The underestimated risk of cancer in patients with multinodular goiters after a benign fine needle aspiration

Michael Campbell, Carolyn D. Seib, Leah Candell, Jessica E. Gosnell, Quan Yang Duh, Orlo H. Clark, Wen T. Shen

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Importance: Ultrasound-guided fine needle aspiration (FNA) is an excellent tool for evaluating patients with solitary thyroid nodules, with a false-negative malignancy rate of <3 %. The utility of FNA in patients with a cervical multinodular goiter (MNG) is unknown, because biopsy and surveillance of thyroids with numerous nodules may be impractical. Objective: To evaluate the incidence and risk factors for unsuspected thyroid cancer on final pathology in patients with a non-functional, cervical MNG who had a benign preoperative FNA and underwent thyroidectomy. Design, setting and participants: Retrospective review of patients with non-functional, cervical MNG at a high-volume tertiary referral center between 2005 and 2012. Main outcome measure(s): Incidence of thyroid cancer on surgical pathology. Results: Of the 134 patients included in the study, 31 (23.1 %) were found to have thyroid cancer on final pathology. Twenty-one (15.7 %) patients had a microscopic papillary cancer (<1 cm) and 10 (7.5 %) patients had other forms of thyroid cancer [five follicular, four papillary (>1 cm), and one patient with a papillary and follicular cancer]. On univariate analysis, male gender had a near-significant association with non-micropapillary thyroid cancer (p = 0.06). On multivariate analysis, male gender (OR = 10.2, 95 % CI 1.35-76.8) and FNA cytology not reviewed at our institution (OR = 6.0, 95 % CI 1.2-30) were independently associated with non-micropapillary thyroid cancer. Conclusions and relevance: The incidence of thyroid cancer in patients with MNG and benign FNA is significant. Men and patients in whom the FNA cytology is not reviewed by an experienced cytopathologist may be at an increased risk for an undetected thyroid cancer.

Original languageEnglish (US)
Pages (from-to)695-700
Number of pages6
JournalPresentations from the 9th Annual Electric Utilities Environmental Conference
Volume39
Issue number3
DOIs
StatePublished - 2015

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Goiter
Fine Needle Biopsy
Thyroid Neoplasms
Cell Biology
Neoplasms
Thyroid Nodule
Multivariate Analysis
Incidence

ASJC Scopus subject areas

  • Surgery

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The underestimated risk of cancer in patients with multinodular goiters after a benign fine needle aspiration. / Campbell, Michael; Seib, Carolyn D.; Candell, Leah; Gosnell, Jessica E.; Duh, Quan Yang; Clark, Orlo H.; Shen, Wen T.

In: Presentations from the 9th Annual Electric Utilities Environmental Conference, Vol. 39, No. 3, 2015, p. 695-700.

Research output: Contribution to journalArticle

Campbell, Michael ; Seib, Carolyn D. ; Candell, Leah ; Gosnell, Jessica E. ; Duh, Quan Yang ; Clark, Orlo H. ; Shen, Wen T. / The underestimated risk of cancer in patients with multinodular goiters after a benign fine needle aspiration. In: Presentations from the 9th Annual Electric Utilities Environmental Conference. 2015 ; Vol. 39, No. 3. pp. 695-700.
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title = "The underestimated risk of cancer in patients with multinodular goiters after a benign fine needle aspiration",
abstract = "Importance: Ultrasound-guided fine needle aspiration (FNA) is an excellent tool for evaluating patients with solitary thyroid nodules, with a false-negative malignancy rate of <3 {\%}. The utility of FNA in patients with a cervical multinodular goiter (MNG) is unknown, because biopsy and surveillance of thyroids with numerous nodules may be impractical. Objective: To evaluate the incidence and risk factors for unsuspected thyroid cancer on final pathology in patients with a non-functional, cervical MNG who had a benign preoperative FNA and underwent thyroidectomy. Design, setting and participants: Retrospective review of patients with non-functional, cervical MNG at a high-volume tertiary referral center between 2005 and 2012. Main outcome measure(s): Incidence of thyroid cancer on surgical pathology. Results: Of the 134 patients included in the study, 31 (23.1 {\%}) were found to have thyroid cancer on final pathology. Twenty-one (15.7 {\%}) patients had a microscopic papillary cancer (<1 cm) and 10 (7.5 {\%}) patients had other forms of thyroid cancer [five follicular, four papillary (>1 cm), and one patient with a papillary and follicular cancer]. On univariate analysis, male gender had a near-significant association with non-micropapillary thyroid cancer (p = 0.06). On multivariate analysis, male gender (OR = 10.2, 95 {\%} CI 1.35-76.8) and FNA cytology not reviewed at our institution (OR = 6.0, 95 {\%} CI 1.2-30) were independently associated with non-micropapillary thyroid cancer. Conclusions and relevance: The incidence of thyroid cancer in patients with MNG and benign FNA is significant. Men and patients in whom the FNA cytology is not reviewed by an experienced cytopathologist may be at an increased risk for an undetected thyroid cancer.",
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AU - Seib, Carolyn D.

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AU - Clark, Orlo H.

AU - Shen, Wen T.

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AB - Importance: Ultrasound-guided fine needle aspiration (FNA) is an excellent tool for evaluating patients with solitary thyroid nodules, with a false-negative malignancy rate of <3 %. The utility of FNA in patients with a cervical multinodular goiter (MNG) is unknown, because biopsy and surveillance of thyroids with numerous nodules may be impractical. Objective: To evaluate the incidence and risk factors for unsuspected thyroid cancer on final pathology in patients with a non-functional, cervical MNG who had a benign preoperative FNA and underwent thyroidectomy. Design, setting and participants: Retrospective review of patients with non-functional, cervical MNG at a high-volume tertiary referral center between 2005 and 2012. Main outcome measure(s): Incidence of thyroid cancer on surgical pathology. Results: Of the 134 patients included in the study, 31 (23.1 %) were found to have thyroid cancer on final pathology. Twenty-one (15.7 %) patients had a microscopic papillary cancer (<1 cm) and 10 (7.5 %) patients had other forms of thyroid cancer [five follicular, four papillary (>1 cm), and one patient with a papillary and follicular cancer]. On univariate analysis, male gender had a near-significant association with non-micropapillary thyroid cancer (p = 0.06). On multivariate analysis, male gender (OR = 10.2, 95 % CI 1.35-76.8) and FNA cytology not reviewed at our institution (OR = 6.0, 95 % CI 1.2-30) were independently associated with non-micropapillary thyroid cancer. Conclusions and relevance: The incidence of thyroid cancer in patients with MNG and benign FNA is significant. Men and patients in whom the FNA cytology is not reviewed by an experienced cytopathologist may be at an increased risk for an undetected thyroid cancer.

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