THY3 cytology: What surgical treatment? Retrospective study and literature review

THY3 nodules collects 20% of cytological examinations, with a rate of malignancy by about 20-30%, and represent one of the most controversial topics of scientific debate. In fact, differential diagnosis of follicular lesions, is very difficult, due to the inability of cytology to differentiate between adenomas and carcinomas. Surgery represents the only possible diagnostic and therapeutic approach, but on the type of surgery there is still absolute discordance of opinions.

We retrospectively analyzed 230 patients undergoing total thyroidectomy for THY3 cytology between May 2007 and September 2013. Subsequently we re-evaluated our results assuming a conservative surgical approach in patients without preoperative contralateral pathological evidence.

Our results indicate an incidence of malignancy in THY3 cytology of 29.6% (n = 68/230), in line with literature data; multifocal bilateral carcinoma in 26.5% of patients; 37 incidental carcinomas (16.5%), 15 of which located contralateral at THY3 nodule; nodular hyperplasia in 52.2% of patients. So, according to a conservative surgery, among patients ideally underwent lobectomy (n = 110), we wouldn't recognize 10 of overall 105 malignancies (9.5%) (including bilateral tumors on THY3 and contralateral incidental carcinomas). Thus, these malignancies would be neither diagnosed nor removed during surgery.

We believe these results allow to state that total thyroidectomy is oncologically the most appropriate intervention to make the patient "disease-free". Moreover, our study could serve as a motivation for further research, but maybe is needed a new Consensus Conference to define a surgical protocol universally recognized.