Incidental thyroid carcinoma: Correlation between FNAB cytology and pathological examination in 1093 cases

Abstract Objective To investigate Incidental Thyroid Carcinoma (ITC) by comparing the results of Fine Needle Aspiration Biopsy (FNAB) cytology and the postoperative pathological findings. Methods Data of 1479 patients who underwent total thyroidectomy were retrieved. Three hundred eighty-six patients were excluded due to insufficient data. Each surgical specimen studied received two histopathological diagnoses: the local diagnosis ‒ for the same area in which the FNAB was performed; and the final diagnosis, which includes a study of the entire surgical specimen. Results A thousand and ninety-three patients were investigated. FNAB result was malignant in 187 patients, benign in 204, suspicious or indeterminate in 668 cases, and inconclusive in 34 cases. The prevalence of ITC was 15.1%. Most of the ITC in this series was less than 0.5 cm. The incidence of ITC was higher in Bethesda III (17.5% ITC) and IV (19% ITC) than in Bethesda II cases (1.5% false negatives and 9% ITC). Conclusion Although the incidence of false-negative results in Bethesda II nodules is only 1.5%, 9% of these patients had ITC in the thyroid parenchyma outside the nodule that underwent preoperative FNAB. The incidence of ITC in the same scenario was even higher in Bethesda III (17.5%) and Bethesda IV cases (19%). Ultrasonography-guided FNAB is an excellent method for the assessment of thyroid nodules. However, biopsy sites should be carefully selected. Despite the high incidence of incidentalomas, total thyroidectomy should not always be the treatment of choice due to its rare but potentially serious complications. The findings of the present study can assist future clinical decisions towards active surveillance strategies for the management of papillary thyroid carcinoma.

Substernal goiter and laryngopharyngeal reflux

ABSTRACT Objective This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension. Subjects and methods A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter. Results The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients. Conclusion This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.

A associação dos níveis séricos de TSH com o risco de câncer bem diferenciado de tireoide e sua relação com a agressividade da doença / The association of serum TSH with the risk of well-differentiated thyroid cancer and its relation with disease aggressiveness

Introdução: O câncer de tireoide é a neoplasia endócrina de maior prevalência, e sua incidência vem aumentando nos últimos anos. Estudos anteriores sugeriram que o nível sérico de Hormônio Estimulante de Tireoide (TSH) é um fator de risco independente para o desenvolvimento de cânceres bem diferenciados de tireoide. Além disso, alguns desses estudos demonstraram que altos níveis de TSH estão relacionados a estágios mais avançados de doença. Objetivos: O objetivo do presente estudo é averiguar se os níveis de TSH, mesmo dentro da faixa da normalidade, se correlacionam com maior incidência e maior agressividade dos carcinomas bem diferenciados de tireoide. Métodos: Analisamos os dados de 1180 pacientes submetidos a tireoidectomia total pela equipe da Disciplina de Cirurgia de Cabeça e Pescoço do HC-FMUSP, sendo 57,9% devido a doenças benignas e 42,1% a neoplasias malignas de tireoide. Para cada paciente, adotamos os valores absolutos de TSH referentes à última coleta antes da cirurgia, e os resultados dos exames anatomopatológicos (AP). Resultados: A comparação dos níveis de TSH estratificado nos pacientes com doenças benignas e com neoplasias malignas demonstrou uma associação estatisticamente significativa (p < 0,0001), nos permitindo inferir que pacientes com valor de TSH sérico maior de 1,16 µIU/mL tem maior risco de serem portadores de câncer bem diferenciado de tireoide do que aqueles que tem níveis de TSH menor ou igual a este valor. Porém, quando comparamos o estadio final dos CBT com os níveis de THS estratificado não houve associação significativa (p = 0,585), e assim pelos nossos resultados não podemos afirmar que valores de TSH maiores de 1,16 µIU/mL estão associados a maior gravidade no câncer de tireoide.

Introduction: The thyroid cancer is the most common endocrine malignancy, and its incidence has increased in recent years. Previous studies have suggested that serum Thyroid Stimulating Hormone (TSH) is an independent risk factor for the development of well differentiated thyroid cancer. Furthermore, some of these studies showed that high TSH levels are related to more advanced stages of disease. Objective: The aim of the present study is to investigate if serum THS levels, even whitin the normal range, are related with higher incidence and increased aggressiveness of well-differentiated thyroid carcinomas. Methods: We analyzed data of 1180 patients who underwent total thyroidectomy by the Discipline of Head and Neck Surgery from Hospital das Clinicas of University of São Paulo (HC-FMUSP). 57.9% was due to benign diseases and 42,1% was due to malignant neoplasms. For each patient, we adopted the value of serum TSH reference to the last collection before surgery, and the results of the pathologic exams. Results: The comparison of the stratified TSH levels in the patients with benign diseases and malignant neoplasms showed a statistically significant association (p < 0,0001), allowing us to infer that patients with TSH levels higher than 1,16 µIU/mL have higher risk of being carriers of well differentiated thyroid cancer than those who TSH levels less than or equal to this value. But when we compared the final stage of CBT with the stratified TSH levels, there was no significant association (p = 0,585), and so by our results we cannot say that THS levels higher then 1,16 µIU/mL are associated with more advanced stage of disease.