Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?

BMC Surgery

Angelo Nicolosi¹  Giuseppe Pisano¹  Enrico Erdas¹  Francesco Podda¹  Rosa Santa Cruz¹  Fabio Medas¹  Pietro Giorgio Calò¹ 

[1] Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042 Monserrato, (CA), Italy

关键词: Cytology;    Fine needle aspiration;    Thyroid;    Thyroid cancer;    Follicular neoplasm;   

Others  :  866877
DOI  :  10.1186/1471-2482-14-12

 received in 2013-12-02, accepted in 2014-02-28,  发布年份 2014

【 摘 要 】

Background

Identification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians. This study investigates the ability of clinical, cytological and sonographic data to predict malignancy in indeterminate nodules with the scope of determining the need for total thyroidectomy in these patients.

Methods

The study population consisted of 249 cases presenting indeterminate nodules (Thy3): 198 females (79.5%) and 51 males (20.5%) with a mean age of 52.43 ± 13.68 years. All patients underwent total thyroidectomy.

Results

Malignancy was diagnosed in 87/249 patients (34.9%); thyroiditis co-existed in 119/249 cases (47.79%) and was associated with cancer in 40 cases (40/87; 45.98%). Of the sonographic characteristics, only echogenicity and the presence of irregular margins were identified as being statistically significant predictors of malignancy. 52/162 benign lesions (32.1%) and 54/87 malignant were hypoechoic (62.07%); irregular margins were present in 13/162 benign lesions (8.02%), and in 60/87 malignant lesions (68.97%). None of the clinical or cytological features, on the other hand, including age, gender, nodule size, the presence of microcalcifications or type 3 vascularization, were significantly associated with malignancy.

Conclusions

The rate of malignancy in cytologically indeterminate lesions was high in the present study sample compared to other reported rates, and in a significant number of cases Hashimoto’s thyroiditis was also detected. Thus, considering the fact that clinical and cytological features were found to be inaccurate predictors of malignancy, it is our opinion that surgery should always be recommended. Moreover, total thyroidectomy is advisable, being the most suitable procedure in cases of multiple lesions, hyperplastic nodular goiter, or thyroiditis; the high incidence of malignancy and the unreliability of intraoperative frozen section examination also support this preference for total over hemi-thyroidectomy.

【 授权许可】

   
2014 Calò et al.; licensee BioMed Central Ltd.

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