DR.Guttler’s Patient Thyroid Blog Post: More extensive total thyroidectomy than is needed in 50% of Cases with class V cytology.

DR.Guttler’s Patient Thyroid Blog Post: More extensive  total thyroidectomy than is needed in 50% of Cases with class V cytology.

DR.Guttler’s Patient Thyroid Blog Post: More extensive total thyroidectomy than is needed in 50% of Cases with class V cytology.

Dr.Guttler’s comments:

  1. 25%-50% of Bethesda V thyroid nodules may be benign, noninvasive follicular neoplasm with papillary-like nuclear features, or low risk cancer.
  2. Total thyroidectomy for Bethesda V nodules may therefore be overtreatment.
  3. cytology and ultrasound may guide extent of surgery for these nodules.
  4. a 10-y prospective database starting January 1, 2004, cytomorphologic and ultrasonographic features of thyroid nodules with Bethesda V cytology were reviewed.
  5. 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.
  6. Sixty-three patients were included in the study. Seventeen (27%) had benign, 14 (22%) NIFTP, and 32 (51%) malignant nodules.
  7. 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,
  8. 68% (38/56) were overtreated with total thyroidectomy.
  9. Warning to thyroid patients with Class V cytology.
  10. Do not submit to a total thyroidectomy without getting molecular marker testing.
  11. This can be done on the slides from your biopsy or obtained with a new biopsy.
  12. A negative classifier or lack of cancer specific markers like BRAF can help you obtain a lobectomy and keep half of your thyroid gland.
  13. You will be able to avoid the trauma of a total and may not need thyroid hormone or additional therapy.
  14. Call me for my opinion.
  15. 310-393-8860 or email to thyroid.manager@thyroid.com
  16. Ask for Alicia.
  17. DR.G.

 

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

https://doi.org/10.1016/j.jss.2021.05.050Get rights and content

ABSTRACT

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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