Positive central lymph-nodes are underdiagnosed in patients with Bethesda V cytology in an endemic goiter region.
Bethesda
Fine needle aspiration (FNA)
central neck dissection
follicular neoplasia
lymph node
Journal
Gland surgery
ISSN: 2227-684X
Titre abrégé: Gland Surg
Pays: China (Republic : 1949- )
ID NLM: 101606638
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
entrez:
19
5
2020
pubmed:
19
5
2020
medline:
19
5
2020
Statut:
ppublish
Résumé
Fine needle aspiration (FNA) is a significant diagnostic procedure for detecting malignancy in patients with nodular thyroid disease. A high proportion of patients with cytological diagnosed follicular neoplasia (Bethesda IV and V) ultimately have thyroid cancer. The aim of this study was to evaluate the incidence of preoperatively undiagnosed central lymph node metastasis in patients with multinodular goiter (MNG). Patients who underwent FNA and were classified as Bethesda IV/V were included. Applying a radical approach, all patients underwent (hemi)thyroidectomy and prophylactic unilateral central neck dissection. During our study period 2009-2013, 60 patients (19.7%) were classified as Bethesda IV and 21 (6.9%) Bethesda V. Final histopathological results revealed malignancy in 35 (43.2%) of 81 Bethesda IV/V nodules. Of the nodules classified as Bethesda IV, 20 (33.3%) showed malignancy in the final histology. Ten patients (16.7%) had papillary micro-carcinoma (mPTC, <10 mm), 4 (6.6%) PTC and 6 (10%) follicular thyroid cancer. Fifteen of 21 (71.4%) Bethesda V nodules were revealed as PTC of whom seven (33.3%) patients also had lymph-node metastases. While 33.3% of the patients with PTC, preoperatively classified as Bethesda V, had previously undetected positive lymph-nodes, only one patient with Bethesda IV had lymph-node metastasis.
Sections du résumé
BACKGROUND
BACKGROUND
Fine needle aspiration (FNA) is a significant diagnostic procedure for detecting malignancy in patients with nodular thyroid disease. A high proportion of patients with cytological diagnosed follicular neoplasia (Bethesda IV and V) ultimately have thyroid cancer. The aim of this study was to evaluate the incidence of preoperatively undiagnosed central lymph node metastasis in patients with multinodular goiter (MNG).
METHODS
METHODS
Patients who underwent FNA and were classified as Bethesda IV/V were included. Applying a radical approach, all patients underwent (hemi)thyroidectomy and prophylactic unilateral central neck dissection.
RESULTS
RESULTS
During our study period 2009-2013, 60 patients (19.7%) were classified as Bethesda IV and 21 (6.9%) Bethesda V. Final histopathological results revealed malignancy in 35 (43.2%) of 81 Bethesda IV/V nodules. Of the nodules classified as Bethesda IV, 20 (33.3%) showed malignancy in the final histology. Ten patients (16.7%) had papillary micro-carcinoma (mPTC, <10 mm), 4 (6.6%) PTC and 6 (10%) follicular thyroid cancer. Fifteen of 21 (71.4%) Bethesda V nodules were revealed as PTC of whom seven (33.3%) patients also had lymph-node metastases.
CONCLUSIONS
CONCLUSIONS
While 33.3% of the patients with PTC, preoperatively classified as Bethesda V, had previously undetected positive lymph-nodes, only one patient with Bethesda IV had lymph-node metastasis.
Identifiants
pubmed: 32420249
doi: 10.21037/gs.2020.02.07
pii: gs-09-02-252
pmc: PMC7225453
doi:
Types de publication
Journal Article
Langues
eng
Pagination
252-260Informations de copyright
2020 Gland Surgery. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs.2020.02.07). The authors have no conflicts of interest to declare.
Références
Langenbecks Arch Surg. 2014 Feb;399(2):141-54
pubmed: 24263684
Surgery. 2012 Dec;152(6):957-64
pubmed: 23158170
Diagn Cytopathol. 2008 Feb;36(2):104-12
pubmed: 18181183
World J Surg. 2012 Jun;36(6):1286-92
pubmed: 22395348
Surgery. 2010 Sep;148(3):516-25
pubmed: 20338609
J Clin Oncol. 2015 Jul 20;33(21):2370-5
pubmed: 26077238
Eur J Ultrasound. 2003 Feb;16(3):191-206
pubmed: 12573788
Otolaryngol Head Neck Surg. 2017 Apr;156(4):611-615
pubmed: 28118554
World J Surg. 2000 Aug;24(8):907-12
pubmed: 10865034
Thyroid. 2000 Aug;10(8):709-12
pubmed: 11014317
Am Surg. 2011 Nov;77(11):1553-8
pubmed: 22196673
World J Surg Oncol. 2014 May 20;12:152
pubmed: 24885654
Surgery. 2014 Jul;156(1):137-46
pubmed: 24878458
Surgery. 2002 Mar;131(3):249-56
pubmed: 11894028
Surgery. 2009 Oct;146(4):696-703; discussion 703-5
pubmed: 19789029
Surgery. 2005 Dec;138(6):1095-100, discussion 1100-1
pubmed: 16360396
Clin Cancer Res. 2013 May 1;19(9):2283-8
pubmed: 23422095
Endocr Pract. 2006 Jan-Feb;12(1):63-102
pubmed: 16596732
Minerva Chir. 2013 Jun;68(3):321-8
pubmed: 23774098
Thyroid. 2018 Apr;28(4):496-503
pubmed: 29620964
World J Surg. 2008 Nov;32(11):2494-502
pubmed: 18784956
Cancer Cytopathol. 2012 Apr 25;120(2):117-25
pubmed: 21998003
Ann Surg Oncol. 2013 Jun;20(6):1906-11
pubmed: 23263904
Wien Klin Wochenschr. 1997 Feb 28;109(4):116-22
pubmed: 9157722
Am J Clin Pathol. 2000 Nov;114(5):681-3
pubmed: 11068539
Thyroid. 2012 Sep;22(9):911-7
pubmed: 22827494
Surgery. 2008 Dec;144(6):1070-7; discussion 1077-8
pubmed: 19041020
Clin Endocrinol (Oxf). 2004 Dec;61(6):732-7
pubmed: 15579188
Ann Surg. 2001 May;233(5):716-22
pubmed: 11323510
Thyroid. 2013 Sep;23(9):1087-98
pubmed: 23402640
Am J Surg. 2005 May;189(5):592-5; discussion 595
pubmed: 15862502
Diagn Cytopathol. 2002 Jan;26(1):41-4
pubmed: 11782086
Acta Otorhinolaryngol Ital. 2017 Feb;37(1):1-8
pubmed: 28374865
ANZ J Surg. 2003 Jul;73(7):480-3
pubmed: 12864820
Thyroid. 2006 Feb;16(2):109-42
pubmed: 16420177
PLoS One. 2016 Jan 19;11(1):e0146883
pubmed: 26784518
Ann Surg. 2004 Jul;240(1):18-25
pubmed: 15213613
Ann Surg Oncol. 2016 Nov;23(12):4016-4022
pubmed: 27393573
Thyroid. 2009 Nov;19(11):1167-214
pubmed: 19860577
J Clin Endocrinol Metab. 2002 May;87(5):1941-6
pubmed: 11994321
Surgery. 2016 Oct;160(4):1049-1058
pubmed: 27521047
World J Surg. 2015 Mar;39(3):695-700
pubmed: 25446471
Acta Cytol. 2011;55(1):4-12
pubmed: 21135515
World J Surg. 2007 May;31(5):895-904
pubmed: 17347896
J Surg Oncol. 2009 Jan 1;99(1):28-31
pubmed: 18942072
Minerva Chir. 2016 Jun;71(3):159-67
pubmed: 26046958
Eur J Endocrinol. 2010 Apr;162(4):763-70
pubmed: 20083557
Ann Surg Oncol. 2017 Aug;24(8):2189-2198
pubmed: 27913945
Surgery. 2012 Aug;152(2):145-51
pubmed: 22503316
Eur J Radiol. 1998 Nov;29(1):4-10
pubmed: 9934552
Endocr J. 2005 Apr;52(2):199-205
pubmed: 15863948
Thyroid. 2016 Jan;26(1):1-133
pubmed: 26462967
J Am Soc Cytopathol. 2017 Nov - Dec;6(6):217-222
pubmed: 31043290
Acta Endocrinol (Copenh). 1991 Jan;124(1):12-8
pubmed: 2000697
AJR Am J Roentgenol. 2009 Jan;192(1):66-72
pubmed: 19098181
CA Cancer J Clin. 2018 Jan;68(1):55-63
pubmed: 29092098
Med Arch. 2018 Apr;72(2):108-111
pubmed: 29736098
Thyroid. 1998 Jul;8(7):565-9
pubmed: 9709908
Langenbecks Arch Surg. 2014 Feb;399(2):155-63
pubmed: 24352594
Am Surg. 2005 Sep;71(9):731-4
pubmed: 16468507