Thyroid cancer risk assessment indicators: A correlation between preoperative and postoperative criteria

To differentiate preoperatively between benign nodule and thyroid cancer (TC) is highly important. Therefore, we investigated the risk assessment indicators that correlate preoperative clinical, radiological, and pathological features with post-operative TC characteristics.

An observational retrospective study was performed in Bahrain Defense Force (BDF) hospital for all patients suspected of having thyroid cancer from January 2016 to October 2020. All the medical records, including clinical, laboratory, radiological, and pathological assessments of these patients, were retrieved and analyzed for association using binary and multivariate logistic regression analysis to estimate significance, odds ratio (OR), and 95% confidence interval.

A total of 87 patients were included in the study with a mean age of 40 ± 12.5 years old. The histopathology revealed that 27 patients had TC with a mean age of 38.1±10.8 years (p>0.05 vs. benign conditions). Furthermore, the TC frequencies within gender were 29.9% and 36.4% for females and males, respectively. Besides, most patients (85.2%) had papillary TC cancer, whereas 7.4% had follicular cancer, and 3.7% had either medullary TC or minimally invasive follicular TC. The correlation results between demographic, clinical characteristic evaluations, laboratory findings of the study patients, and TC as reported by the histopathology were all not significant except for ultrasound features including solitary nodule (p<0.05), lymph node involvement, and consistency (p<0.01). The sensitivity and specificity values of FNAC for detection of TC were 77.8% and 86.3%, respectively. Multivariate analysis revealed that only solid consistency of the tumor (OR = 9.88) and lymph node involvement (OR = 14.78) were correlated with TC detection. On the other hand, gender, symptoms of hypothyroidism, hyperthyroidism, or compression, family history of TC, abnormal thyroid function tests, neck swelling, and ultrasounds imaging with regards to vascularization and microcalcification were not correlated with the detection of TC.

Preoperative nodule and FNAC assessments need further research and development to approach higher sensitivity in detecting TC.