Al Dawish, Mohamed Abdulaziz 1; Robert, Asirvatham Alwin1; Braham, Rim2
1 Department of Endocrinology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
2 Department of Endocrinology, Henri Mondor Hospital, Paris, France.
Background /Purpose: Determine the contribution of thyroid-stimulating hormone (TSH), Thyroid image reporting and data system (TI-RADS) and cytological classification system for predicting malignancy.
Methods: From January, 2012 to December, 2014, a retrospective analysis was performed among 1188 patients (15-90 years) who had 1433 thyroid nodules and fine-needle aspiration at Prince Sultan Military Medical City, Saudi Arabia. All thyroid cyto-pathological slides and ultra sound reports were reviewed and classified according to the Bethesda and TI-RADS classification respectively.
Results: Of the 1188 patients, 311 were underwent surgery (253 had one nodule; 58 had two nodule), with total of 369 cases (124 malignant), giving an overall malignancy of 33.6%. Risk of malignancy in thyroid nodules of <cm was 48.1%; 1-1.9 cm 41.3%, 2-2.9 cm 31.6%, 3-3.9 cm 32.8% and >4 cm 20.5%. Compared to patients with TSH <0.4 mIU/l, significant risk of malignancy was observed among patients with TSH > 4.5 mIU/l (p<0.001). Majority of the thyroid cancer nodules (46%) in Bethesda 6 category and papillary thyroid carcinoma (89.6%) was the most common form of thyroid cancer. Among the 315 completed ultrasound data (95 malignant), the risk of malignancy in TI-RADS category 2; 3 4A , 4B and 5 were 7.6%, 13.3%, 26.4%, 48.2%, 78% respectively.
Discussion & Conclusion: The factors associated with high risk of malignancy in the study population were TSH level > 4.5cm, Bethesda categories from 3 to 6 and TIRADS 4B and 5. While the size of thyroid nodule >4 cm was not associated with risk of malignancy .