The frequency of malignancy and the relationship between malignancy and ultrasonographic features of thyroid nodules wit
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ORIGINAL ARTICLE
The frequency of malignancy and the relationship between malignancy and ultrasonographic features of thyroid nodules with indeterminate cytology Yasemin Tutuncu • Dilek Berker • Serhat Isik • Gulhan Akbaba • Ufuk Ozuguz • Ferit Kerim Kucukler • Erdal Go¨cmen • Yavuz Yalcın Yusuf Aydin • Serdar Guler
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Received: 10 December 2012 / Accepted: 6 March 2013 Ó Springer Science+Business Media New York 2013
Abstract Various approaches are available for the management of nodules that are evaluated to be indeterminate according to the results of thyroid fine needle aspiration biopsy. The present study aimed to determine the rate of malignancy and the ultrasonographic features that could be used as predictor of malignant pathologies at the nodules with indeterminate cytology. A total of 201 patients who underwent total thyroidectomy and whose fine needle aspiration biopsy results were evaluated to be Hurthle cell lesion (n = 99), follicular neoplasm (n = 61) or suspicious for malignancy (n = 41) were enrolled in this study. Of these patients, 178 were females (88.6 %) and 23 were males (11.4 %). The rates of malignancy were found to be 33.3 % in the Hurthle cell lesion group, 23.0 % in the follicular Y. Tutuncu (&) D. Berker S. Isik G. Akbaba U. Ozuguz F. K. Kucukler E. Go¨cmen Y. Yalcın S. Guler Department of Surgery, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey e-mail: [email protected]
neoplasm group and 53.7 % in the suspicious for malignancy group (p = 0.006). The comparison of the ultrasonographic characteristics of the malignant and benign nodules revealed hypoechogenicity and microcalcification to be more common in malignant nodules (34.3 vs. 16.9 %, p = 0.005; 27.1 vs. 13.1 %, p = 0.014; respectively). While 92.3 % of the malignant nodules were C1 cm, 82.9 % of the benign nodules were C1 cm (p = 0.042). In the current study, malignancy was observed in 33.3 % of the Hurthle cell lesion group, 23 % of the follicular neoplasm group and 53.7 % of the suspicious for malignancy group. In addition, we detected that microcalcification and benign hypoechoic at patients with indeterminate cytology can be related with increased risk of malignancy. We believe that as the patients at Hurthle cell lesion group have higher risk of malignancy than the patients with Follicular Neoplasia, total thyroidectomy will be suitable for these patients. Keywords Thyroid cancer Follicular neoplasm Hurthle cell neoplasm Suspicion of malignancy
D. Berker e-mail: [email protected] S. Isik e-mail: [email protected]
Introduction
G. Akbaba e-mail: [email protected]
Thyroid diseases are common clinical problems in Turkey as in worldwide. After the employment of high resolution ultrasonography (US) in the evaluation of thyroid nodules, the incidence of thyroid nodules has reached up to 30–50 % of the population [1, 2]. While the overall rate of malignancy in thyroid nodules is about 5 %, recent studies have reported that the malignancy rates are 12 % in i
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