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