Nathalie Silva de Morais; Jessica Stuart; Haixia Guan; Zhihong Wang; Edmund S. Cibas; Mary C. Frates; Carol B. Benson; Nancy L. Cho; Mathew A. Nehs; Caroline A. Alexander; Ellen Marqusee; Mathew I. Kim; Jochen H. Lorch; Justine A. Barletta; Trevor E. Angell; Erik K. Alexander
DisclosuresJ Endo Soc. 2019;3(4):791-800.
Patient Characteristics | |
---|---|
No. of patients | 9851 |
Sex | |
Female | 8263 (83.9) |
Male | 1588 (16.1) |
Age, y | |
Mean ± SD | 52.2 ± 15.0 |
Range | 18–95 |
Multinodular gland | |
Yes | 4495 (45.6) |
No | 5356 (54.4) |
Thyroidectomy | 3186 (32.3) |
Hashimoto thyroiditisa | |
Yes | 2651 (26.9) |
No | 7200 (73.1) |
Nodule characteristics | |
No. of nodules | 21,397 |
Largest dimension, cm | |
Mean ± SD | 2.6 ± 1.3 |
Range | 1.0–12.8 |
Nodules biopsied | 14,063 (65.7) |
Data reported as no. (%) unless otherwise indicated.
aHT criteria: chronic lymphocytic thyroiditis on histopathology and/or elevated thyroperoxidase antibodies and/or diffuse heterogeneity on ultrasound.
HT | Non-HT | P Valuea | |
---|---|---|---|
No. of nodules biopsied | 3895 | 10,168 | |
Nodule cytology by TBSRTC, no. (%) | <0.01 | ||
Nondiagnostic | 168 (4.3) | 728 (7.2) | |
No malignant cells | 2652 (68.1) | 7217 (71.0) | |
Indeterminate | 791 (20.3) | 1750 (17.2) | |
AUS, FLUS | 307 (7.9) | 635 (6.2) | |
SFN | 249 (6.4) | 626 (6.2) | |
SUSP | 235 (6.0) | 489 (4.8) | |
Positive for malignancy | 284 (7.3) | 473 (4.7) |
Abbreviations: AUS, atypia of undetermined significance; FLUS, follicular lesion of undetermined significance; SFN, suspicious for follicular or Hürthle cell neoplasm; SUSP, suspicious for malignancy.
a
P value for 2 × 6 χ
2 analysis of six TBSRTC categories.
Total (n = 9851) | HT (n = 2651) | Non-HT (n = 7200) | P Value | |
---|---|---|---|---|
Benign disease, no. (%) | 8140 (82.7) | 2045 (77.2) | 6095 (84.6) | |
Thyroid cancer, no. (%) | ||||
All subtypes | 1711 (17.3) | 606 (22.8) | 1105 (15.4) | <0.01 |
PTC | 1521 (88.9) | 547 (90.3) | 974(88.1) | |
FTC | 118 (6.8) | 39 (6.4) | 79 (7.1) | |
MTC | 14 (0.8) | 5 (0.8) | 9 (0.8) | |
Anaplastic | 18 (1.1) | 3 (0.5) | 15 (1.4) | |
Poorly differentiated | 18 (1.1) | 4 (0.7) | 14 (1.3) | |
Nonthyroid malignancy | 22(1.3) | 8 (1.3) | 14 (1.3) |
Abbreviations: FTC, follicular thyroid cancer; MTC, medullary thyroid cancer; PTC, papillary thyroid cancer.
TBSRTC Categorya | HT (n = 2,651) | Non-HT (n = 7,200) | P Value | RR | 95% CI |
---|---|---|---|---|---|
Nondiagnostic | 0.08 | 2.34 | 0.877–6.292 | ||
Total no. | 87 | 458 | |||
Thyroid cancer, no. (%)b | 6 (6.8) | 14 (3.0) | |||
No malignant cells | <0.01 | 2.10 | 1.450–3.063 | ||
Total no. | 1602 | 4707 | |||
Thyroid cancer, no. (%)b | 48 (2.9) | 68 (1.4) | |||
Indeterminate | 0.05 | 1.19 | 0.999–1.436 | ||
Total no. | 696 | 1572 | |||
Thyroid cancer, no. (%)b | 300 (43.1) | 609 (38.7) | |||
AUS, FLUS | 0.02 | 1.48 | 1.045–2.095 | ||
Total no. | 250 | 537 | |||
Thyroid cancer, no. (%)b | 69 (27.6) | 110 (20.4) | |||
SFN | 0.50 | 1.11 | 0.808–1.538 | ||
Total no. | 235 | 589 | |||
Thyroid cancer, no. (%)b | 79 (33.6) | 184 (31.2) | |||
SUSP | 0.71 | 1.07 | 0.745–1.541 | ||
Total no. | 211 | 446 | |||
Thyroid cancer, no. (%)b | 152 (72.0) | 315 (70.3) | |||
Positive for malignancy | 0.39 | 2.32 | 0.258–20.907 | ||
Total no. | 265 | 460 | |||
Thyroid cancer, no. (%)b | 264 (99.6) | 456 (99.1) |
Abbreviations: AUS, atypia of undetermined significance; FLUS, follicular lesion of undetermined significance; SFN, suspicious for follicular or Hürthle cell neoplasm; SUSP, suspicious for malignancy.
aPatients with more than one evaluable nodule were classified according to the highest TBSRTC score of the multiple nodules.
bThyroid cancer was defined using histopathology as well as TBSRTC 6 cytology in cases where surgery did not occur.
HT (n = 2651) | Non-HT (n = 7200) | P Value | |
---|---|---|---|
Microinvasion, n (%) | 122 (20.4) | 192 (18.6) | 0.39 |
Gross invasion, n (%) | 44 (6.7) | 87 (7.2) | 0.70 |
Lymph node metastasis, n (%) | 108 (22.3) | 177 (26.7) | 0.09 |
Distant metastasis, n (%) | 23 (5.8) | 41 (6.1) | 0.89 |
Multifocal, n (%)a | 85 (15.1) | 122(12.5) | 0.16 |
Tumor size, largest dimension, cm | 0.04 | ||
≤2 | 430 (66.0) | 729 (61.9) | |
>2–4 | 182 (27.9) | 339 (28.8) | |
>4 | 40 (6.1) | 109 (9.3) |
Data reported as no. (%) unless otherwise indicated.
aMultifocal: two or more nodules each ≥1 cm.
Nathalie Silva de Morais1,2,3*, Jessica Stuart1*, Haixia Guan1,4, Zhihong Wang1,5, Edmund S. Cibas1, Mary C. Frates1, Carol B. Benson1, Nancy L. Cho1, Mathew A. Nehs1, Caroline A. Alexander1, Ellen Marqusee1, Mathew I. Kim1, Jochen H. Lorch1, Justine A. Barletta1, Trevor E. Angell1 and Erik K. Alexander1
1Thyroid Interdisciplinary Team, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; 2Endocrinology Service, Instituto Nacional de Câncer and Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil 21941–902; 3Endocrinology Service, Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rio de Janeiro, Brazil 20211–340; 4Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, China 110001; and 5Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China 110001
*N.S.M and J.S. contributed equally to this study.
Correspondence
Nathalie Silva de Morais, MD, Harvard Institute of Medicine, Thyroid Section, 77 Avenue Louis Pasteur, Suite 641, Boston, Massachussetts 02115. E-mail: nathalieaos@gmail.com.
Disclosure Summary
J.H.L. has received research support from Bristol-Myers Squibb, Bayer; and Novartis; and consulting fees from Bayer, Genentech, and Eisai. The remaining authors have nothing to disclose.
You have already selected for My Alerts
Click the topic below to receive emails when new articles are available.
You've successfully added to your alerts. You will receive email when new content is published.
Manage Email Alertsprocessing....
Comments