Background: Thyroid nodules are a common clinical finding and differentiating benign ones from malignant ones is a clinical challenge. The aim of this study was to compare the rate of thyroid malignancies in patients with single thyroid nodules (STN) and multi-nodular goiter (MNG).Methods: This retrospective study was conducted on 200 patients who underwent surgical thyroidectomy, between 2008 and 2010, in Shariati hospital, affiliated with Tehran University of Medical Sciences. Data analysis performed using SPSS (version 13).Results: Of these, 63 patients (12 male and 51 female) had STN and 137 subjects (28 male and 109 female) were MNG. The mean ± standard deviation of age in patients with STN and MNG were 39.1 ± 7.1 and 42.7 ± 6.2, respectively. The two groups had no significant difference in age or sex. The rate of thyroid malignancies in patients with MNG and STN were 34.4% and 36.5% respectively, showing no significance difference.Conclusions: The study did not show any statistically significant difference between the frequency of malignant and benign nodules in single and multiple thyroid. Therefore, performing accurate pathologic assessment is recommended for all cases of thyroid nodules (MNG or STN)

Hedayat, Anooshirvan

Mahmoodzadeh, Hosein

Sharifi, Maryam

Shojaiefard, Abolfazl

Soroush, Ahmadreza

English

Academic Journal of Surgery (AJS - Tehran University of Medical Sciences)

Acad J Surg, Vol. 2, No. 1-2 (2015) ORIGINAL REPORTCorresponding Author: Abolfazl Shojaiefard Department of General Surgery, Shariati Hospital, North Kargar St., P.O. Box: 14117-13135, Tehran, Iran. Tel: +98 21 84902450/Fax: +98 21 88220053, E-mail: shojaief@sina.tums.ac.ir Comparison of the Rate of Thyroid Malignancies in Patient with Single Thyroid Nodules and Multi-Nodular Goiter Abolfazl Shojaiefard1, Maryam Sharifi2, Ahmadreza Soroush1, Hosein Mahmoodzadeh3, Anooshirvan Hedayat31 Department of Surgery, Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran 2 Tehran University of Medical Sciences, Tehran, Iran 3 Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Received: 7 Jul. 2014; Received in revised form: 17 Aug. 2014; Accepted: 22 Sep. 2014 Abstract Background: Thyroid nodules are a common clinical finding and differentiating benign ones from malignant ones is a clinical challenge. The aim of this study was to compare the rate of thyroid malignancies in patients with single thyroid nodules (STN) and multi-nodular goiter (MNG). Methods: This retrospective study was conducted on 200 patients who underwent surgical thyroidectomy, between 2008 and 2010, in Shariati hospital, affiliated with Tehran University of Medical Sciences. Data analysis performed using SPSS (version 13). Results: Of these, 63 patients (12 male and 51 female) had STN and 137 subjects (28 male and 109 female) were MNG. The mean ± standard deviation of age in patients with STN and MNG were 39.1 ± 7.1 and 42.7 ± 6.2, respectively. The two groups had no significant difference in age or sex. The rate of thyroid malignancies in patients with MNG and STN were 34.4% and 36.5% respectively, showing no significance difference. Conclusions: The study did not show any statistically significant difference between the frequency of malignant and benign nodules in single and multiple thyroid. Therefore, performing accurate pathologic assessment is recommended for all cases of thyroid nodules (MNG or STN). © 2015 Tehran University of Medical Sciences. All rights reserved. Citation: Shojaiefard A, Sharifi M, Soroush A, Mahmoodzadeh H, Hedayat A. Comparison of the Rate of Thyroid Malignancies in Patient with Single Thyroid Nodules and Multi-Nodular Goiter. Acad J Surg, 2015; 2(1-2): 11-3. Keywords: Thyroid gland, Thyroid nodule, Thyroid neoplasms, Thyroidectomy, Goiter, biopsy, Fine-needleIntroduction Thyroid nodules are solid or fluid-filled lumps that form within thyroid, which are common clinical findings (1-3). The prevalence of thyroid nodule in different populations, largely depends on the method of screening and the population evaluated. It has been reported as 2-6%, 19-35%, and 8-65% by using palpitation, ultrasonography and autopsy as the screening methods, respectively (1-3). Increasing  age, female sex (sex ratio, F/M: 4/1), Iodine deficiency, and history of head and neck radiation seem to increase the risk of  thyroid nodules (4). A minority of thyroid nodules have malignant changes. Based on presence of risk factors in studied population and screening method, the prevalence of thyroid malignancies in patient with thyroid nodule varies from 4.6% to 15% (5,6), however, the incidence of new malignancy in a specific nodule has been reported very low (7). Most of the studies in this field focus on finding the risk factors and different features that differentiate this minority (8,9). Nodular disease of the thyroid is common; about 5% of thyroid nodules are malignant; the remainder represent a variety of benign diagnoses, including colloid nodules, degenerative cysts, hyperplasia, thyroiditis or benign neoplasms. A rational approach to management of a thyroid nodule is based on the clinician’s ability to distinguish the more common benign diagnoses from malignancy in a highly reliable and cost-effective manner. A comprehensive history and physical examination provide the foundation for decision making in the management of thyroid nodules. The diagnosis algorithm includes lab tests, ultrasound exam, scintigraphy, and fine-needle aspiration (FNA) biopsy. MNG with no carcinoma, MNG with papillary carcinoma, MNG with follicular carcinoma, single colloidal node with no carcinoma, single node with papillary carcinoma, single node with follicular carcinoma, single node with follicular adenoma and single node with medullary adenoma. The demographic data and results of FNA and permanent pathology were collected by valid questionnaire. Data analysis performed by SPSS for Windows (version 13; SPSS Inc., Chicago, IL, USA).  Results Of 200 patients selected for this study, FNA and permanent pathology results of 197 and 194 patients were available, respectively. For 191 patients both FNA and permanent pathology results had been recorded. Of 160 female patients, 109 (68.1%) and of 40 male patients 28 (70%) had MNG. The mean ± standard deviation of age were 39.1 ± 7.1 in patients with STN and 42.7 ± 6.2 in subjects with MNG. Categories of FNA results and final pathological reports are shown in table 1. The prevalence of each permanent pathology categories in patients with STN and MNG is shown. The prevalence of each FNA categories per each permanent pathology categories is shown that six patients with STN finally had MNG in pathologist’s reports in table 2. The most prevalence of FNA result finding were 98 (49.7%), 39 (19.8), for colloidal, and papillary carcinoma. Table 1. Comparison of FNA results with permanent pathological reports in studied patients FNA result Permanent pathological report categories Total MNG N (%) STN N (%) Colloidal Papillary carcinoma Follicular carcinoma Colloidal Papillary carcinoma Follicular carcinoma Follicular adenoma Medullary adenoma Colloidal 86 (87.8) - - 12 (12.2) - - - - 98 Papillary carcinoma - 28 (71.8) - - 11 (28.2) - - - 30 Follicular adenoma - - 5 (17.9) - - - 18 (64.3) 5 (17.9) 28 Medullary carcinoma - - - - - - - 5 (100) 5 Equivocal - - 6 (85.7) - - 1 (14.3) - - 7 No diagnosis - 6 (85.7) - - - 1 (14.3) - - 7 Others - - 6 (85.7) - - 1 (14.3) - - 7 Total 86 (45.0) 34 (17.8) 17 (8.9) 12 (6.3) 11 (5.8) 3 (1.6) 18 (9.4) 10 (5.2) 191 MNG: Multi-nodular goiter; STN: Single thyroid nodules; FNA: Fine-needle aspiration Table 2. The prevalence of each FNA categories per each permanent pathology categories Patient categories Permanents pathology categories MNG (%) STN Total Colloidal Papillary carcinoma Follicular carcinoma Colloidal Papillary carcinoma Follicular carcinoma Follicular adenoma Medullary adenoma STN 6 (9.5) - - 12 (19.0) 11 (17.5) 6 (9.5) 12 (19.0) 10 (15.9) 63 MNG 80 (61.1) 28 (21.4) 17 (13.0) - - - 6 (4.6) - 131Total 86 (44.3) 34 (17.5) 17 (8.8) 12 (6.2) 11 (5.7) 6 (3.1) 18 (9.3) 10 (5.2) 194MNG: Multi-nodular goiter; STN: Single thyroid nodules; FNA: Fine-needle aspiration 12    Acad J Surg, Vol. 2, No. 1-2 (2015) Thyroid Malignancies in Patient with STN & MNG The aim of this study is to compare the rate of thyroid malignancies between patients with single thyroid nodules (STN) and multi-nodular goiter (MNG) to see if any of these groups are at increased risk of thyroid malignancies. Materials and Methods A retrospective descriptive study was conducted on patients referred to clinic of general surgery, Shariati hospital (an affiliated hospital to Tehran University of Medical Sciences, Tehran, Iran) between 2008 and 2010 due to palpable thyroid mass or incidental thyroid nodule; 200 patients were selected by convenience sampling method. Subjects included in this study were those underwent FNA of the dominant nodule with or without the guide of sonography, and then underwent surgical thyroidectomy or lobectomy due to the result of FNA or thyroid sonography suggestive of possible malignancy. Cases with a history of head and neck surgery or radioiodine exposure were excluded. Patients were categorized into MNG and STN according to the result of thyroid sonography. Direct FNA was done by palpitation method, and ultrasound used only in small nodule, which were difficult to palpate, cystic nodule and nodules located posteriorly. The smears were evaluated by an experienced pathologist and diagnosis assigned as colloidal, papillary carcinoma, medullary carcinoma, follicular adenoma, equivocal, no diagnosis and others. Tissues obtained from the surgery were sent for pathology evaluation. The results were categorized as Discussion The male to female ratio in this study was 1:4 and the prevalence of thyroid nodules was higher in female patients (P < 0.05), which is in concordance with previous studies (7,10-12); and there is no significant difference for sex or age between patients with STN or MNG (P > 0.05). The very high prevalence of thyroid malignancies in this study, 34.5% for MNG and 36.5 for STN, is due to the population selected from a tertiary center. Most of the patients were referred to our clinic based on thyroid sonography or FNA results in concordance with a high risk of malignancies (12-15). Comparing the result of FNA and permanent pathology result shows that all colloidal, papillary carcinoma result of FNA is confirmed by permanent pathology showing high specificity of FNA for detecting these types of nodules which has been shown in other studies (16,17). There were no significant differences in the prevalence of thyroid malignancy between patients with STN and MNG which is in concordance with the result of other studies, including: Frates et al. studied 1985 patients who underwent FNA of 3483 thyroid nodules and reported no significance difference in the rate of thyroid malignancies between patients with STN and multiple thyroid nodules (6). Papini et al. assessed the risk of malignancy in 494 patients with STN and MNG. The risk of malignancy was not significantly higher in solitary thyroid nodules as opposed to lesions embedded in MNG (18). Conclusion In summary, the results of the present study suggests that the prevalence of malignant and benign nodules in both single and multiple thyroid no statistically significant difference, so it is recommended in all cases of thyroid nodules (MNG or STN), an accurate assessment of nature pathologic be performed. References 1. Zou S, Wu F, Guo C, Song J, Huang C, Zhu Z, et al.Iodine nutrition and the prevalence of thyroid diseaseafter salt iodization: a cross-sectional survey in Shanghai,a coastal area in China. PLoS One. 2012; 7(7): e40718.2. Desser TS, Kamaya A. Ultrasound of thyroid nodules.Neuroimaging Clin N Am. 2008; 18(3): 463-78, vii.3. Knudsen N, Bulow I, Jorgensen T, Laurberg P, Ovesen L,Perrild H. Goitre prevalence and thyroid abnormalities atultrasonography: a comparative epidemiological study intwo regions with slightly different iodine status. ClinEndocrinol (Oxf). 2000; 53(4): 479-85.4. Dean DS, Gharib H. Epidemiology of thyroid nodules.Best Pract Res Clin Endocrinol Metab. 2008; 22(6):901-11.5. Belfiore A, La Rosa GL, La Porta GA, Giuffrida D,Milazzo G, Lupo L, et al. Cancer risk in patients withcold thyroid nodules: relevance of iodine intake, sex, age,and multinodularity. Am J Med. 1992; 93(4): 363-9.6. Frates MC, Benson CB, Doubilet PM, Kunreuther E,Contreras M, Cibas ES, et al. Prevalence and distributionof carcinoma in patients with solitary and multiplethyroid nodules on sonography. J Clin Endocrinol Metab.2006; 91(9): 3411-7.7. Vander JB, Gaston EA, Dawber TR. The significance ofnontoxic thyroid nodules. Final report of a 15-year studyof the incidence of thyroid malignancy. Ann Intern Med.1968; 69(3): 537-40.8. Hamberger B, Gharib H, Melton LJ, III, Goellner JR,Zinsmeister AR. Fine-needle aspiration biopsy of thyroidnodules. Impact on thyroid practice and cost of care. AmJ Med. 1982; 73(3): 381-4.9. Iannuccilli JD, Cronan JJ, Monchik JM. Risk formalignancy of thyroid nodules as assessed bysonographic criteria: the need for biopsy. J UltrasoundMed. 2004; 23(11): 1455-64.10. Tunbridge WM, Evered DC, Hall R, Appleton D, BrewisM, Clark F, et al. The spectrum of thyroid disease in acommunity: the Whickham survey. Clin Endocrinol(Oxf). 1977; 7(6): 481-93.11. Brander A, Viikinkoski P, Nickels J, Kivisaari L. Thyroidgland: US screening in a random adult population.Radiology. 1991; 181(3): 683-7.12. Mazzaferri EL. Management of a solitary thyroid nodule.N Engl J Med. 1993; 328(8): 553-9.13. Albores-Saavedra J, Henson DE, Glazer E, SchwartzAM. Changing patterns in the incidence and survival ofthyroid cancer with follicular phenotype--papillary,follicular, and anaplastic: a morphological andepidemiological study. Endocr Pathol. 2007; 18(1): 1-7.14. Tollin SR, Mery GM, Jelveh N, Fallon EF, Mikhail M,Blumenfeld W, et al. The use of fine-needle aspirationbiopsy under ultrasound guidance to assess the risk ofmalignancy in patients with a multinodular goiter.Thyroid. 2000; 10(3): 235-41.15. Cappelli C, Castellano M, Pirola I, Gandossi E, De ME,Cumetti D, et al. Thyroid nodule shape suggestsmalignancy. Eur J Endocrinol. 2006; 155(1): 27-31.16. Nam-Goong IS, Kim HY, Gong G, Lee HK, Hong SJ,Kim WB, et al. Ultrasonography-guided fine-needleaspiration of thyroid incidentaloma: correlation withpathological findings. Clin Endocrinol (Oxf). 2004;60(1): 21-8.17. Silverman JF, West RL, Larkin EW, Park HK, Finley JL,Swanson MS, et al. The role of fine-needle aspirationbiopsy in the rapid diagnosis and management of thyroidneoplasm. Cancer. 1986; 57(6): 1164-70.18. Papini E, Guglielmi R, Bianchini A, Crescenzi A,Taccogna S, Nardi F, et al. Risk of malignancy innonpalpable thyroid nodules: predictive value ofultrasound and color-Doppler features. 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Comparison of the Rate of Thyroid Malignancies in Patient with Single Thyroid Nodules and Multi-Nodular Goiter

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Comparison of the Rate of Thyroid Malignancies in Patient with Single Thyroid Nodules and Multi-Nodular Goiter

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