Tirupati Sunanda, Puthenveetil Pradeep, Lakkundi Shilpa, Gaddam Anudeep, Sarathi Vijaya
Endocrinology, Narayana Medical College, Nellore, IND.
Endocrine Surgery, Baby Memorial Hospital, Kozhikode, IND.
Cureus. 2024 Feb 26;16(2):e54923. doi: 10.7759/cureus.54923. eCollection 2024 Feb.
Global data reports a low malignancy risk, whereas regional data report a variable risk of malignancy in Bethesda II thyroid nodules. The limited availability of surgical histopathology might have underestimated the risk of malignancy. Here, we report the prevalence of malignancy and its predictors in Bethesda II thyroid nodules for which the surgical histopathological diagnosis was available.
This retrospective study was done at a tertiary healthcare center in South India between January 2008 and September 2015. Case records of adults with thyroid nodules who underwent surgery were collected. Patients with inadequate data were excluded from the study. The data was analyzed using SPSS version 21.0 and a p-value of < 0.05 was considered statistically significant.
A total of 563 patients were included in the study with a mean age of 36±12 years. Serum thyrotropin (TSH) was low in 87 (15.4%) patients whereas 362 (64.2%) patients had multinodular goiter (MNG). Sonographic evidence of suspicious cervical lymph node and microcalcification was seen in four (0.7%) and 48 (8.5%) patients, respectively. A total of 48 (8.5%) patients had thyroid carcinoma in the final histopathology. Of these, 42 (87.5%) had papillary thyroid carcinoma, five (10.4%) had follicular thyroid carcinoma and one (4.1%) had anaplastic carcinoma. Age, gender, and maximum nodule size were not associated with malignancy. Thyrotoxicosis was negatively associated with malignancy whereas multi-nodularity, thyroid calcification, or suspicious cervical lymph node on ultrasound and total thyroidectomy were positively associated with malignancy on univariate analysis. On binary logistic regression, only the former four, but not total thyroidectomy, were independent predictors of malignancy.
We report a high (8.5%) prevalence of malignancy among South Indian patients with Bethesda II thyroid nodules. Thyroid microcalcification, presence of suspicious cervical lymph node on ultrasound, and multinodularity were associated with high and suppressed TSH with low risk of malignancy. Further prospective studies are warranted to confirm the study observations.
全球数据显示恶性风险较低，而区域数据表明贝塞斯达Ⅱ类甲状腺结节的恶性风险存在差异。手术组织病理学检查的有限可用性可能低估了恶性风险。在此，我们报告了有手术组织病理学诊断结果的贝塞斯达Ⅱ类甲状腺结节的恶性患病率及其预测因素。
这项回顾性研究于2008年1月至2015年9月在印度南部的一家三级医疗中心进行。收集了接受手术的甲状腺结节成年患者的病例记录。数据不完整的患者被排除在研究之外。使用SPSS 21.0版本对数据进行分析，p值<0.05被认为具有统计学意义。
共有563例患者纳入研究，平均年龄为36±12岁。87例（15.4%）患者血清促甲状腺激素（TSH）水平较低，362例（64.2%）患者患有结节性甲状腺肿（MNG）。分别有4例（0.7%）和48例（8.5%）患者超声检查显示可疑颈部淋巴结和微钙化。最终组织病理学检查显示共有48例（8.5%）患者患有甲状腺癌。其中，42例（87.5%）为乳头状甲状腺癌，5例（10.4%）为滤泡状甲状腺癌，1例（4.1%）为未分化癌。年龄、性别和最大结节大小与恶性肿瘤无关。甲状腺毒症与恶性肿瘤呈负相关，而多结节性、甲状腺钙化、超声检查显示可疑颈部淋巴结以及全甲状腺切除术在单因素分析中与恶性肿瘤呈正相关。在二元逻辑回归分析中，只有前四项因素，而非全甲状腺切除术，是恶性肿瘤的独立预测因素。
我们报告了印度南部贝塞斯达Ⅱ类甲状腺结节患者中较高的（8.5%）恶性患病率。甲状腺微钙化、超声检查显示可疑颈部淋巴结以及多结节性与高TSH水平和低恶性风险相关。需要进一步的前瞻性研究来证实本研究的观察结果。
