Abstract
Importance
Ultrasound-guided fine needle aspiration (FNA) is an excellent tool for evaluating patients with solitary thyroid nodules, with a false-negative malignancy rate of <3 %. The utility of FNA in patients with a cervical multinodular goiter (MNG) is unknown, because biopsy and surveillance of thyroids with numerous nodules may be impractical.
Objective
To evaluate the incidence and risk factors for unsuspected thyroid cancer on final pathology in patients with a non-functional, cervical MNG who had a benign preoperative FNA and underwent thyroidectomy.
Design, setting and participants
Retrospective review of patients with non-functional, cervical MNG at a high-volume tertiary referral center between 2005 and 2012.
Main outcome measure(s)
Incidence of thyroid cancer on surgical pathology.
Results
Of the 134 patients included in the study, 31 (23.1 %) were found to have thyroid cancer on final pathology. Twenty-one (15.7 %) patients had a microscopic papillary cancer (<1 cm) and 10 (7.5 %) patients had other forms of thyroid cancer [five follicular, four papillary (>1 cm), and one patient with a papillary and follicular cancer]. On univariate analysis, male gender had a near-significant association with non-micropapillary thyroid cancer (p = 0.06). On multivariate analysis, male gender (OR = 10.2, 95 % CI 1.35–76.8) and FNA cytology not reviewed at our institution (OR = 6.0, 95 % CI 1.2–30) were independently associated with non-micropapillary thyroid cancer.
Conclusions and relevance
The incidence of thyroid cancer in patients with MNG and benign FNA is significant. Men and patients in whom the FNA cytology is not reviewed by an experienced cytopathologist may be at an increased risk for an undetected thyroid cancer.
Similar content being viewed by others
Reference
Gandolfi PP, Frisina A, Maurizio R et al (2004) The incidence of thyroid cancer in multinodular goiter: retrospective analysis. Acta Bio Medica Ateneo Parmense 75:114–117
Nixon IJ, Simo R (2013) The neoplastic goitre. Curr Opin Otolaryngol Head Neck Surg 21:143–149
Cooper DS, Doherty GM, Haugen BR et al (2006) Revised American thyroid association management guideline for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 10(11):1–48
Cibas ES, Ali SZ (2009) The Bethesda system for reporting thyroid cytopathology. Thyroid 19(11):1159–1165
Al-Yaarubi S, Farhan H, Al-Futaisi A et al (2011) Accuracy of ultrasound-guided fine-needle aspiration cytology for diagnosis of carcinoma in patients with multinodular goiter. Indian J Endocrinol Metab 15(Suppl2):S132–S135
Ríos A, Rodríguez JM, Galindo PJ et al (2004) Utility of fine-needle aspiration for diagnosis of carcinoma associated with multinodular goitre. Clin Endocrinol 61(6):732–737
Hay ID, Hutchinson MR, Gonzalez-Losada T et al (2008) Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery 144:980–988
Luo J, McMannus C, Chen H et al (2012) Are there predictors of malignancy in patients with multinodular goiter. J Surg Research 174:207–210
Frates MC, Benson CB, Doubilet PM et al (2006) Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab 91(9):3411–3417
Brito JP, Yarur AJ, Prokop LJ et al (2013) Prevalence of thyroid cancer in multinodular goiter versus single nodule: a systematic review and meta-analysis. Thyroid 23(4):449–455
Rago T, Fiore E, Scutari M et al (2010) Male sex, single nodularity, and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series of patients with nodular thyroid disease. Eur J Endocrinol 162(4):763–770
Botrugno I, Lovisetto F, Cobianchi L et al (2011) Incidental carcinoma in multinodular goiter: risk factors. Am Surg 77(11):1553–1558
Agarwal A, Agarwal S, Tewari P et al (2012) Clinicopathological profile, airway management, and outcome in huge multinodular goiters: an institutional experience from an endemic goiter region. World J Surg 36(4):755–760. doi:10.1007/s00268-012-1447-x
Belfiore A, La Rosa GL, La Port GA et al (1992) Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity. Am J Med 93(4):363–369
Mazzaferri EL (1993) Management of a solitary thyroid nodule. N Engl J Med 328(8):553–559
Lew JI, Snyder RA, Sanchez YM et al (2011) Fine needle aspiration of the thyroid: correlation with final histopathology in a surgical series of 797 patients. J Am Coll Surg 213(1):188–194
Bakhos R, Selvaggi SM, DeJong S et al (2000) Fine-needle aspiration of the thyroid: rate and causes of cytohistopathologic discordance. Diagn Cytopathol 23(4):233–237
Kocjan G, Chandra A, Cross PA et al (2011) The interobserver reproducibility of thyroid fine-needle aspiration using the UK Royal College of Pathologists’ classification system. Am J Clin Pathol 135(6):852–859
Sidawy MK, Del Vecchio DM, Knoll SM (1997) Fine-needle aspiration of thyroid nodules: correlation between cytology and histology and evaluation of discrepant cases. Cancer 81(4):253–259
Paksoy N, Yazal K, Corak S (2011) Malignancy rate in nondominant nodules in patients with multinodular goiter: Experience with 1,606 cases evaluated by ultrasound-guided fine needle aspiration cytology. Cytojournal 8:19
Tan YY, Kebebew E, Reiff E et al (2007) Does routine consultation of thyroid fine-needle aspiration cytology change surgical management? J Am Coll Surg 205(1):8–12
Chernyavsky VS, Shanker BA, Davidov T et al (2012) Is one benign fine needle aspiration enough? Ann Surg Oncol 19(5):1472–1476
Conflicts of interest
The authors have no conflicts of interest to disclose. Department funds were used for incidental expenses.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Campbell, M.J., Seib, C.D., Candell, L. et al. The Underestimated Risk of Cancer in Patients with Multinodular Goiters After a Benign Fine Needle Aspiration. World J Surg 39, 695–700 (2015). https://doi.org/10.1007/s00268-014-2854-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-014-2854-y