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Underestimated risk of cancer in solitary thyroid nodules ≥3 cm reported as benign

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Abstract

Background

The study aims to assess the risk of cancer in solitary thyroid nodules ≥30 mm in size reported as Bethesda II, and its implications.

Method

The clinical records of 202 patients, who underwent thyroid lobectomy for solitary nodules measuring ≥30 mm, reported as Bethesda II on preoperative FNAC between Jan 2015 and Apr 2016 were reviewed. Data collected included nodule size and consistency, and final histopathology results. The risk of cancer and the recommended management according to ATA guidelines were the outcomes of interest. Comparisons were then made between two size categories: (30–40 mm; n = 72; C1) and (>40 mm; n = 130; C2), and two nodule consistencies.

Results

Mean nodule size was 43.2 mm (range 30–92). Ninety-five percent were solid and 5% were predominantly cystic. The risk of cancer was 22.8% (46/202) with no size threshold, or graded increase in risk observed. Based on biologic behavior, 50% of cancers were considered clinically significant. Accordingly, the risk of cancer for which surgery is recommended was 11.4% (23/202). The risk of cancer requiring total thyroidectomy was 9.4% and was influenced by nodule size (19 vs. 60% in C1 and C2, respectively; p = 0.01). Predominantly cystic nodules had a greater risk of malignancy compared to predominantly solid nodules even after adjusting for size (40 vs. 9.9%; p = 0.01 and 40 vs. 12.5%; p = 0.02, respectively).

Conclusion

The risk of malignancy in Bethesda II solitary nodules ≥30 mm is considerable implying a need for changing the way these are approached and refining cytopathology reporting.

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Authors’ contributions

Corresponding: Sohail Bakkar participated in the study concept and design, data interpretation, article writing, and final approval and takes accountability for all aspects of the work. Anello Marcello Poma participated in data collection, drafting, and final approval and takes accountability for all aspects of the work. Caterina Corsini participated in data collection, drafting, and final approval and takes accountability for all aspects of the work. Carlo Enrico Ambrosini participated in data interpretation and final approval and takes accountability for all aspects of the work. Mario Miccoli participated in data analysis and final approval and takes accountability for all aspects of the work. Paolo Miccoli participated in study design, revision, and final approval and also takes accountability for all aspects of the work.

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Authors and Affiliations

  1. Division of Endocrine Surgery, University of Pisa, Pisa, Italy

    Sohail Bakkar, Caterina Corsini, Carlo Enrico Ambrosini & Paolo Miccoli

  2. Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan

    Sohail Bakkar

  3. Division of Endocrine Surgery, Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Building No. 30 E, 2nd floor, Via Paradisa 2, 56124, Pisa, Italy

    Sohail Bakkar

  4. Division of Pathology- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy

    Anello Marcello Poma

  5. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

    Mario Miccoli

Authors
  1. Sohail Bakkar
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Correspondence to Sohail Bakkar.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

Funding

The authors have no financial ties to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This work was approved by the Ethics Committee at the University Hospital of Pisa, Pisa-Italy.

Informed consent

The requirement for informed consent was waived because of the retrospective nature of the study.

Additional information

Abstract has been presented (OC 15) at the European Society of Endocrine Surgeons (ESES) symposium, Oxford 2017.

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Bakkar, S., Poma, A.M., Corsini, C. et al. Underestimated risk of cancer in solitary thyroid nodules ≥3 cm reported as benign. Langenbecks Arch Surg 402, 1089–1094 (2017). https://doi.org/10.1007/s00423-017-1600-y

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  • DOI: https://doi.org/10.1007/s00423-017-1600-y

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