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Indeterminate thyroid nodules: a challenge for the surgical strategy.
Reza Asari1, Barbara E Niederle, Christian Scheuba
1Section of Endocrine Surgery, Division of General Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria. reza.asari@meduniwien.ac.at
Clinical parameters cannot predict malignancy in indeterminate thyroid nodules (ITN). A tailored surgical approach, including hemithyroidectomy for unilateral goiter and thyroidectomy for bilateral goiter with first step central neck dissection, is recommended for oncologically adequate resection and staging with low morbidity.
Area of Science:
- Endocrinology
- Surgical Oncology
- Pathology
Background:
- Cytologically indeterminate thyroid nodules (ITN) lack reliable clinical parameters to determine malignancy or nodal metastasis.
- Initial surgical strategy for ITN must balance oncological adequacy with low morbidity.
Purpose of the Study:
- To analyze prognostic relevance of clinical parameters in ITN.
- To determine the accuracy of frozen sections in diagnosing malignancy.
- To compare clinical parameters for identifying malignancy and nodal metastases to guide initial operative strategy.
Main Methods:
- Retrospective analysis of 156 consecutive patients with ITN.
- Evaluation of prognostic relevance of sex, age, tumor size, multifocality, thyroid function, and recurrence.
- Assessment of frozen section accuracy for malignancy detection.
- Comparison of clinical parameters for predicting malignancy and nodal metastases.
Main Results:
- Malignancy was found in 35.3% of patients.
- Frozen section sensitivity for malignancy was 30.9% with 100% specificity.
- No significant association found between malignancy and sex, age, tumor size, or thyroid function.
- First step lymphadenectomy in 142 patients identified 10 nodal metastases with no permanent complications.
Conclusions:
- Clinical parameters are insufficient for predicting malignancy in cytologically indeterminate thyroid nodules.
- Hemithyroidectomy for unilateral goiter and thyroidectomy for bilateral goiter are recommended.
- Ipsilateral "first step central neck dissection" provides oncologically adequate resection and staging with low morbidity, avoiding reoperation.
