Can Cytologic and Sonographic Features Help Prevent Overtreatment of Bethesda V Thyroid Nodules?

•25%-50% of Bethesda V thyroid nodules may be benign, noninvasive follicular thyroid neoplasm with papillary-like nuclear features, or low risk cancer.•Total thyroidectomy for Bethesda V nodules may therefore be overtreatment.•Cytology and ultrasonography may guide extent of surgery for these nodule...

Full description

Saved in:
Bibliographic Details
Published in:The Journal of surgical research 2021-12, Vol.268, p.112-118
Main Authors: Higgins, Sara, James, Benjamin C., Sacks, Barry, Mowschenson, Peter, Nishino, Michiya, Hasselgren, Per-Olof
Format: Article
Language:English
Subjects:
Bethesda V cytology
Cytomorphology
Overtreatment
Thyroid nodule
Thyroidectomy
Ultrasonography
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:•25%-50% of Bethesda V thyroid nodules may be benign, noninvasive follicular thyroid neoplasm with papillary-like nuclear features, or low risk cancer.•Total thyroidectomy for Bethesda V nodules may therefore be overtreatment.•Cytology and ultrasonography may guide extent of surgery for these nodules. Although nearly half of thyroid nodules with Bethesda V cytology (suspicious for malignancy) may be benign or harbor low-grade neoplasms that can be sufficiently treated with lobectomy, many patients with Bethesda V cytology continue to be treated with total thyroidectomy. The objectives of this study were to establish whether cytomorphologic and ultrasonographic features can determine appropriate surgery for thyroid nodules with Bethesda V cytology and how often patients are overtreated with total instead of partial thyroidectomy. Utilizing a 10-y prospective database starting January 1, 2004, cytomorphologic and ultrasonographic features of thyroid nodules with Bethesda V cytology were reviewed. Overtreatment was defined as total thyroidectomy when histopathology revealed benign nodule, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) or a unilateral < 4 cm low risk cancer. Sixty-three patients were included in the study. Seventeen (27%) had benign, 14 (22%) NIFTP, and 32 (51%) malignant nodules. On cytology, nuclear pseudoinclusions, and on ultrasound, taller-than-wide configuration, were more common in malignant than benign or NIFTP nodules. Among 56 patients who underwent total thyroidectomy, 14 and 11 had a benign or NIFTP nodule, respectively, and 13 had a unilateral < 4 cm low risk cancer, suggesting that 68% (38/56) were overtreated. Total thyroidectomy for Bethesda V thyroid nodules may result in overtreatment in more than half of the patients. Although certain cytomorphologic and ultarsonographic features may be helpful in determining appropriate surgery for Bethesda V thyroid nodules, additional characteristics are needed to reduce overtreatment of these nodules.
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2021.05.050