The Role of “Critical” Ultrasound Reassessment in the Decision-Making of Bethesda III Thyroid Nodules
Abstract
:1. Introduction
2. Materials and Methods
2.1. Clinical Management
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- any ‘non aggressive’ PTC recruited in BIII diagnostic category (2018–2022);
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- US performed by endocrinologist/endocrine surgeon of multidisciplinary team.
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- two or more BIII-IV-V-VI nodules;
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- US reports not in agreement with ACE/AACE/AME standards;
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- cytology reports not in agreement with Bethesda system;
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- Grave’s disease and other benign diseases;
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- cancers other than PTC;
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- aggressive variants of PTC;
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- NIFTP and other tumors of uncertain malignant potential;
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- PTC ≤ 1 cm.
2.2. Thyroid Ultrasound
2.3. Thyroid Cytology
2.4. Thyroid Surgery
2.5. Variables Analyzed
2.6. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Benign | Malignant | OR (CI95%) | p-Value | |
---|---|---|---|---|---|
Age | 54 | 55 | 0.4298489 | ||
Sex | Benign | Malignant | Total | OR (CI95%) | p-value |
m | 66 (23%) | 22 (7%) | 88 (30%) | 0.895 | 0.7743 |
f | 153 (51%) | 57 (19%) | 210 (70%) | ||
Total | 219 (74%) | 79 (26%) | 298 (100%) | ||
Variable | Benign | Malignant | OR (CI95%) | p-value | |
Size | 3.85 | 2.3 | <0.00001 | ||
Cystic | Benign | Malignant | Total | OR (CI95%) | p-value |
N | 182 (61%) | 78 (26.2%) | 260 (87.2%) | 0.0633 (0.0085–0.4678) | <0.001 |
Y | 37 (12.5%) | 1 (0.3%) | 38 (12.8%) | ||
Total | 219 (73.5%) | 79 (26.5%) | 298 (100%) | ||
Echogenicity | Benign | Malignant | Total | OR (CI95%) | p-value |
Isohechoic | 60 (20.1%) | 0 (0%) | 60 (20.1%) | 13.9 | 0.000001 |
Slightly hypohechoic | 108 (36.3%) | 15 (5%) | 123 (41.3%) | ||
Hypohechoic | 51 (17.1%) | 64 (21.5%) | 115 (38.6%) | ||
Total | 219 (73.5) | 79 (26.5%) | 298 (100%) | ||
Intralesional vascularization | Benign | Malignant | Total | OR (CI95%) | p-value |
N | 108 (36.3%) | 14 (4.7%) | 122 (41%) | 4.5 (2.3–9.2) | 0.000001 |
Y | 111 (37.2%) | 65 (21.8%) | 176 (59%) | ||
Total | 219 (73.5%) | 79 (26.5%) | 298 (100%) | ||
Spiculated margins | Benign | Malignant | Total | OR (CI95%) | p-value |
N | 209 (70.1%) | 24 (8%) | 233 (78.1%) | 46.7 (20.5–116.9) | 0.000001 |
Y | 10 (3.4%) | 55 (18.5%) | 65 (21.9%) | ||
Total | 219 (73.5%) | 79 (26.5%) | 298 (100%) | ||
Microcalcification | Benign | Malignant | Total | OR (CI95%) | p-value |
N | 165 (55.4%) | 10 (3.3%) | 175 (58.7%) | 20.8 (9.8–48.6) | 0.000001 |
Y | 54 (18.1%) | 69 (23.2%) | 123 (41.3%) | ||
Total | 219 (73.5%) | 79 (26.5%) | 298 (100%) | ||
Taller than wide | Benign | Malignant | Total | OR (CI95%) | p-value |
N | 218 (73.2%) | 54 (18.1%) | 272 (91.3%) | 99.2 (15.6–4060.8) | 0.000001 |
Y | 1 (0.3%) | 25 (8.4%) | 26 (8.7%) | ||
Total | 219 (73.5%) | 79 (26.5%) | 298 (100%) | ||
Extra-thyroid growth | Benign | Malignant | Total | OR (CI95%) | p-value |
N | 219 (73.5%) | 54 (18.1) | 273 (91.6%) | 205.4 (12.3–3427.38) | 0.000001 |
Y | 0 | 25 (8.4%) | 25 (8.4%) | ||
Total | 219 (73.5%) | 79 (26.5%) | 298 (100%) | ||
Increase | Benign | Malignant | Total | OR (CI95%) | p-value |
N | 66 (22.2%) | 14 (4.7%) | 80 (26.9%) | 2.0 (1.02–4.13) | <0.05 |
Y | 153 (51.3%) | 65 (21.8%) | 218 (73.1%) | ||
Total | 219 (73.5%) | 79 (26.5%) | 298 (100%) |
Reassessment | Benign | Malignant | Total | OR (CI95%) | p-Value |
---|---|---|---|---|---|
N | 11 (3.7%) | 0 (0%) | 11 (3.7%) | Inf (0.93-Inf) | 0.05 |
Y | 208 (69.8%) | 79 (26.5%) | 287 (96.3%) | ||
Total | 219 (73.5%) | 79 (26.5%) | 298 (100%) | ||
Change of strategy | Benign | Malignant | Total | OR (CI95%) | p-value |
N | 197 | 3 | 200 | 218.7 (64.1–1155.2) | <0.00001 |
Y | 22 | 76 | 98 | ||
Total | 219 | 79 | 298 |
Variable | OR | CI (Inf) 95% | CI (Sup) 95% | p-Value |
---|---|---|---|---|
Size | 0.193 | 0.081 | 0.404 | <0.00005 *** |
Spiculated margins + | 5.694 | 1.992 | 10.70 | <0.005 ** |
Microcalcifications + | 5.050 | 1.542 | 10.88 | <0.01 ** |
Taller than wide + | 10.16 | 1.006 | 30.09 | 0.07456 |
Extra-thyroidal growth + | >6000 | >0.001 | <20,000 | 0.98672 |
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Orlando, G.; Graceffa, G.; Mazzola, S.; Vassallo, F.; Proclamà, M.P.; Richiusa, P.; Radellini, S.; Paladino, N.C.; Melfa, G.; Scerrino, G. The Role of “Critical” Ultrasound Reassessment in the Decision-Making of Bethesda III Thyroid Nodules. Medicina 2023, 59, 1484. https://doi.org/10.3390/medicina59081484
Orlando G, Graceffa G, Mazzola S, Vassallo F, Proclamà MP, Richiusa P, Radellini S, Paladino NC, Melfa G, Scerrino G. The Role of “Critical” Ultrasound Reassessment in the Decision-Making of Bethesda III Thyroid Nodules. Medicina. 2023; 59(8):1484. https://doi.org/10.3390/medicina59081484
Chicago/Turabian StyleOrlando, Giuseppina, Giuseppa Graceffa, Sergio Mazzola, Fabrizio Vassallo, Maria Pia Proclamà, Pierina Richiusa, Stefano Radellini, Nunzia Cinzia Paladino, Giuseppina Melfa, and Gregorio Scerrino. 2023. "The Role of “Critical” Ultrasound Reassessment in the Decision-Making of Bethesda III Thyroid Nodules" Medicina 59, no. 8: 1484. https://doi.org/10.3390/medicina59081484