Faculty of Medicine, Department of Endocrinology and Metabolism, Hitit University, Çorum, Turkey.
Department of Endocrinology and Metabolism, Yozgat State Hospital, Yozgat, Turkey.
Diagn Cytopathol. 2021 Oct;49(10):1110-1115. doi: 10.1002/dc.24823. Epub 2021 Jul 1.
The clinical management of Bethesda III category thyroid nodules has some undefined points and differs among centers and conflicting malignancy rates are present in the literature. The aim of this study was to investigate the Bethesda category III thyroid nodule outcomes in our centers, to determine malignancy rates and also to evaluate clinical and sonographic features which may help to predict malignancy.
This retrospective study included 333 patients with thyroid nodules who had Bethesda category III on fine needle aspiration (FNA) in three tertiary medical centers of Turkey.
Among 333 patients, 302 had appropriate follow up. Eighteen patients received thyroidectomy after the first FNA, with a malignancy rate of 38.89% (7/18) and 284 patients received a second FNA. After the second FNA, thyroidectomy was performed in 80 patients and 41 patients needed the third FNA. Thirteen thyroidectomies were performed after the third FNA. Totally 111 patients received thyroidectomy with a malignancy rate of 48.65% (54/111) among patients with surgery and the lower bound was detected as 17.88% (54/302). Of these patients the malignancy rates of patients receiving thyroidectomy with two and three FNAs were 47.50% (38/80) and 69.23% (9/13), respectively. Hypoechogenicity, microcalcification, and irregular margin were found as good predictors for malignancy.
We demonstrated that the malignancy rate was 48.65% in patients receiving thyroidectomy. We showed a higher malignancy rate than the traditionally rate of 5%-15%. This study showed that repeat FNAs decrease the rate of unnecessary surgery performed for benign lesions by increasing the rate of malignancy detection.
贝塞斯达 III 类甲状腺结节的临床管理存在一些未定义的问题，并且在不同中心之间存在差异，并且文献中存在相互矛盾的恶性肿瘤发生率。本研究旨在调查我们中心的贝塞斯达 III 类甲状腺结节的结果，确定恶性肿瘤发生率，并评估可能有助于预测恶性肿瘤的临床和超声特征。
这项回顾性研究包括土耳其三个三级医疗中心的 333 名细针抽吸（FNA）诊断为贝塞斯达 III 类甲状腺结节的患者。
在 333 名患者中，有 302 名患者有适当的随访。18 名患者在第一次 FNA 后接受了甲状腺切除术，恶性肿瘤发生率为 38.89%（7/18），284 名患者接受了第二次 FNA。第二次 FNA 后，80 名患者接受了甲状腺切除术，41 名患者需要第三次 FNA。第三次 FNA 后进行了 13 次甲状腺切除术。总共 111 名患者接受了甲状腺切除术，手术患者的恶性肿瘤发生率为 48.65%（54/111），下限为 17.88%（54/302）。在这些患者中，接受两次和三次 FNA 甲状腺切除术的患者的恶性肿瘤发生率分别为 47.50%（38/80）和 69.23%（9/13）。低回声、微钙化和不规则边缘被认为是恶性肿瘤的良好预测指标。
我们证明，接受甲状腺切除术的患者恶性肿瘤发生率为 48.65%。我们显示的恶性肿瘤发生率高于传统的 5%-15%。本研究表明，重复 FNA 通过提高恶性肿瘤检出率，降低了对良性病变进行不必要手术的比率。
