Thyroid cancers with benign-looking sonographic features have different lymph node metastatic risk and histologic subtypes according to nodule size

Multifocality as a prognostic factor in thyroid cancer: A meta-analysis

BACKGROUND

Thyroid cancer is one of the most common endocrine cancers whose incidence has been steadily increasing. Previous studies have suggested that multifocality in thyroid cancer is associated with poor prognosis. The present study aims to quantify the data on multifocality as a factor indicating poor prognosis by meta-analysis.

METHODS

A systematic search was carried out using the electronic databases PubMed and Medline. We searched for articles containing keywords of multifocality and thyroid cancer, as well as risk factors and prognostic factors for thyroid cancer (Lymph node metastases, extrathyroidal extension, distant metastases, disease recurrence, Age, tumour size. and gender). Data sets containing hazard ratios and odds ratios were then compared.

RESULTS

The meta-analysis was performed using a total of 21 articles, showed that multifocality is associated with an increased risk of development of LNM (12 Studies: OR = 1.87; 95% CI = 1.51-2.32; I2 = 49.11; p-value = .03), Extrathyroidal extension (15 Studies: OR = 3.18; 95% CI = 0.69-14.71; I2 = 95.62; p-value <.001), Tumour Size > 1 cm (3 Studies: OR = 2.75; 95% CI = 1.95-3.89; I2 = 0.00 and p-value = .88) and disease recurrence (5 Studies: HR = 2.81; 95% CI = 1.07-7.36; I2 = 95.85; p-value < .001). Risk factors that did not significantly contribute to a higher incidence of multifocality include Age >45, Male Gender.

CONCLUSIONS

Multifocality in thyroid cancer is a significant risk factor for disease progression and increases the risk of disease recurrence. The present study suggests that patients who have multifocal disease should therefore be managed more aggressively from an operative and post-operative perspective.

Reliability of fine-needle aspiration and ultrasound-based characteristics of thyroid nodules for diagnosing malignancy in Iranian patients

BACKGROUND

Sonography and fine-needle aspiration biopsy (FNA-B) have been approved as method of choice in diagnosis of malignant thyroid nodules. Unnecessary FNA-B not only is invasive and costly but also results in second biopsy or unnecessary surgery. So we aimed to determine the specificity and sensitivity of sonography and FNA-B, without sonography guidance, in diagnosis of malignant and benign thyroid nodules.

METHODS

Patients with thyroid nodule referred to Baqiyatallah Hospital in 2014-2015 and candidates for surgical nodule resection were selected using simple random sampling method. Patients were evaluated by sonography and FNA. Sonographic characteristics of nodule were described. All patients underwent surgical resection and gross samples were sent for pathological evaluation, the gold standard for measuring the specificity and sensitivity of sonographic findings and FNA in diagnosis of malignant nodules.

RESULTS

Ninety patients with the mean age of 45.95 ± 12.3 years were evaluated (17 male and 73 female). Comparing the patients with correct and incorrect sonography-based diagnosis showed significant differences in nodule's width, area, calcification, border, and cervical lymphadenopathy (P < 0.05). Comparing the patients with correct and incorrect FNA-based diagnosis showed significant differences in patients' age and tall-shape nodule (P < 0.05). The diagnosis of sonographist had 56.25% sensitivity and 95.9% specificity, and the FNA-based diagnosis had 81.25% sensitivity and 93.7% specificity.

CONCLUSION

Among sonography findings, width and area of nodule, calcification, and nodule border have significant effect on malignancy diagnosis. Also FNA is necessary in nodules with calcification, border irregularity, and less width and area, especially in younger patients.