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Published on: June 9, 2023
Age as a Risk Stratification Factor in Surgically Treated Low-Risk Indeterminate Thyroid Nodules: Insight From the
Elisa Gatta1, Ilenia Pirola1, Anna Maria Bozzola2
1Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy; Centro per la Diagnosi e Cura Delle Neoplasie Endocrine e Delle Malattie Della Tiroide, University of Brescia, Brescia, Italy.
Summary
Age can help assess the risk of malignancy in TIR3A/Bethesda III thyroid nodules. While not a standalone tool, it aids in decision-making for thyroid cancer risk stratification.
Area of Science:
- Endocrinology
- Oncology
- Surgical Pathology
Background:
- Thyroid nodules classified as TIR3A/Bethesda III require careful risk assessment.
- Accurate risk stratification is crucial for guiding surgical intervention.
Purpose of the Study:
- To determine if age is a clinically significant factor in stratifying risk for TIR3A/Bethesda III thyroid nodules.
- To evaluate the role of age in predicting malignancy in these nodules.
Main Methods:
- Retrospective analysis of 435 adult patients with TIR3A cytology undergoing thyroid surgery.
- Age analyzed as continuous and categorical variable; logistic regression and ROC curves used.
- Malignancy at final histology was the primary outcome.
Main Results:
- 17.5% of patients had differentiated thyroid cancer.
- Increasing age was independently associated with a lower risk of malignancy (aOR 0.98 per year).
- Age showed modest discriminative performance (AUC 0.608) and influenced malignancy probability by 8-10% between ages 40-60.
Conclusions:
- Age acts as a meaningful risk modifier for TIR3A/Bethesda III nodules, not a sole diagnostic tool.
- Age can aid in shared decision-making for thyroid surgery, especially when molecular testing is inconclusive.
- Age helps contextualize malignancy probability in thyroid nodule management.
