US features, were evaluated. RESULTS: Of 214 patients, 100 patients were diagnosed with PTC, 55 patients with FLT, and 59 patients with AH. The proportion of elevated thyrotropin (TSH) levels (p=0.014) and thyroglobulin antibody (Tg-Ab) or thyroid peroxidase antibody (TPO-Ab) positivity (p<0.001) in the FLT group was significantly higher than that in the PTC group. Regarding US features, absence of calcification (p=0.006) and "diffuse thyroid disease" (DTD) pattern on US (p<0.001) were frequently seen in the FLT group. On multivariate analysis, Tg-Ab positivity, presence of a DTD pattern on US, and absence of calcification in nodules were associated with FLT with the best specificity of 99% and positive predictive value of 96%. In contrast, a taller than wide shape of nodules was the only variable significant for differentiating AH from PTC. CONCLUSION: Suspicious thyroid nodules with cytologic benign results could be followed up with US rather than repeat FNAB, if patients exhibit Tg-Ab positivity, no calcifications in nodules, and a DTD pattern on US.
