Dynamic Predictors for Malignancy Risk of Follicular Thyroid Neoplasms: A Real-World, 10-Year Cohort Study

Area of Science:

• Endocrinology
• Oncology
• Radiology

Background:

• Malignancy risk in follicular thyroid neoplasms (FTN) is variable.
• Previous studies often use static, single-time-point assessments.
• Dynamic changes in FTN are under-investigated for malignancy prediction.

Purpose of the Study:

• To evaluate dynamic ultrasound predictors for malignancy risk in FTN.
• To assess the association between dynamic features and follicular thyroid carcinoma (FTC) vs. follicular thyroid adenoma (FTA) diagnosis.
• To identify key predictors beyond static factors.

Main Methods:

• Included patients with ≥2 preoperative ultrasounds diagnosed as FTN.
• Analyzed 11 predictors: 5 static (age, sex, BMI, diameter, duration) and 6 dynamic (TSH level/instability, diameter rate/instability, margin/calcification changes).
• Used logistic regression to assess dynamic predictors, adjusting for static confounders.

Main Results:

• Higher average thyroid-stimulating hormone (TSH) levels correlated with decreased malignancy risk (OR: 0.67).
• Irregular or changing tumor margins significantly increased malignancy risk (ORs: 4.18–5.33).
• No significant association found between tumor diameter growth rate/instability and malignancy risk.

Conclusions:

• Changes in tumor margins (to irregular/lobulated) are key indicators of higher FTN malignancy risk.
• Lower average TSH levels are associated with increased malignancy risk.
• Tumor growth rate and instability appear to play a minor role in malignancy prediction.