Preoperative diagnosis of THYR 3 versus follicular lesion: malignant postoperative ratio

In the evaluation of nodular thyroid lesions, cytology is the main diagnostic instrument, associated with ultrasound examination.

We prospectively categorized into a dedicated database, 612 patients submitted to thyroidectomy from January 2009 to December 2011. We selected two groups of patients: the cases with "follicular lesions" and the cases classified as "THYR 3" using Bethesda Classification.

Of 612 patients submitted to TT, in 68 cases, 8 males (M) and 60 females (F), we recorded a preoperative cytological diagnosis compatible with THYR 3 class. In 56 cases, 82.4% of the patients (5 M, 51 F), we performed a thyroidectomy with Conventional technique (CT) and in 12 cases, 12.6% of the patients (3M, 9F) with video-assisted technique (MIVAT). In 39 cases (57.1%) of the THYR 3 patients treated, a benign disease was found while in the other 29 cases (42.9%) a differentiated thyroid cancer (DTC) were found. In patients with nodules classified as "follicular proliferation", treated in the same period and by the same surgical team, we recorded 97 cases (79 F, 18 M). The patients were treated with TT in 72 cases, with MIVAT in 22 cases; in 3 cases we performed a HT with traditional technique. Adenomatous hyperplasia was found in 51; DTC was found in 21 cases and adenoma in 25 cases. The analysis of the incidence of benign versus malignant disease between the 2 groups showed a P<0.0001.

In our experience, we recommend surgery, TT or HT, for THYR 3 nodules analyzed for the first time by FNAB with sonographic pattern suspicious for malignancy.