Do sonographic and cytological features predict malignancy in cytologically indeterminate thyroid nodules?

Area of Science:

• Endocrinology
• Oncology
• Pathology

Background:

• Management of indeterminate (Thy3) thyroid cytology typically involves staged surgery: lobectomy followed by completion thyroidectomy.
• Predicting malignancy in Thy3 thyroid nodules is crucial to optimize surgical management and patient outcomes.

Purpose of the Study:

• To investigate if sonographic, cytological, and clinical features can predict malignancy in patients with indeterminate (Thy3) thyroid cytology.
• To identify specific indicators that may guide surgical decisions for Thy3 thyroid nodules.

Main Methods:

• Retrospective analysis of a clinical database of patients undergoing ultrasound-guided fine needle aspiration (FNA) for thyroid nodules.
• Comparison of demographic, sonographic, and cytological details between benign and malignant Thy3 lesions using statistical tests (t-test, chi-square, Fisher's exact).
• Binary logistic regression analysis to assess the association between characteristics and malignancy.

Main Results:

• Out of 1,019 FNA procedures, 69 (6.8%) were classified as Thy3. Of 59 surgically treated Thy3 nodules, 17 (28.8%) were malignant.
• No significant differences were found in age, sex, or sonographic features between benign and malignant groups.
• The absence of normal follicular cells was the only variable significantly associated with malignancy in univariate analysis (p=0.034).

Conclusions:

• Malignancy is more prevalent in Thy3 thyroid nodules characterized by the absence of normal follicular cells.
• This cytological finding suggests that patients with Thy3 nodules lacking normal follicular cells may benefit from a total thyroidectomy instead of a staged approach.