Predictors of malignancy in patients with cytologically suspicious thyroid nodules

M. Regina Castro, Rachel P. Espiritu, Rebecca S. Bahn, Michael R. Henry, Hossein Gharib, Pedro Caraballo, John C. Morris

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Background: Fine needle aspiration (FNA), although very reliable for cytologically benign and malignant thyroid nodules, has much lower predictive value in the case of suspicious or indeterminate nodules. We aimed to identify clinical predictors of malignancy in the subset of patients with suspicious FNA cytology. Methods: We reviewed the electronic medical records of 462 patients who had FNA of thyroid nodules at our institution with a suspicious cytological diagnosis, and underwent surgery at Mayo Clinic between January 2004 and September 2008. Demographic data including age, gender, history of exposure to radiation and use of thyroid hormone was collected. The presence of single versus multiple nodules by ultrasonography, nodule size, and serum thyroid-stimulating harmone (TSH) level before thyroid surgery were recorded. Analysis of the latter was limited to patients not taking thyroid hormone or antithyroid drugs at the time of FNA. Results: Of the 462 patients, 327 had lesions suspicious for follicular neoplasm (S-FN) or Hürthle cell neoplasm (S-HCN), 125 had cytology suspicious for papillary carcinoma (S-PC) and 10 had a variety of other suspicious lesions (medullary cancer, lymphoma and atypical). Malignancy rate for suspicious neoplastic lesions (FN+HCN) was ∼15%, whereas malignancy rate for lesions S-PC was 77%. Neither age, serum TSH level, or history of radiation exposure were associated with increased malignancy risk. The presence of multiple nodules (41.1% vs. 26.4%, p=0.0014) or smaller nodule size (2.6±1.8 cm vs. 2.9±1.6 cm, p=0.008) was associated with higher malignancy risk. In patients with cytology suspicious for neoplasm (FN, HCN) malignancy risk was higher in those receiving thyroid hormone therapy than in nonthyroid hormone users (37.7% vs. 16.5%, p=0.0004; odds ratio: 3.1), although serum TSH values did not differ significantly between thyroid hormone users and nonusers. Conclusion: In patients with cytologically suspicious thyroid nodules, the presence of multiple nodules or smaller nodule size was associated with increased risk of malignancy. In addition, our study demonstrates for the first time, an increased risk of malignancy in patients with nodules suspicious for neoplasm who are taking thyroid hormone therapy. The reason for this association is unknown.

Original languageEnglish (US)
Pages (from-to)1191-1198
Number of pages8
JournalThyroid
Volume21
Issue number11
DOIs
StatePublished - Nov 1 2011

Fingerprint

Thyroid Nodule
Neoplasms
Thyroid Hormones
Fine Needle Biopsy
Thyroid Gland
Cell Biology
Papillary Carcinoma
Serum
Antithyroid Agents
Electronic Health Records
Ultrasonography
Lymphoma

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Castro, M. R., Espiritu, R. P., Bahn, R. S., Henry, M. R., Gharib, H., Caraballo, P., & Morris, J. C. (2011). Predictors of malignancy in patients with cytologically suspicious thyroid nodules. Thyroid, 21(11), 1191-1198. https://doi.org/10.1089/thy.2011.0146

Predictors of malignancy in patients with cytologically suspicious thyroid nodules. / Castro, M. Regina; Espiritu, Rachel P.; Bahn, Rebecca S.; Henry, Michael R.; Gharib, Hossein; Caraballo, Pedro; Morris, John C.

In: Thyroid, Vol. 21, No. 11, 01.11.2011, p. 1191-1198.

Research output: Contribution to journalArticle

Castro, MR, Espiritu, RP, Bahn, RS, Henry, MR, Gharib, H, Caraballo, P & Morris, JC 2011, 'Predictors of malignancy in patients with cytologically suspicious thyroid nodules', Thyroid, vol. 21, no. 11, pp. 1191-1198. https://doi.org/10.1089/thy.2011.0146
Castro, M. Regina ; Espiritu, Rachel P. ; Bahn, Rebecca S. ; Henry, Michael R. ; Gharib, Hossein ; Caraballo, Pedro ; Morris, John C. / Predictors of malignancy in patients with cytologically suspicious thyroid nodules. In: Thyroid. 2011 ; Vol. 21, No. 11. pp. 1191-1198.
@article{36f3948d97df41caa2c9bd7e8b4225c0,
title = "Predictors of malignancy in patients with cytologically suspicious thyroid nodules",
abstract = "Background: Fine needle aspiration (FNA), although very reliable for cytologically benign and malignant thyroid nodules, has much lower predictive value in the case of suspicious or indeterminate nodules. We aimed to identify clinical predictors of malignancy in the subset of patients with suspicious FNA cytology. Methods: We reviewed the electronic medical records of 462 patients who had FNA of thyroid nodules at our institution with a suspicious cytological diagnosis, and underwent surgery at Mayo Clinic between January 2004 and September 2008. Demographic data including age, gender, history of exposure to radiation and use of thyroid hormone was collected. The presence of single versus multiple nodules by ultrasonography, nodule size, and serum thyroid-stimulating harmone (TSH) level before thyroid surgery were recorded. Analysis of the latter was limited to patients not taking thyroid hormone or antithyroid drugs at the time of FNA. Results: Of the 462 patients, 327 had lesions suspicious for follicular neoplasm (S-FN) or H{\"u}rthle cell neoplasm (S-HCN), 125 had cytology suspicious for papillary carcinoma (S-PC) and 10 had a variety of other suspicious lesions (medullary cancer, lymphoma and atypical). Malignancy rate for suspicious neoplastic lesions (FN+HCN) was ∼15{\%}, whereas malignancy rate for lesions S-PC was 77{\%}. Neither age, serum TSH level, or history of radiation exposure were associated with increased malignancy risk. The presence of multiple nodules (41.1{\%} vs. 26.4{\%}, p=0.0014) or smaller nodule size (2.6±1.8 cm vs. 2.9±1.6 cm, p=0.008) was associated with higher malignancy risk. In patients with cytology suspicious for neoplasm (FN, HCN) malignancy risk was higher in those receiving thyroid hormone therapy than in nonthyroid hormone users (37.7{\%} vs. 16.5{\%}, p=0.0004; odds ratio: 3.1), although serum TSH values did not differ significantly between thyroid hormone users and nonusers. Conclusion: In patients with cytologically suspicious thyroid nodules, the presence of multiple nodules or smaller nodule size was associated with increased risk of malignancy. In addition, our study demonstrates for the first time, an increased risk of malignancy in patients with nodules suspicious for neoplasm who are taking thyroid hormone therapy. The reason for this association is unknown.",
author = "Castro, {M. Regina} and Espiritu, {Rachel P.} and Bahn, {Rebecca S.} and Henry, {Michael R.} and Hossein Gharib and Pedro Caraballo and Morris, {John C.}",
year = "2011",
month = "11",
day = "1",
doi = "10.1089/thy.2011.0146",
language = "English (US)",
volume = "21",
pages = "1191--1198",
journal = "Thyroid",
issn = "1050-7256",
publisher = "Mary Ann Liebert Inc.",
number = "11",

}

TY - JOUR

T1 - Predictors of malignancy in patients with cytologically suspicious thyroid nodules

AU - Castro, M. Regina

AU - Espiritu, Rachel P.

AU - Bahn, Rebecca S.

AU - Henry, Michael R.

AU - Gharib, Hossein

AU - Caraballo, Pedro

AU - Morris, John C.

PY - 2011/11/1

Y1 - 2011/11/1

N2 - Background: Fine needle aspiration (FNA), although very reliable for cytologically benign and malignant thyroid nodules, has much lower predictive value in the case of suspicious or indeterminate nodules. We aimed to identify clinical predictors of malignancy in the subset of patients with suspicious FNA cytology. Methods: We reviewed the electronic medical records of 462 patients who had FNA of thyroid nodules at our institution with a suspicious cytological diagnosis, and underwent surgery at Mayo Clinic between January 2004 and September 2008. Demographic data including age, gender, history of exposure to radiation and use of thyroid hormone was collected. The presence of single versus multiple nodules by ultrasonography, nodule size, and serum thyroid-stimulating harmone (TSH) level before thyroid surgery were recorded. Analysis of the latter was limited to patients not taking thyroid hormone or antithyroid drugs at the time of FNA. Results: Of the 462 patients, 327 had lesions suspicious for follicular neoplasm (S-FN) or Hürthle cell neoplasm (S-HCN), 125 had cytology suspicious for papillary carcinoma (S-PC) and 10 had a variety of other suspicious lesions (medullary cancer, lymphoma and atypical). Malignancy rate for suspicious neoplastic lesions (FN+HCN) was ∼15%, whereas malignancy rate for lesions S-PC was 77%. Neither age, serum TSH level, or history of radiation exposure were associated with increased malignancy risk. The presence of multiple nodules (41.1% vs. 26.4%, p=0.0014) or smaller nodule size (2.6±1.8 cm vs. 2.9±1.6 cm, p=0.008) was associated with higher malignancy risk. In patients with cytology suspicious for neoplasm (FN, HCN) malignancy risk was higher in those receiving thyroid hormone therapy than in nonthyroid hormone users (37.7% vs. 16.5%, p=0.0004; odds ratio: 3.1), although serum TSH values did not differ significantly between thyroid hormone users and nonusers. Conclusion: In patients with cytologically suspicious thyroid nodules, the presence of multiple nodules or smaller nodule size was associated with increased risk of malignancy. In addition, our study demonstrates for the first time, an increased risk of malignancy in patients with nodules suspicious for neoplasm who are taking thyroid hormone therapy. The reason for this association is unknown.

AB - Background: Fine needle aspiration (FNA), although very reliable for cytologically benign and malignant thyroid nodules, has much lower predictive value in the case of suspicious or indeterminate nodules. We aimed to identify clinical predictors of malignancy in the subset of patients with suspicious FNA cytology. Methods: We reviewed the electronic medical records of 462 patients who had FNA of thyroid nodules at our institution with a suspicious cytological diagnosis, and underwent surgery at Mayo Clinic between January 2004 and September 2008. Demographic data including age, gender, history of exposure to radiation and use of thyroid hormone was collected. The presence of single versus multiple nodules by ultrasonography, nodule size, and serum thyroid-stimulating harmone (TSH) level before thyroid surgery were recorded. Analysis of the latter was limited to patients not taking thyroid hormone or antithyroid drugs at the time of FNA. Results: Of the 462 patients, 327 had lesions suspicious for follicular neoplasm (S-FN) or Hürthle cell neoplasm (S-HCN), 125 had cytology suspicious for papillary carcinoma (S-PC) and 10 had a variety of other suspicious lesions (medullary cancer, lymphoma and atypical). Malignancy rate for suspicious neoplastic lesions (FN+HCN) was ∼15%, whereas malignancy rate for lesions S-PC was 77%. Neither age, serum TSH level, or history of radiation exposure were associated with increased malignancy risk. The presence of multiple nodules (41.1% vs. 26.4%, p=0.0014) or smaller nodule size (2.6±1.8 cm vs. 2.9±1.6 cm, p=0.008) was associated with higher malignancy risk. In patients with cytology suspicious for neoplasm (FN, HCN) malignancy risk was higher in those receiving thyroid hormone therapy than in nonthyroid hormone users (37.7% vs. 16.5%, p=0.0004; odds ratio: 3.1), although serum TSH values did not differ significantly between thyroid hormone users and nonusers. Conclusion: In patients with cytologically suspicious thyroid nodules, the presence of multiple nodules or smaller nodule size was associated with increased risk of malignancy. In addition, our study demonstrates for the first time, an increased risk of malignancy in patients with nodules suspicious for neoplasm who are taking thyroid hormone therapy. The reason for this association is unknown.

UR - http://www.scopus.com/inward/record.url?scp=83755220919&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=83755220919&partnerID=8YFLogxK

U2 - 10.1089/thy.2011.0146

DO - 10.1089/thy.2011.0146

M3 - Article

VL - 21

SP - 1191

EP - 1198

JO - Thyroid

JF - Thyroid

SN - 1050-7256

IS - 11

ER -