RAEM REVISTA ARGENTINA DE
ENDOCRINOLOGÍA Y METABOLISMO
     
Volumen 52 #1 | Año 2015 Volver Indice
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  TRABAJO ORIGINAL
  Analysis of Clinical and Ultrasound Features of Thyroid Nodules With Bethesda III Cytology and their Evolution  
  Authors: Rosmarin M, Urrutia MA, Blanc E, Macías M, Vera MI, Gómez M, Cejas C, Serrano S, Schnitman M, Faingold MC, Brenta G, Pacenza NA  
     
  Background: Since the implementation of the Bethesda System for cytology classification of thyroid nodules into 6 categories, the Bethesda III group (B III) has been the most controversial as regards follow-up management. Reported data shows that about 4 to 20 % of all biopsied nodules belong to this category, with the risk of malignancy being 5 to 15 %.
Objective: To determine clinical and sonographic features of thyroid nodules classified as BIII in our population and analyze their evolution over time.
Methods: We determined the clinical and ultrasonographic (US) features of all patients who had undergone fine needle aspiration biopsy (FNAB) in 2011-2013 at our Institution for Retirees and Pensioners. Descriptive study of all patients with nodules classified as BIII with a median follow-up time of 24 months (2 to 35 months).
Results: Out of 945 nodules from 784 patients biopsied (age, mean ± SD:71.1±7.1 years), 85 (8.99 %) were classified as BIII. Six patients had received neck radiation, and 5 reported family history of thyroid cancer. The median (range) largest diameter of nodules was 18 mm (9-54 mm). Fifty-four nodules (76.1 %) were solid, 16 (22.5 %) mixed, and 1 spongiform. Based on echogenicity, 36.7 % were hypoechoic, 54.4 % isoechoic and 8.9 % hyperechoic. Twenty-two nodules (25.88 %) were taller than wider, 8.33 % had microcalcifications and 9.9 % had irregular margins. At Doppler evaluation, 39.43 % of nodules had peripheral vascularity, 4.23 % showed central vascularity and 56.34 % had mixed vascularity.
In 7 out of 72 patients with BIII classification, surgery was indicated at the start based on suspicious clinical and US findings for malignancy, or family history of thyroid cancer. Out of these 7 patients, 3 were found to have papillary carcinoma (PTC), 1 follicular adenoma (FA), 1 colloid goiter (CG), 1 adenomatous nodule (AN) and 1 chronic lymphocytic thyroiditis (CLT). As regards the follow-up and evolution of the rest of the group, 9 were lost, 21 remained in observation and 35 (48.6 %) with 40 nodules underwent a second FNAB, with the following results: 2 BI, 23 BII, 14 BIII and 1 BV. Out of 14 nodules confirmed as BIII on repeat FNAB, 7 were operated on, resulting in: 2 CLT, 3 CG, 1 FA and 1 PTC. The BV nodule proved to be PTC. A total of 16 patients with BIII nodules underwent surgery (7 initially, 8 after a second FNAB, and 1 during clinical and US follow-up) and 5 (31.25 %) were PTC while 11 (68.75 %) were benign.
Conclusion: Even though BIII thyroid nodules generally require a second FNAB, in our experience clinical and US findings suspicious for malignancy, or family history of thyroid cancer could allow some patients to be offered surgery at initial presentation.

Rev Argent Endocrinol Metab 52:14-21, 2015
No financial conflicts of interest exist.
 
     
  Key words: Thyroid nodules, Bethesda III, Thyroid FNAB, Thyroid cancer, Thyroid US  
 
 
 
 
 
 
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