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High rates of false negative cytological diagnosis and incidental multifocal microcarcinoma in solitary thyroid nodule and multinodular goitre, justifying a preference for total thyroidectomy
  • Ethem Unal,
  • Sema Yuksekdag
Ethem Unal
Umraniye Training and Research Hospital
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Sema Yuksekdag
Umraniye Training and Research Hospital
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Abstract

Background: Our purpose was to detect false negative rate (FNR) of preoperative cytology and prevalence of thyroid carcinoma in patients who underwent total thyroidectomy for solitary thyroid nodule (STN) and multinodular goitre (MNG). Cytology-histology discrepant cases were also further evaluated. Methods: Database of 141 patients were conducted retrospectively. Demographics, ultrasound (US) features with Thyroid Imaging Reporting and Data System (TI-RADS), fine-needle aspiration (FNA), histology reports, risk factors and malignancy rate were recorded. Statistical analyses were performed using Fisher’s exact and Mann-Whitney U tests. Results: Of the 43 patients with confirmed thyroid carcinoma (30.4%), 21 had incidentalomas (48.8%). Even the prevalence of carcinoma was higher in STN (39.2% vs 28.3%, p<0.001), incidental cancers were more common in MNG (56.2% vs 27.2%, p<0.001). While macrocarcinomas were significantly more frequent and larger in STN (63.6% vs 21.8%, p<0.001; 2.4+1.9 cm vs 1.2+0.8 cm; p<0.001, each), microcarcinomas (≤1 cm) were seen to be in higher ratio and smaller in MNG (56.2% vs 27.2%, p<0.001; 0.48+0.34 cm vs 0.64+0.3 cm, p<0.05). Multifocality was more significant in MNG (43.7% vs 18.1%). FNR in MNG was higher than that of STN (15.9% vs 10.7%, p<0.001). Indeterminate cytology was more frequent in MNG group (20.3% vs 14.2%, p<0.001). Mean TI-RADS was 3 in each group (p>0.05) and displayed mostly sampling errors (76.1%). Family history and previous radiation treatment were more significant in patients with STN (25% and 10.7%, respectively). 77.3% of patients were from the endemic Black Sea Region. Conclusions: The risk of malignancy in a presumably benign thyroid diseases should not be ignored. Since both the FNR of cytology and the prevelance of malignancy in STN and MNG are comparably high, other predictive factors of malignancy should be evaluated in detail, especially in endemic areas. Complete resection during the first thyroid surgery have a good outcome.

Peer review status:UNDER REVIEW

30 May 2020Submitted to International Journal of Clinical Practice
02 Jun 2020Assigned to Editor
02 Jun 2020Submission Checks Completed
09 Jun 2020Reviewer(s) Assigned
24 Jun 2020Review(s) Completed, Editorial Evaluation Pending