BACKGROUND: The Bethesda classification system for reporting on thyroid fine-needle aspiration (FNA) cytology was recently proposed by the National Cancer Institute, USA. We aimed to report our experience with applying this system for thyroid FNA, with a focus on comparing it with the four categorical system. METHODS: We retrospectively reviewed the 4,966 thyroid FNAs that were performed at the Seoul St. Mary's Hospital between October 2008 and September 2009. All the FNAs were classified according to the Bethesda system and the four tier system. RESULTS: The cytologic diagnoses of the Bethesda system included 10.0% unsatisfactory, 67.7% benign, 3.1% atypia of undetermined significance, 0.6% follicular neoplasm, 0.5% follicular neoplasm, Hurthle cell type, 5.1% suspicious for malignancy and 13.0% malignancy. Using four tier system, 10.1%, 67.6%, 9.3%, and 13% were diagnosed as unsatisfactory, negative for malignancy, atypical cells and malignancy, respectively. Of the 4,966 nodules, 905 were histologically confirmed. The specificity of the Bethesda system and the four tier system for diagnosing malignancy was 99.6% and 82.6%, respectively. CONCLUSIONS: The Bethesda system can classify indeterminate thyroid nodules into more detailed categories and provide clinicians with useful information for management.
Biopsy, Fine-Needle ; Diagnostic Techniques and Procedures ; National Cancer Institute (U.S.) ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

BACKGROUND: The Bethesda classification system for reporting on thyroid fine-needle aspiration (FNA) cytology was recently proposed by the National Cancer Institute, USA. We aimed to report our experience with applying this system for thyroid FNA, with a focus on comparing it with the four categorical system. METHODS: We retrospectively reviewed the 4,966 thyroid FNAs that were performed at the Seoul St. Mary's Hospital between October 2008 and September 2009. All the FNAs were classified according to the Bethesda system and the four tier system. RESULTS: The cytologic diagnoses of the Bethesda system included 10.0% unsatisfactory, 67.7% benign, 3.1% atypia of undetermined significance, 0.6% follicular neoplasm, 0.5% follicular neoplasm, Hurthle cell type, 5.1% suspicious for malignancy and 13.0% malignancy. Using four tier system, 10.1%, 67.6%, 9.3%, and 13% were diagnosed as unsatisfactory, negative for malignancy, atypical cells and malignancy, respectively. Of the 4,966 nodules, 905 were histologically confirmed. The specificity of the Bethesda system and the four tier system for diagnosing malignancy was 99.6% and 82.6%, respectively. CONCLUSIONS: The Bethesda system can classify indeterminate thyroid nodules into more detailed categories and provide clinicians with useful information for management.
Biopsy, Fine-Needle ; Diagnostic Techniques and Procedures ; National Cancer Institute (U.S.) ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

PURPOSE: To clarify the value of mass screening for thyroid cancer by ultrasonography. MATERIALS AND METHODS: We evaluated the incidence of thyroid nodules and the detection rate of malignant nodules in 2856 patients who underwent screening thyroid ultrasonography while undergoing breast ultrasonography. We also analyzed the ultrasonographic characteristics of nodules in the screening (34 patients) and clinical (48 patients) groups which were diagnosed with thyroid cancer. RESULTS: The incidence of thyroid nodules detected by ultrasonography was 39% and the detection rate of thyroid cancer was 1.19% in the screening group and 17% in the clinical group. The mean size of nodules in clinical group was larger than that in the screening group (p<0.05) and the prevalence of nodules with ill-defined margin in the screening group was higher than that in the clinical group (p<0.05). There was no significant difference in internal echogenicity, shape, presence of internal calcifications, lymph node metastasis and extrathyroidal extension between the two groups. CONCLUSION: Although the incidence of thyroid cancer was low, sonographic screening for thyroid cancer while undergoing breast ultrasonography could be valuable.
Breast* ; Early Detection of Cancer ; Humans ; Incidence ; Lymph Nodes ; Mass Screening* ; Neoplasm Metastasis ; Prevalence ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Ultrasonography ; Ultrasonography, Mammary*

Carcinoma, Papillary/diagnostic imaging* ; Humans ; Retrospective Studies ; Thyroid Cancer, Papillary/diagnostic imaging* ; Thyroid Neoplasms/diagnostic imaging* ; Thyroid Nodule/diagnostic imaging* ; Ultrasonography

Objective: To analyze the features of degenerating cystic thyroid nodules (DCTN) on conventional ultrasound and contrast-enhanced ultrasound (CEUS), and to explore the differentiation between DCTN and papillary thyroid carcinomas (PTC). Methods: A total of 46 DCTN (39 cases, including 12 males and 27 females, with an age range of 25 to 76 years) and 36 PTC (32 cases, including 8 males and 24 females, with an age range of 23 to 68 years) diagnosed via fine- needle aspiration (FNA) or surgery from February 2019 to January 2020 in the First Affiliated Hospital of Nanchang University were enrolled. The size, shape, margin, echogenicity, presence of shadowing, calcification and vascularity of DCTN and PTC were retrospectively evaluated, and 28 DCTN and 30 PTC underwent CEUS were separately analyzed and compared.The t test, χ² test or Fisher's exact test were implemented to compare the features of ultrasound among the two groups. The binary Logistic regression test was performed to determine whether the feature whose difference was statistically significant was an independent predictive risk factor. Results: A univariate analysis indicated that DCTN more frequently showed wider-than-tall shapes, marked hypoechogenicity, well-defined margin and no or dot-lined enhancement (wider-than-tall shapes: 36 vs. 17, χ²=8.511; well-defined margin: 30 vs. 15, χ²=4.523; marked hypoechogenicity: 27 vs. 9, χ²=9.310; no or dot-lined enhancement: 24 vs. 3, χ²=33.369; all P＜0.05). A multivariate analysis demonstrated that wider-than-tall shapes, well-defined margin and marked hypoechogenicity were independent predictors for DCTN (OR values were 5.204, 3.134 and 5.042, P values were 0.003, 0.031, and 0.003, respectively). Among 28 DCTN, 15 showed a decrease in mean maximum diameter (24.3±11.4 mm) with a mean time span of (18.6±10.5) months between the presence and absence of suspicious ultrasound features. Conclusions: Compared with PTC, DCTN shows the ultrasound characteristics of wider-than-tall shapes, well-defined margin, marked hypoechogenicity and no or dot-lined enhancement pattern. Ultrasound follow-up can help to identify spontaneous DCTN.
Adult ; Aged ; Carcinoma, Papillary/diagnostic imaging* ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Cancer, Papillary/diagnostic imaging* ; Thyroid Neoplasms/diagnostic imaging* ; Thyroid Nodule/diagnostic imaging* ; Ultrasonography

OBJECTIVE: To investigate whether serum thyroid-stimulating hormone(TSH) levels are of value in predicting malignancy in patients with nodular thyroid disease. The relationship between TSH levels and thyroid cancer incidence was also investigated. METHOD: One hundred and eight patients with thyroid tumors who underwent surgical treatment were included in this study (25 cases of papillary thyroid cancer and 83 cases of benign tumors). The data of their preoperative serum TSH level, gender, age, number of tumors detected by ultrasonic inspection, and pathological type were retrospectively analyzed, and their association with thyroid cancer incidence was explored. Logistic regression analysis was used to predict thyroid cancer risk factors. RESULT: Patients with malignancy had a higher mean value of TSH than that of the patients with benignancy [(1.94±1.01)mlU/L vs (1.16± 0.85)mIU/L, respectively; P<0.05]. Compared with the patients below the population mean, patients above the population mean had a significantly higher malignancy rate (35.9% vs 15.9%, P<0.05). High serum TSH level (OR=10.913, P=0.001), male (OR=4. 845, P=0.028) and age ≥45 (OR=10.831, P=0.001) are independent risk factors of thyroid cancer. CONCLUSION The preoperative serum TSH level may be useful in predicting the probability of cancer. The high serum TSH level, male, age ≥45 are risk factors of thyroid cancer.
Carcinoma ; pathology ; Carcinoma, Papillary ; Humans ; Incidence ; Male ; Prognosis ; Retrospective Studies ; Risk Factors ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; pathology ; Thyroid Nodule ; blood ; Thyrotropin ; blood

The cell origin, histopathologic features, and prognosis of medullary and papillary thyroid carcinoma are different and to have them occur simultaneously in a single patient is a rare occurrence. This is a case of a 38-year-old female who presented with an enlarging anterior neck mass whose fine needle aspiration biopsy could not rule out a papillary lesion. Thus, she was advised to undergo total thyroidectomy, and her final histopath showed a simultaneous medullary and papillary thyroid carcinoma. Her initial serum calcitonin was elevated at 252 pg/ ml, and it remained persistently elevated over the course of 7 months. A repeat ultrasound revealed solid nodules with coarse calcifications and enlarged lymph nodes at both submandibular regions. This warranted a repeat surgery with neck dissection with the finding of eight lymph nodes positive for metastatic carcinoma. On follow up after her second surgery, the calcitonin decreased to 42.70 pg/ml. Knowledge of this simultaneous occurrence of medullary thyroid carcinoma and papillary cancer is important for its prognostic implications and therapeutic plan
Thyroid Neoplasms ; Thyroid Cancer, Papillary

INTRODUCTION

Papillary thyroid cancer (PTC) is generally considered to be an indolent disease with relatively good prognosis. However, some studies have shown that the Filipino population has a higher risk for disease recurrence compared to non-Filipino patients and hence early identification and management during the follow-up period would be beneficial, especially those in whom risk factors for recurrence were identified.

This study aims to identify determinants for disease recurrence of patients with papillary thyroid carcinoma (as defined by the American Thyroid Association (ATA) guidelines 2015) diagnosed from January 1, 2013-December 31, 2017, seen at the University of Santo Tomas Hospital (USTH) outpatient endocrine clinic and underwent total thyroidectomy with or without radioactive iodine ablation therapy.

Retrospective review of outpatient medical records of 82 patients with PTC who underwent total thyroidectomy with or without radioactive iodine (RAI) therapy and achieved excellent response (ER) to therapy was performed. Baseline clinical profile such as age at diagnosis, sex, family history of thyroid cancer, family history of goiter, histopathology result, serial thyroglobulin (Tg), anti-thyroglobulin (anti-Tg) levels, whole body scan reports, neck ultrasound reports and RAI doses were collected. Logistic regression analysis was used to identify determinants to the development of worsening response.

Of the 82 patients, 18 (21.9%) developed worsening response to therapy. Predictors of poor outcomes identified from previous studies such as age, sex, extent of disease, size and multifocality of tumors, ATA risk classification and initial dynamic risk assessment, RAI therapy, level of thyroid-stimulating hormone (TSH) suppression were analyzed. After logistic regression analysis, there was no significant association between variables and progression to worsening response that were previously identified in other studies.

Even though no significant association between investigated variables and worsening response were identified in this study, previous studies with larger populations that had exhibited positive association should be considered and hence current Philippine guidelines for the management of PTC must still be applied.

Humans ; Thyroid Neoplasms/surgery* ; Thyroid Cancer, Papillary

Objective: To compare the diagnostic performance of American College of Radiology-Thyroid Image Reporting and Data Systems (ACR-TIRADS) and the American Thyroid Association (ATA) guidelines on screening for thyroid malignancy. Methodology: A cross-sectional criterion-referenced study involving Filipino patients with thyroid nodules, 18-80 years old, who underwent ultrasound guided fine needle aspiration biopsy at the Thyroid Clinic of The Medical City from July to December 2019. The ACR-TIRADS and the ATA guidelines were compared for 197 nodules. Standard diagnostic parameters were calculated, namely sensitivity, specificity, PPV, NPV, positive and negative likelihood ratios and overall accuracies. Results: The risks of malignancy were 15% and 22% for TIRADS 4 and 5 respectively. For ATA guidelines, it’s 2%, 20%, and 15% for nodules with low, intermediate, and high suspicion respectively. The sensitivity, specificity, PPV, NPV, and accuracy of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TIRADS) in relation to Fine Needle Aspiration Cytology (FNAC) is 100%, 52.2%, 16.5%, 100%, and 56.4% respectively. For the American Thyroid Association (ATA) guidelines it is 88.2%, 57.8%, 16.5%, 98.1%, and 60.4% respectively. Conclusion The ACR TIRADS classifications appears to be more sensitive than the ATA classification. The ATA guidelines prove to be a more specific test. Each tool has its unique advantages and disadvantages. Therefore, clinicians must use these tools with utmost vigilance to avoid over or under diagnosis and to avoid unnecessary thyroid nodule biopsies.
Thyroid Neoplasms ; Thyroid Nodule