Risk of malignancy in follicular thyroid neoplasm

Summary

The cytological diagnosis of follicular neoplasm is a common finding in fine needle aspiration cytology (FNAC) of thyroid nodules and includes benign disease as well as differentiated thyroid cancer. The aim of the study is to determine if thyrotropin is a predictive factor for a malignant nature of follicular neoplasm. Patients, methods: The records of 119 patients with follicular neoplasm on FNAC, who underwent surgery for final diagnosis, were reviewed retrospectively. The predictive value of serum parameters including thyrotropin, thyroglobulin, and anti-thyroid antibodies, ultrasonographic criteria and clinical variables was evaluated by univariate analysis and logistic regression analysis. Results, discussion: Patients with malignant nodules showed a higher thyrotropin concentration compared to patients with benign nodules (median 1.6 mU/l, interquartile range 1.4–3.0 mU/l vs. median 1.2 mU/l, interquartile range 0.8–1.6 mU/l, p < 0.01). ROC-analysis of thyrotropin revealed an optimal cut off value to differentiate benign and malignant nodules of 1.34 mU/l. The incidence of malignancy was 30.3% for a thyrotropin concentration higher than 1.34 mU/l compared to 6.4% for a thyrotropin concentration lower than or equal to 1.34 mU/l. On univariate analysis thyroglobulin higher than 300 ng/ml, positive anti-thyroid antibodies, hypoechogenicity, and ill-defined margins, respectively, were also significantly associated with malignancy. On logistic regression analysis higher thyrotropin concentrations, ill-defined margins, and thyroglobulin higher than 300 ng/ml, respectively, were independent predictive factors for malignancy (OR 20.0, 10.7, and 22.7, respectively). Conclusion: Higher thyrotropin concentrations are predictive for a malignant nature of follicular neoplasm.

Zusammenfassung

Die zytologische Diagnose einer follikulären Neoplasie ist ein häufiger Befund bei der Feinnadelpunktion von Schilddrüsenknoten und beinhaltet gutartige Knoten wie auch differenzierte Schilddrüsenkarzinome. Ziel der Studie ist es zu klären, ob TSH ein prädiktiver Faktor für eine maligne Genese einer follikulären Neoplasie ist. Patienten, Methodik: Die Patienten akten von 119 Patienten mit der zytologischen Diagnose einer follikulären Neoplasie bei der Feinnadelpunktion, bei denen eine Schilddrüsenoperation zur histologischen Klärung erfolgte, wurden retrospektiv ausgewertet. Der prädiktive Wert von Serumparametern wie TSH, Thyreoglobulin, Schilddrüsen- Autoantikörper sowie sonomorphologischen Kriterien und klinischen Variablen wurde mittels univariater Analyse und logistischer Regressionsanalyse untersucht. Ergebnisse: Patienten mit bösartigen Schilddrüsenknoten zeigten eine höhere TSH-Konzentration als Patienten mit gutartigen Knoten (Median 1,6 mU/l, Interquartilbereich 1,4–3,0 mU/l vs. Median 1,2 mU/l, Interquartilbereich 0,8–1,6 mU/l, p < 0,01). Der optimale Schwellenwert zur Differenzierung zwischen gutartigen Knoten und Schilddrüsenkarzinomen errechnete sich in einer ROC-Analyse mit 1,34 mU/l. Die Inzidenz von Schilddrüsenkarzinomen war 30,3% bei einem TSH > 1,34 mU/l gegenüber 6,4% bei einem TSH ≤ 1,34 mU/l. Bei der univariaten Analyse waren außerdem eine Thyreoglobulinkonzentration > 300 ng/ml, positive Schilddrüsen-Autoantikörper, Echoarmut und unscharfe Randbegrenzung der Knoten mit einer höheren Wahrscheinlichkeit für Malignität vergesellschaftet. Die logistische Regressionsanalyse ergab eine höhere TSH-Konzentration, eine unscharfe Randbegrenzung der Knoten und eine Thyreoglobulinkonzentration > 300 ng/ml als unabhängige prädiktive Faktoren für das Vorliegen eines Schild drüsenkarzinoms (OR 20,0, 10,7 und 22,7). Schlussfolgerung: Eine höhere TSH-Konzentration ist bei follikulärer Neoplasie prädiktiv für das Vorliegen eines Schilddrüsen karzinoms.

Keywords

Thyroid nodule - follicular neoplasm - follicular proliferation - thyrotropin - thyroid carcinoma

Schlüsselwörter

Schilddrüsenknoten - follikuläre Neoplasie - follikuläre Proliferation - TSH - Schilddrüsenkarzinom

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