SONOGRAPHIC PATTERN STRATIFIES THE RISK OF MALIGNANCY OF THYROID NODULES WITH INDETERMINATE CYTOLOGY
AACE ePoster Library. Valderrabano P. 05/14/15; 97740; 1003
Pablo Valderrabano
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Abstract
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Objective: Currently, the management of thyroid nodules relies on the cytological diagnosis. However cytology is indeterminate in around 25% of the specimens and most of these patients end up with a diagnostic surgery. To better select nodules that need to be biopsied, the provisional revised ATA guidelines for the management of thyroid nodules recommends using a classification based on the sonographic appearance of the nodules. Each pattern is associated with an estimated risk of malignancy (ROM) and a different size threshold for biopsy. We hypothesize that the same sonographic patterns could stratify the ROM of cytologically indeterminate nodules.
Methods: In this IRB-approved study, we reviewed the charts of all patients with cytological evaluation at our institution between October 2008 and May 2014. Only those nodules with indeterminate cytology (Bethesda categories III and IV) and histological confirmation that had ultrasound images available for review were included in this analysis.
Results: During the study period 387 (86%) of 452 thyroid nodules with indeterminate cytology and histological confirmation, had ultrasound images available for review. The overall ROM in this cohort was 30.2%. Cytology was classified as Atypia of Undetermined Significance (AUS) in 151 nodules (39%) and Follicular Neoplasm (FN) in 236 (61%). The overall ROM in these categories was 27.8% and 31.8% respectively. According to the new ATA classification the sonographic suspicion pattern was “Very-low” in 28 nodules (7%), “Low” in 178 (46%), “Intermediate” in 37 (10%) and “High” in 144 (37%). The ROM observed in these categories was 3.6%, 25.3%, 21.6% and 43.7% respectively. No significant differences were observed in the ROM of nodules with cytological diagnosis of AUS or FN in each category. Differences in the ROM between the “Low” and “Intermediate” suspicion patterns were not significant, and were grouped for other comparisons. Differences in the ROM were statistically significant (p<0.01) when the “Low-Intermediate” suspicion pattern was compared to the “Very-low” suspicion pattern and to the “High” suspicion pattern.
Discussion: The sonographic pattern effectively stratifies the ROM of nodules with indeterminate cytology. Surgery could be avoided in nodules with a “very low” suspicion sonographic pattern, with a negative predictive value of 96%. Hypoechogenicity alone does not seem to improve risk stratification for thyroid nodules with indeterminate cytology. However, any other suspicious sonographic feature significantly increases the ROM.
Conclusion: Sonographic pattern should be used to set the threshold for biopsy of thyroid nodules, and may also stratify the ROM to guide management after the biopsy.
Methods: In this IRB-approved study, we reviewed the charts of all patients with cytological evaluation at our institution between October 2008 and May 2014. Only those nodules with indeterminate cytology (Bethesda categories III and IV) and histological confirmation that had ultrasound images available for review were included in this analysis.
Results: During the study period 387 (86%) of 452 thyroid nodules with indeterminate cytology and histological confirmation, had ultrasound images available for review. The overall ROM in this cohort was 30.2%. Cytology was classified as Atypia of Undetermined Significance (AUS) in 151 nodules (39%) and Follicular Neoplasm (FN) in 236 (61%). The overall ROM in these categories was 27.8% and 31.8% respectively. According to the new ATA classification the sonographic suspicion pattern was “Very-low” in 28 nodules (7%), “Low” in 178 (46%), “Intermediate” in 37 (10%) and “High” in 144 (37%). The ROM observed in these categories was 3.6%, 25.3%, 21.6% and 43.7% respectively. No significant differences were observed in the ROM of nodules with cytological diagnosis of AUS or FN in each category. Differences in the ROM between the “Low” and “Intermediate” suspicion patterns were not significant, and were grouped for other comparisons. Differences in the ROM were statistically significant (p<0.01) when the “Low-Intermediate” suspicion pattern was compared to the “Very-low” suspicion pattern and to the “High” suspicion pattern.
Discussion: The sonographic pattern effectively stratifies the ROM of nodules with indeterminate cytology. Surgery could be avoided in nodules with a “very low” suspicion sonographic pattern, with a negative predictive value of 96%. Hypoechogenicity alone does not seem to improve risk stratification for thyroid nodules with indeterminate cytology. However, any other suspicious sonographic feature significantly increases the ROM.
Conclusion: Sonographic pattern should be used to set the threshold for biopsy of thyroid nodules, and may also stratify the ROM to guide management after the biopsy.
Objective: Currently, the management of thyroid nodules relies on the cytological diagnosis. However cytology is indeterminate in around 25% of the specimens and most of these patients end up with a diagnostic surgery. To better select nodules that need to be biopsied, the provisional revised ATA guidelines for the management of thyroid nodules recommends using a classification based on the sonographic appearance of the nodules. Each pattern is associated with an estimated risk of malignancy (ROM) and a different size threshold for biopsy. We hypothesize that the same sonographic patterns could stratify the ROM of cytologically indeterminate nodules.
Methods: In this IRB-approved study, we reviewed the charts of all patients with cytological evaluation at our institution between October 2008 and May 2014. Only those nodules with indeterminate cytology (Bethesda categories III and IV) and histological confirmation that had ultrasound images available for review were included in this analysis.
Results: During the study period 387 (86%) of 452 thyroid nodules with indeterminate cytology and histological confirmation, had ultrasound images available for review. The overall ROM in this cohort was 30.2%. Cytology was classified as Atypia of Undetermined Significance (AUS) in 151 nodules (39%) and Follicular Neoplasm (FN) in 236 (61%). The overall ROM in these categories was 27.8% and 31.8% respectively. According to the new ATA classification the sonographic suspicion pattern was “Very-low” in 28 nodules (7%), “Low” in 178 (46%), “Intermediate” in 37 (10%) and “High” in 144 (37%). The ROM observed in these categories was 3.6%, 25.3%, 21.6% and 43.7% respectively. No significant differences were observed in the ROM of nodules with cytological diagnosis of AUS or FN in each category. Differences in the ROM between the “Low” and “Intermediate” suspicion patterns were not significant, and were grouped for other comparisons. Differences in the ROM were statistically significant (p<0.01) when the “Low-Intermediate” suspicion pattern was compared to the “Very-low” suspicion pattern and to the “High” suspicion pattern.
Discussion: The sonographic pattern effectively stratifies the ROM of nodules with indeterminate cytology. Surgery could be avoided in nodules with a “very low” suspicion sonographic pattern, with a negative predictive value of 96%. Hypoechogenicity alone does not seem to improve risk stratification for thyroid nodules with indeterminate cytology. However, any other suspicious sonographic feature significantly increases the ROM.
Conclusion: Sonographic pattern should be used to set the threshold for biopsy of thyroid nodules, and may also stratify the ROM to guide management after the biopsy.
Methods: In this IRB-approved study, we reviewed the charts of all patients with cytological evaluation at our institution between October 2008 and May 2014. Only those nodules with indeterminate cytology (Bethesda categories III and IV) and histological confirmation that had ultrasound images available for review were included in this analysis.
Results: During the study period 387 (86%) of 452 thyroid nodules with indeterminate cytology and histological confirmation, had ultrasound images available for review. The overall ROM in this cohort was 30.2%. Cytology was classified as Atypia of Undetermined Significance (AUS) in 151 nodules (39%) and Follicular Neoplasm (FN) in 236 (61%). The overall ROM in these categories was 27.8% and 31.8% respectively. According to the new ATA classification the sonographic suspicion pattern was “Very-low” in 28 nodules (7%), “Low” in 178 (46%), “Intermediate” in 37 (10%) and “High” in 144 (37%). The ROM observed in these categories was 3.6%, 25.3%, 21.6% and 43.7% respectively. No significant differences were observed in the ROM of nodules with cytological diagnosis of AUS or FN in each category. Differences in the ROM between the “Low” and “Intermediate” suspicion patterns were not significant, and were grouped for other comparisons. Differences in the ROM were statistically significant (p<0.01) when the “Low-Intermediate” suspicion pattern was compared to the “Very-low” suspicion pattern and to the “High” suspicion pattern.
Discussion: The sonographic pattern effectively stratifies the ROM of nodules with indeterminate cytology. Surgery could be avoided in nodules with a “very low” suspicion sonographic pattern, with a negative predictive value of 96%. Hypoechogenicity alone does not seem to improve risk stratification for thyroid nodules with indeterminate cytology. However, any other suspicious sonographic feature significantly increases the ROM.
Conclusion: Sonographic pattern should be used to set the threshold for biopsy of thyroid nodules, and may also stratify the ROM to guide management after the biopsy.
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