DOI: http://dx.doi.org/10.18203/2349-2902.isj20184712

A study of predictive factors of malignancy in thyroid nodules

P. Umapathy, G. Ashok Swaminathan, M. Fathima Farshana, M. Devagi

Abstract


Background: Thyroid nodule is a common presentation and requires structured diagnostic approach to ascertain the risk of malignancy and determine appropriate management. The aims of this randomized study is to evaluate potentiate role of thyroglobulin (Tg), thyroid stimulating hormone (TSH), and size of nodule as preoperative indicators of primary well differentiated thyroid cancer (WDTC).

Methods: This is a retrospective Study of 70 cases of colorectal carcinoma analysing incidence, clinicopathological features and outcome after different therapies including surgery, radiotherapy and chemotherapy.

Results: Preoperative Tg with cut-off >36 ng/ml is a significant predictor of malignancy. Anti-Tg Ab with cut-off of 3 IU/ml along with TSH are independent predictors of malignancy.

Conclusions: FNAC and Frozen section study has specificity of 67 and 75% and sensitivity of 74 and 80%, respectively. Accuracy of FNAC and frozen section study are 71 and 73%, respectively and preoperative thyroglobulin (Tg) with cut-off >36 ng/ml is a significant predictor of malignancy.


Keywords


Benign, Malignant, Thyroid nodule, Thyroglobulin

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References


British Thyroid Association, Royal College of Physicians. British Thyroid Association Guidelines for the Management of Thyroid Cancer. 2007. Available at http://www.british-thyroid-association.org

Datta RV, Petrelli NJ, Ramzy J. Evaluation and management of incidentally discovered thyroid nodules. Surgical Oncol. 2006;15:33-42.

Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. The American Thyroid Association Guidelines Taskforce. Thyroid. 2006;16:109-42.

Khan SA, Gafur MA, Khan MK, Karim MR, Mohiuddin M, Islam MS. Pattern of malignancy in clinically solitary thyroid nodule. Mymensingh Med J. 2012;21:1-7.

Pinchera A, Aghini-Lombardi F, Antonangeli L, Vitti P. Multinodular goiter. Epidemiology and prevention. Annali Italiani di Chirurgia, 1996;67:317-25.

Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metabol. 2002;87:1941-6.

Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metabol. 2006;91:3411-7.

Okayasu I, Fujiwara M, Hara Y, Tanaka Y, Rose NR. Association of chronic lymphocytic thyroiditis and thyroid papillary carcinoma. A study of surgical cases among Japanese, and white and African Americans. Cancer. 1995;76:2312-8.

Kim HJ, Mok JO, Kim CH, Kim YJ, Kim SJ, Park HK, et al. Preoperative serum thyroglobulin and changes in serum thyroglobulin during TSH suppression independently predict follicular thyroid carcinoma in thyroid nodules with a cytological diagnosis of follicular lesion. Endocrine Res. 2017;42:154-62.

Hosseini S, Payne RJ, Zawawi F, Mlynarek A, Hier MP, Tamilia M, et al. Can preoperative thyroglobulin antibody levels be used as a marker for well differentiated thyroid cancer? J Otolaryngol-Head Neck Surg. 2016;45:31.

Zeng Q, Liu J, Zhu J, Hu G. Association between preoperative serum thyroid-stimulating hormone level and non-functioning malignant nodule thyroid disease. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014;28:1931-3.

Jin J, Machekano R, McHenry CR. The utility of preoperative serum thyroid-stimulating hormone level for predicting malignant nodular thyroid disease. Am J Surg. 2010;199:294-8.

Morgan JL, Serpell JW, Cheng MS. Fine-needle aspiration cytology of thyroid nodules: how useful is it? ANZ J Surg. 2003;73:480-3.

Remonti LR, Kramer CK, Leitao CB, Pinto LC, Gross JL. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid. 2015;25:538-50.

Nieto H, Boelaert K. Women in cancer thematic review: thyroid-stimulating hormone in thyroid cancer: does it matter? Endocrine-Related Cancer. 2016;23:T109-21.

Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid. 1998;8:15-21.

Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Internal Med. 1993;118:282-9.

Bagga PK, Mahajan NC. Fine needle aspiration cytology of thyroid swellings: How useful and accurate is it? Indian J Cancer. 2010;47:437-42.

Sinna EA, Ezzat N. Diagnostic accuracy of fine needle aspiration cytology in thyroid lesions. J Egyp National Cancer Institute. 2012;24:63-70.

Muratli A, Erdogan N, Sevim S, Unal I, Akyuz S. Diagnostic efficacy and importance of fine-needle aspiration cytology of thyroid nodules. J Cytol. 2014;31:73-8.

Mahar SA, Husain A, Islam N. Fine needle aspiration cytology of thyroid nodule: diagnostic accuracy and pitfalls. J Ayub Med Coll Abbottabad. 2006;18:26-9.

Haberal AN, Toru S, Ozen O, Arat Z, Bilezikci B. Diagnostic pitfalls in the evaluation of fine needle aspiration cytology of the thyroid: Correlation with histopathology in 260 cases. Cytopathol. 2009;20:103-8.

Guevara N, Lassalle S, Benaim G, Sadoul JL, Santini J, Hofman P. Role of frozen section analysis in nodular thyroid pathology. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132:67-70.