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Thyroid incidentaloma as a "PAIN" phenomenon- does it always require surgery?
Krzysztof Kaliszewski1, Dorota Diakowska2, Marcin Ziętek3
1First Department and Clinic of General, Gastroenterological and Endocrine Surgery.
Medicine
|December 15, 2018
Summary
Patients with "PAIN" phenomenon, a thyroid nodule found during PET scans, require surgery if cytology results are Bethesda category III or higher. This indicates a significant risk of thyroid cancer.
Area of Science:
- Endocrinology
- Oncology
- Surgical Pathology
Background:
- Thyroid incidentalomas are nodules found incidentally during unrelated thyroid disease investigations.
- The "PAIN" phenomenon describes incidental thyroid neoplasms identified via positron emission tomography (PET).
- Determining surgical necessity for "PAIN" phenomenon patients is crucial for managing potential malignancy.
Purpose of the Study:
- To identify which patients with the "PAIN" phenomenon warrant surgical intervention based on cytological findings.
- To assess the predictive value of thyroid cytology in determining malignancy risk within the "PAIN" phenomenon cohort.
Main Methods:
- Retrospective review of 4716 surgically treated patients at a tertiary center.
- Identification of 49 patients (1.04%) with the "PAIN" phenomenon.
- Ultrasound-guided fine needle aspiration biopsy (UG-FNAB) and cytological evaluation using The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC).
Main Results:
- Cytology results were significant predictors of cancer occurrence in "PAIN" phenomenon patients (P < .0001).
- TBSRTC category III or higher significantly increased the risk of thyroid cancer (OR = 168.7, P < .0001).
- Of 49 patients, 24 (49%) were diagnosed with thyroid cancer upon histopathological examination.
Conclusions:
- Patients with the "PAIN" phenomenon and TBSRTC cytology category III or higher face a substantial risk of thyroid malignancy.
- Surgical intervention is recommended for "PAIN" phenomenon patients with Bethesda category III or higher cytology to address the significant risk of thyroid cancer.