Clinical and Ultrasound Thyroid Nodule Characteristics and Their Association with Cytological and Histopathological Outcomes: A Retrospective Multicenter Study in High-Resolution Thyroid Nodule Clinics
María Molina-Vega 1 , Carlos Antonio Rodríguez-Pérez 2 , Ana Isabel Álvarez-Mancha 3 , Gloria Baena-Nieto 4 , María Riestra 5 , Victoria Alcázar 6 , Ana Reyes Romero-Lluch 7 , Juan C Galofré 8 , José C Fernández-García 1
(1) Department of Endocrinology and Nutrition, Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain.
(2) Department of Endocrinology, Insular University Hospital of Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain.
(3) Department of Pathology, Virgen de la Victoria University Hospital, 29010 Málaga, Spain.
(4) Department of Endocrinology, Jerez Hospital, 11408 Jerez de la Frontera, Cádiz, Spain.
(5) Department of Endocrinology, University Hospital of Cabueñes, 33394 Gijón, Spain.
(6) Department of Endocrinology, Hospital Severo Ochoa, 28911 Leganés, Madrid, Spain.
(7) Department of Endocrinology, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain.
(8) Department of Endocrinology, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
Introduction: Thyroid nodules are a common finding. A high-resolution thyroid nodule clinic (HR-TNC) condenses all tests required for the evaluation of thyroid nodules into a single appointment. We aimed to evaluate the clinical outcomes at HR-TNCs.
Design and methods: A retrospective cross-sectional multicenter study including data from four HR-TNCs in Spain. We evaluated fine-needle aspiration (FNA) indications and the association between clinical and ultrasound characteristics with cytological and histopathological outcomes.
Results: A total of 2809 thyroid nodules were included; FNA was performed in 82.1%. Thyroid nodules that underwent FNA were more likely larger, isoechoic, with microcalcifications, and in younger subjects. The rate of nondiagnostic FNA was 4.3%. A solid component, irregular margins or microcalcifications, significantly increased the odds of Bethesda IV-V-VI (vs. Bethesda II).
Irregular margins and a solid component were independently associated with increased odds of malignancy. Thyroid nodules <20 mm and ≥20-<40 mm had a 6.5-fold and 3.3-fold increased risk for malignancy respectively in comparison with those ≥40 mm.
Conclusion: In this large multicenter study, we found that the presence of a solid component and irregular margins are factors independently related to malignancy in thyroid nodules. Since nodule size ≥40 mm was associated with the lowest odds of malignancy, this cut-off should not be a factor leading to indicate thyroid surgery. HR-TNCs were associated with a low rate of nondiagnostic FNA.
CITA DEL ARTÍCULO J Clin Med. 2019 Dec 9;8(12):2172. doi: 10.3390/jcm8122172