Correlation of Bethesda tier IV cytology with histopathology and extent of thyroid surgery

  • Background
    Follicular?patterned lesions of the thyroid are common. However, preoperative discrimination of follicular adenoma and cancer is infeasible and many patients still require surgery to confirm diagnosis. The aim of this study was to define factors which correlate with high risk of malignancy in patients with preoperative cytology classified as Bethesda tier IV.

    A retrospective cohort study. Institutional database was searched for eligible patients who were operated on in 2016 – 2018 at our institution with preoperative FNA-based diagnosis of Bethesda tier IV. Further univariable analysis included: extension of surgery, age, presence of oxyphilic cells, diameter of the tumor, Hashimoto disease, clinical and ultrasound features of malignancy.  

    Of 258 patients who were found eligible for the study, 80 patients (68 female, 12 male) with mean age 55.9 +/-   35.3 years had complete data and were included. Thyroid cancer was diagnosed in 10 patients (2 follicular cancers, and 8 papillary cancers). Twelve hemithyroidectomies were performed. Comparing to patients with benign lesion, in group with thyroid cancer patients were: younger (51.4 vs. 56.1, p=0,69), mean tumor size was smaller (12.7mm vs. 19.3mm, p=0,26), presented less clinical and ultrasound risk factors of malignancy (1.1 vs 1.3, p=0,19), Hashimoto disease was less frequent  (30% vs. 34%, p=0,016), suspicion for Hurthle cell neoplasm was less common (30% vs. 53%, p=0,84).

    Conclusion and discussion
    Despite progress in preoperative work-up diagnosis of follicular-pattern lesion of thyroid requires better tools. To date, there is no highly reliable clinical and imagine examination with adequate accuracy for malignancy profiling.


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