Am J Otolaryngol Head Neck Surg | Volume 2, Issue 1 | Research Article | Open Access

An Institutional Analysis of Malignancy Rate in Bethesda III and IV Nodules of the Thyroid

Abbas Al-Kurd1*, Aus Maree1, Ido Mizrahi1, Kira Kaganov1, Jeffrey M Weinberger2, Bela Mali3, Haggi Mazeh1 and Nir Hirshoren2

1Department of Surgery, Hadassah-Hebrew University Medical Center, Israel
2Department of Otolaryngology-Head and Neck Surgery, Hadassah-Hebrew University Medical Center, Israel
3Department of Pathology, Hadassah-Hebrew University Medical Center, Israel

*Correspondance to: Abbas Al-Kurd 

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Abstract

Background: Bethesda III and IV nodules constitute a problematic entity, with previous reports demonstrating a large variability in their malignancy rate between different institutions and regions.
Methods: A retrospective analysis recognized patients who underwent thyroidectomy due to Bethesda III and IV nodule between 2011 and 2016. The primary outcome was to identify the malignancy rate in these nodules. A secondary outcome was to recognize predictors of malignancy in these patients.
Results: During the study period 176 thyroidectomies were performed due to Bethesda III/IV lesions. This group had a mean age of 47.1 years ± 14.6 years and 73.9% were females. They had a mean of 1.6 ± 1.0 nodules per patient and a mean size 30.6 mm ± 16.6 mm. Total thyroidectomy was performed in 48.3%, and lobectomy in 51.7%. Malignancy was identified in 109 patients (61.9%) on final pathology, leading to the performance of completion thyroidectomy in 47/91 (51.6%) of the patients who first underwent lobectomy. Patients with benign and malignant pathologic results had similar mean age, gender distribution, number and size of nodules. Significantly more patients with malignancy were found to have positive family history of thyroid cancer when compared to patients with benign nodules (7.3 vs. 0%, respectively, p=0.02).
Conclusion: This study emphasizes the vast inter-institutional and regional variability in malignancy rate in Bethesda III/IV nodules, a finding which can guide an informed dialogue with patients and endocrinologists, and assist in determining appropriate management. The presence of positive family history of thyroid carcinoma may justify a more aggressive approach to these patients.

Keywords:

Bethesda III and IV; Follicular lesion; Malignancy; Variability; Family history

Citation:

Al-Kurd A, Maree A, Mizrahi I, Kaganov K, Weinberger JM, Mali B, et al. An Institutional Analysis of Malignancy Rate in Bethesda III and IV Nodules of the Thyroid. Am J Otolaryngol Head Neck Surg. 2019;2(1):1034.

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