Risk Stratification in Multinodular Goiter: A Retrospective Review of Sonographic Features, Histopathological Results, and Cancer Risk

Canadian Association of Radiologists Journal - Tập 68 - Trang 425-430 - 2017
Brendan S. Kelly1, Pradeep Govender1, Michael Jeffers2, John Kinsella3, James Gibney4, Mark Sherlock4, William C. Torreggiani1
1Department of Radiology, Adelaide Meath Incorporating the National Children's Hospital, Tallaght, Ireland
2Department of Pathology, Adelaide Meath Incorporating the National Children's Hospital, Tallaght, Ireland
3Department of Otolaryngology, Adelaide Meath Incorporating the National Children's Hospital Tallaght, Ireland
4Department of Endocrinology, Adelaide Meath Incorporating the National Children's Hospital, Tallaght, Ireland

Tóm tắt

Purpose In the management of thyroid nodules, although the potential for malignancy exists, there is also the potential for overtreatment of subclinical disease. Although the TI-RADS (Thyroid Imaging-Reporting and Data System) system outlines a risk stratification score based on suspicious ultrasound findings, it has not been universally accepted. Many TI-RADS 2 or 3 patients proceed to fine needle aspiration biopsy (FNAB), potentially unnecessarily. The aim of the study was to identify whether lesions within a multinodular goiter (MNG) without suspicious features can be followed with ultrasound rather than biopsied as is recommended for single nodules. Methods Pathology records were retrospectively analysed for proven MNGs over a 5-year period. A total of 293 cases were identified. FNAB, prebiopsy ultrasound images, and reports were identified for each case. Images were reviewed and assessed for sonographically suspicious criteria guided by TI-RADS. Logistic regression was applied to determine if any sonographic features were associated with neoplasia. Odds ratios with 95% confidence intervals were calculated. Results Of 293 samples, 14 (4.7%) were neoplastic. Having no suspicious features conferred an average risk of 0.0339 (95% confidence interval: 0.02831-0.04087) of neoplasia. Risk of neoplasm significantly increased by having 1 and >1 suspicious feature ( P < .001). Regarding cytological results, of 237 patients with Thy-2 cytology, 159 were followed up and 8 had a neoplasm. Conclusion Ultrasound can be used to estimate risk of neoplasia in MNG. In the absence of suspicious radiological findings, follow-up with ultrasound rather than FNAB may be appropriate in patients who have a low clinical suspicion for neoplasia.

Tài liệu tham khảo

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Canadian Association of Radiologists Journal

Tập 68

425-430

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