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Incidence of malignancy in solitary thyroid nodules

Published online by Cambridge University Press:  08 July 2015

S M Keh ,
S K El-Shunnar ,
T Palmer  and
S F Ahsan
S M Keh
Affiliation:
Department of Otolaryngology, Raigmore Hospital, Inverness, UK
S K El-Shunnar*
Affiliation:
Otolaryngology Department, Shrewsbury & Telford Hospitals NHS Trust, UK
T Palmer
Affiliation:
Department of Pathology, Raigmore Hospital, Inverness, UK
S F Ahsan
Affiliation:
Department of Otolaryngology, Raigmore Hospital, Inverness, UK Otolaryngology Department, Shrewsbury & Telford Hospitals NHS Trust, UK
*
Address for correspondence: Mr S K El-Shunnar, Otolaryngology Department, Princess Royal Hospital, Grainger Drive, Apley Castle, Telford TF1 6TF, UK E-mail: [email protected]
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Abstract

Objectives:

This study aimed to investigate the prevalence and clinical significance of solitary thyroid nodules in patients who underwent thyroid surgery.

Methods:

A retrospective review was performed of the case notes of all adult patients who underwent thyroid surgery from January 2003 to December 2009. All patients with solitary thyroid nodules identified by ultrasonography were included.

Results:

In total, 225 patients underwent thyroid surgery. The prevalence of solitary thyroid nodules was 27.1 per cent (61 out of 225 patients). Seventy-two per cent of patients were women and the mean age at presentation was 52 ± 16 years. In all, 75.4 per cent of solitary nodules had neoplastic pathology and the malignancy rate was 34.4 per cent. The sensitivity and specificity of fine needle aspiration cytology for neoplasm detection were 73.9 per cent and 80.0 per cent, respectively. There was no association between the various ultrasonography parameters and malignancy risk (p > 0.05).

Conclusion:

Solitary thyroid nodules should be investigated thoroughly with a high index of suspicion because there is a high probability (34.0 per cent) of malignancy.

Keywords

Thyroid GlandNeoplasmsUltrasonographyIncidenceCytology
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 7 , July 2015 , pp. 677 - 681
Copyright
Copyright © JLO (1984) Limited 2015 

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References

1Hegedus, L. Clinical practice. The thyroid nodule. N Engl J Med 2004;351:1764–71CrossRefGoogle ScholarPubMed
2Ezzat, S, Sarti, DA, Cain, DR, Braunstein, GD. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med 1994;154:1838–40CrossRefGoogle ScholarPubMed
3Volzke, H, Ludemann, J, Robinson, DM, Spieker, KW, Schwahn, C, Kramer, A et al. The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 2003;13:803–10CrossRefGoogle Scholar
4Hegedus, L. Thyroid ultrasound. Endocrinol Metab Clin North Am 2001;30:339–60, viii–ixCrossRefGoogle ScholarPubMed
5Cooper, DS, Doherty, GM, Haugen, BR, Kloos, RT, Lee, SL, Mandel, SJ et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167–214CrossRefGoogle ScholarPubMed
6Yeung, MJ, Serpell, JW. Management of the solitary thyroid nodule. Oncologist 2008;13:105–12CrossRefGoogle ScholarPubMed
7Coleman, PM, Babb, P, Damiecki, P. Cancer Survival Trends in England and Wales 1971–1995: Deprivation and NHS Region, Series SMPS No 61. London: Stationery Office, 1999;471–8Google Scholar
8Thyroid Cancer Incidence Statistics. In: http://www.cancerresearchuk.org/cancer-info/cancerstats/types/thyroid/incidence/#By [3 April 2010]Google Scholar
9Abu-Eshy, SA, Khan, AR, Khan, GM, al-Humaidi, MA, al-Shehri, MY, Malatani, TS. Thyroid malignancy in multinodular goitre and solitary nodule. J R Coll Surg Edinb 1995;40:310–2Google ScholarPubMed
10Ramsden, J, Watkinson, JC. Thyroid cancer. In: Scott-Brown's Otorhinolaryngology: Head and Neck Surgery, 7th edn.London: Hodder Arnold, 2008;2663–701CrossRefGoogle Scholar
11Pacini, F, Schlumberger, M, Dralle, H, Elisei, R, Smit, JW, Wiersinga, W. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006;154:787–803CrossRefGoogle ScholarPubMed
12American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi: Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract 2006;12:63–102CrossRefGoogle Scholar
13British Thyroid Association. Guidelines for the Management of Thyroid Cancer, 2nd edn.Royal College of Physicians: London, 2007Google Scholar
14Delbridge, L. Solitary thyroid nodule: current management. ANZ J Surg 2006;76:381–6CrossRefGoogle ScholarPubMed
15Wong, TH, Ong, CL, Tan, WT, Rauff, A. The solitary thyroid nodule revisited. Ann Acad Med Singapore 1993;22:593–7Google Scholar
16Khairy, GA. Solitary thyroid nodule: the risk of cancer and the extent of surgical therapy. East Afr Med J 2004;81:459–62CrossRefGoogle ScholarPubMed
17Bashier, AH, Abdin, I, Elhassan, M, Sanhouri, M, Ahmed, ME. Solitary thyroid nodule in Khartoum. East Afr Med J 1996;73:694–6Google ScholarPubMed
18Adwok, JA. Evaluation and surgical treatment of solitary thyroid nodules. East Afr Med J 1995;72:191–3Google ScholarPubMed
19Frates, 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 Metab 2006;91:3411–7CrossRefGoogle ScholarPubMed
20Khadilkar, UN, Maji, P. Histopathological study of solitary nodules of thyroid. Kathmandu Univ Med J 2008;6:486–90CrossRefGoogle ScholarPubMed
21Enewold, L, Zhu, K, Ron, E, Marrogi, AJ, Stojadinovic, A, Peoples, GE et al. Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980–2005. Cancer Epidemiol Biomarkers Prev 2009;18:784–91CrossRefGoogle ScholarPubMed
22Polyzos, SA, Kita, M, Efstathiadou, Z, Goulis, DG, Benos, A, Flaris, N et al. The use of demographic, ultrasonographic and scintigraphic data in the diagnostic approach of thyroid nodules. Exp Clin Endocrinol Diabetes 2009;117:159–64Google ScholarPubMed
23Mazzaferri, EL, Sipos, J. Should all patients with subcentimeter thyroid nodules undergo fine-needle aspiration biopsy and preoperative neck ultrasonography to define the extent of tumor invasion? Thyroid 2008;18:597–602CrossRefGoogle ScholarPubMed
24Gul, K, Ersoy, R, Dirikoc, A, Korukluoglu, B, Ersoy, PE, Aydin, R et al. Ultrasonographic evaluation of thyroid nodules: comparison of ultrasonographic, cytological, and histopathological findings. Endocrine 2009;36:464–72CrossRefGoogle ScholarPubMed
25Papini, 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 Metab 2002;87:1941–6CrossRefGoogle ScholarPubMed
26Kakkos, SK, Scopa, CD, Chalmoukis, AK, Karachalios, DA, Spiliotis, JD, Harkoftakis, JG et al. Relative risk of cancer in sonographically detected thyroid nodules with calcifications. J Clin Ultrasound 2000;28:347–523.0.CO;2-O>CrossRefGoogle ScholarPubMed
27Popowicz, B, Klencki, M, Lewinski, A, Słowińska-Klencka, D. The usefulness of sonographic features in selection of thyroid nodules for biopsy in relation to the nodule's size. Eur J Endocrinol 2009;161:103–11CrossRefGoogle Scholar
28Cignarelli, M, Ambrosi, A, Marino, A, Lamacchia, O, Campo, M, Picca, G et al. Diagnostic utility of thyroglobulin detection in fine-needle aspiration of cervical cystic metastatic lymph nodes from papillary thyroid cancer with negative cytology. Thyroid 2003;13:1163–7CrossRefGoogle ScholarPubMed
29Cunha, N, Rodrigues, F, Curado, F, Ilhéu, O, Cruz, C, Naidenov, P et al. Thyroglobulin detection in fine-needle aspirates of cervical lymph nodes: a technique for the diagnosis of metastatic differentiated thyroid cancer. Eur J Endocrinol 2007;157:101–7CrossRefGoogle ScholarPubMed
30Pacini, F, Fugazzola, L, Lippi, F, Ceccarelli, C, Centoni, R, Miccoli, P et al. Detection of thyroglobulin in fine needle aspirates of nonthyroidal neck masses: a clue to the diagnosis of metastatic differentiated thyroid cancer. J Clin Endocrinol Metab 1992;74:1401–4Google Scholar
31Snozek, CL, Chambers, EP, Reading, CC, Sebo, TJ, Sistrunk, JW, Singh, RJ et al. Serum thyroglobulin, high-resolution ultrasound, and lymph node thyroglobulin in diagnosis of differentiated thyroid carcinoma nodal metastases. J Clin Endocrinol Metab 2007;92:4278–81CrossRefGoogle ScholarPubMed
32Gharib, H, Papini, E, Paschke, R, Duick, DS, Valcavi, R, Hegedüs, L et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract 16(suppl 1):1–43CrossRefGoogle Scholar
33Caruso, D, Mazzaferri, EL. Fine needle aspiration biopsy in the management of thyroid nodules. Endocrinologist 1991;1:194–202CrossRefGoogle Scholar
34Hamburger, JI, Hamburger, SW. Fine needle biopsy of thyroid nodules: avoiding the pitfalls. N Y State J Med 1986;86:241–9Google ScholarPubMed
35Wu, HH, Jones, JN, Osman, J. Fine-needle aspiration cytology of the thyroid: ten years experience in a community teaching hospital. Diagn Cytopathol 2006;34:93–6CrossRefGoogle Scholar
36Hall, TL, Layfield, LJ, Philippe, A, Rosenthal, DL. Sources of diagnostic error in fine needle aspiration of the thyroid. Cancer 1989;63:718–253.0.CO;2-N>CrossRefGoogle ScholarPubMed
37Akerman, M, Tennvall, J, Biorklund, A, Mårtensson, H, Möller, T. Sensitivity and specificity of fine needle aspiration cytology in the diagnosis of tumors of the thyroid gland. Acta Cytol 1985;29:850–5Google ScholarPubMed
38Ramacciotti, CE, Pretorius, HT, Chu, EW, Barsky, SH, Brennan, MF, Robbins, J. Diagnostic accuracy and use of aspiration biopsy in the management of thyroid nodules. Arch Intern Med 1984;144:1169–73CrossRefGoogle ScholarPubMed
39DeMay, R. The Art and Science of Cytopathology. Chicago: American Society of Clinical Pathologists Press, 1996;2:724Google Scholar
40Schlinkert, RT, van Heerden, JA, Goellner, JR, Gharib, H, Smith, SL, Rosales, RF et al. Factors that predict malignant thyroid lesions when fine-needle aspiration is ‘suspicious for follicular neoplasm’. Mayo Clin Proc 1997;72:913–6CrossRefGoogle ScholarPubMed
41Tuttle, RM, Lemar, H, Burch, HB. Clinical features associated with an increased risk of thyroid malignancy in patients with follicular neoplasia by fine-needle aspiration. Thyroid 1998;8:377–83CrossRefGoogle ScholarPubMed
42Zeiger, MA, Smallridge, RC, Clark, DP, Liang, CK, Carty, SE, Watson, CG et al. Human telomerase reverse transcriptase (hTERT) gene expression in FNA samples from thyroid neoplasms. Surgery 1999;126:1195–8; discussion 98–9CrossRefGoogle ScholarPubMed
43Hunt, JL, Yim, JH, Tometsko, M, Finkelstein, SD, Swalsky, P, Carty, SE. Loss of heterozygosity of the VHL gene identifies malignancy and predicts death in follicular thyroid tumors. Surgery 2003;134:1043–7; discussion 47–8CrossRefGoogle ScholarPubMed
44Grebe, SK, McIver, B, Hay, ID, Wu, PS, Maciel, LM, Drabkin, HA et al. Frequent loss of heterozygosity on chromosomes 3p and 17p without VHL or p53 mutations suggests involvement of unidentified tumor suppressor genes in follicular thyroid carcinoma. J Clin Endocrinol Metab 1997;82:3684–91Google ScholarPubMed
45Kroll, TG, Sarraf, P, Pecciarini, L, Chen, CJ, Mueller, E, Spiegelman, BM et al. PAX8-PPARgamma1 fusion oncogene in human thyroid carcinoma [corrected]. Science 2000;289:1357–60CrossRefGoogle ScholarPubMed
46Marques, AR, Espadinha, C, Catarino, AL, Moniz, S, Pereira, T, Sobrinho, LG. Expression of PAX8-PPAR gamma 1 rearrangements in both follicular thyroid carcinomas and adenomas. J Clin Endocrinol Metab 2002;87:3947–52Google ScholarPubMed
47Miettinen, M, Karkkainen, P. Differential reactivity of HBME-1 and CD15 antibodies in benign and malignant thyroid tumours. Preferential reactivity with malignant tumours. Virchows Arch 1996;429:213–9Google ScholarPubMed
48Barden, CB, Shister, KW, Zhu, B, Guiter, G, Greenblatt, DY, Zeiger, MA et al. Classification of follicular thyroid tumors by molecular signature: results of gene profiling. Clin Cancer Res 2003;9:1792–800Google ScholarPubMed
49Finley, DJ, Arora, N, Zhu, B, Gallagher, L, Fahey, TJ 3rd.Molecular profiling distinguishes papillary carcinoma from benign thyroid nodules. J Clin Endocrinol Metab 2004;89:3214–23.CrossRefGoogle ScholarPubMed
50Napoli, C, de Nigris, F, Sica, V. New advances in microarrays: finding the genes causally involved in disease. Methods Mol Med 2005;108:215–33Google ScholarPubMed