Thyroid scintigraphy in the era of fine-needle aspiration cytology.
fine‐needle aspiration cytology
nodule
thyroid scintigraphy
Journal
Clinical endocrinology
ISSN: 1365-2265
Titre abrégé: Clin Endocrinol (Oxf)
Pays: England
ID NLM: 0346653
Informations de publication
Date de publication:
17 Dec 2020
17 Dec 2020
Historique:
received:
16
08
2020
revised:
18
11
2020
accepted:
20
11
2020
entrez:
22
12
2020
pubmed:
23
12
2020
medline:
23
12
2020
Statut:
aheadofprint
Résumé
To evaluate whether thyroid scintigraphy would alter the clinical management of patients referred for fine-needle aspiration cytology (FNA). We reviewed the medical and imaging records of patients referred to our Department between 2016 and 2019. All the patients had to take a serum thyrotropin test administered in our hospital at least two months before the FNA; where the TSH level was ≤1.5 mIU/L, the patients were subjected to a scan and subsequently to FNA, where indicated. We selected only healthy patients with no previous history of thyroid disease, who were not taking any drugs and who had a TSH level of ≤1.5 mIU/L. We excluded patients with multinodular goitre. A total of 176 patients were analysed. A total of 67/176 patients (38%) showed a serum of TSH ≤ 0.27 mIU/L. Scintigraphy identified a hot nodule in 142 lesions (80.7%), a warm nodule in 8 lesions (4.5%) and a cold nodule in 26 lesions (14.8%). The ROC curve analysis indicated that a TSH value of ≤0.42 mIU/L identified patients with hyperfunctioning nodules with a sensitivity of 65% and a specificity of 77%. All patients with cold and warm nodules were submitted to FNA: 22/26 (85%) and 5/8 (63%) lesions showed suspected malignancy or were compatible with malignancy, respectively. Speculating on our data, if we had subjected our patients to FNA as indicated by the 2015 ATA guidelines, we would have subjected 117 patients to cytology, from whom 83 had undetected hot nodules. Conversely, by adopting scintigraphy for all patients with TSH ≤ 1.5 mIU/L, 109 patients have avoided FNA. However, our study was performed in a region with a history of mild iodine deficiency. Therefore, we cannot claim that our observation is valid for patients born and living in areas with sufficient iodine uptake. We recommend thyroid scintigraphy for treating single thyroid nodules in euthyroid patients born and living in regions with an iodine deficiency, when TSH levels are below 1.5 mIU/L before FNA.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Burman KD, Wartofsky L. Thyroid nodules. N Engl J Med. 2016;374:1294‐1295.
Vander JB, Gaston EA, Dawber TR. The significance of nontoxic thyroid nodules. Final report of a 15‐year study of the incidence of thyroid malignancy. Ann Intern Med. 1968;69:537‐540.
Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med. 1994;54:1838‐1840.
Hegedus L. Clinical practice. the thyroid nodule. N Engl J Med. 2004;351:1764‐1771.
Cappelli C, Castellano M, Pirola I, et al. Reduced thyroid volume and nodularity in dyslipidaemic patients on statin treatment. Clin Endocrinol (Oxf). 2008;68:16‐21.
Lin JD, Chao TC, Huang BY, Chen ST, Chang HY, Hsueh C. Thyroid cancer in the thyroid nodules evaluated by ultrasonography and fine‐needle aspiration cytology. Thyroid. 2005;15:708‐717.
Kwong N, Medici M, Angell TE, et al. The influence of patient age on thyroid nodule formation, multinodularity, and thyroid cancer risk. J Clin Endocrinol Metab. 2015;100:4434‐4440.
Cappelli C, Castellano M, Pirola I, et al. The predictive value of ultrasound findings in the management of thyroid nodules. QJM. 2007;100:29‐35.
Cappelli C, Pirola I, Agosti B, et al. Complications after fine‐needle aspiration cytology: a retrospective study of 7449 consecutive thyroid nodules. Br J Oral Maxillofac Surg. 2017;55:266‐269.
Burch HB, Shakir F, Fitzsimmons TR, Jaques DP, Shriver CD. Diagnosis and management of the autonomously functioning thyroid nodule: the Walter Reed Army Medical Center experience, 1975–1996. Thyroid. 1998;8:871‐880.
Gharib H, Papini E, Garber JR, et al. AACE/ACE/AME task force on thyroid nodules. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules‐‐2016 update. Endocr Pract. 2016;22:622‐639.
Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1‐133.
Treglia G, Trimboli P, Verburg FA, Luster M, Giovanella L. Prevalence of normal TSH value among patients with autonomously functioning thyroid nodule. Eur J Clin Invest. 2015;45:739‐744.
Chami R, Moreno‐Reyes R, Corvilain B. Prevalence of normal TSH value among patients with autonomously functioning thyroid nodule. Eur J Clin Invest. 2015;45:999‐1000.
Chami R, Moreno‐Reyes R, Corvilain B. TSH measurement is not an appropriate screening test for autonomous functioning thyroid nodules: a retrospective study of 368 patients. Eur J Endocrinol. 2014;170:593‐599.
Cappelli C, Rotondi M, Pirola I, et al. Thyreotropin levels in diabetic patients on metformin treatment. Eur J of Endocrinol. 2012;167:261‐265.
Cappelli C, Rotondi M, Pirola I, et al. TSH‐lowering effect of metformin in type 2 diabetic patients: differences between euthyroid, untreated hypothyroid, and euthyroid on L‐T4 therapy patients. Diabetes Care. 2009;32:1589‐1590.
Martino E, Bartalena L, Bogazzi F, Braverman LE. The effects of amiodarone on the thyroid. Endocr Rev. 2011;22:240‐254.
Thomas Z, Bandali F, McCowen K, Malhotra A. Drug‐induced endocrine disorders in the intensive care unit. Crit Care Med. 2010;38:219‐230.
Kim J‐H, Baek JH, Lim HK, et al. 2017 Thyroid radiofrequency ablation guideline: Korean Society of Thyroid Radiology. Korean J Radiol. 2018;19:632‐655.
Papini E, Pacella CM, Solbiati LA, et al. Minimally‐invasive treatments for benign thyroid nodules: a Delphi‐based consensus statement from the Italian minimally‐invasive treatments of the thyroid (MITT) group. Int J Hyperth. 2019;36:376‐382.
Dobnig H, Zechmann W, Hermann M, et al. Radiofrequency ablation of thyroid nodules: “Good Clinical Practice Recommendations” for Austria: an interdisciplinary statement from the following professional associations: Austrian Thyroid Association (ÖSDG), Austrian Society for Nuclear Medicine and Molecular Imaging (OGNMB), Austrian Society for Endocrinology and Metabolism (ÖGES), Surgical Endocrinology Working Group (ACE) of the Austrian Surgical Society (OEGCH). Wien Med Wochenschr. 2020;170:6‐14.
Cappelli C, Franco F, Pirola I, et al. Radiofrequency ablation of functioning and non‐functioning thyroid nodules: a single institution 12‐month survey. J Endocrinol Invest. 2020;43:477‐482.
Schenke S, Seifert P, Zimny M, Winkens T, Binse I, Görges R. Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): the omission of thyroid scintigraphy increases the rate of falsely suspected lesions. J Nucl Med. 2019;60:342‐347.
Dirikoc A, Polat SB, Kandemir Z, et al. Comparison of ultrasonography features and malignancy rate of toxic and non‐toxic autonomous nodules: a preliminary study. Ann Nucl Med. 2015;29:883‐889.
Noto B, Eveslage M, Pixberg M, et al. Prevalence of hyperfunctioning thyroid nodules among those in need of fine needle aspiration cytology according to ATA 2015, EU‐TIRADS, and ACR‐TIRADS. Eur J Nucl Med Mol Imaging. 2020;47:1518‐1526.
Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine‐needle aspiration. J Clin Endocrinol Metab. 2006;91:4295‐4301.
Cappelli C, Agosti B, Tironi A, et al. Prevalence and aggressiveness of thyroid carcinoma with diameter less than one centimetre in iodine deficiency areas. Minerva Endocrinol. 2002;27:65‐71.
Tofthagen C. Threats to validity in retrospective studies. J Adv Pract Oncol. 2012;3:181‐183.