Endocrine Abstracts

Introduction: Thyroid nodules are very common in the general population (20-75% ultrasound). There are clinical management criteria established by international societies and standardized cytological diagnostic criteria (Bethesda). However, there is still uncertainty in the management of category 5.

Objectives: To evaluate the clinical attitude to the cytological diagnosis of Bethesda category 5 (B5) in thyroid fine-needle aspiration cytology (FNA). And study associations between malignancy and other variables.

Material and methods: Retrospective study of thyroid nodules classified as B5 after FNA referred to our hospital between 2020 and 2021. Statistical analysis: SPSS v.22.0 (Student’s t-test to compare means and Chi-square/Fisher’s test for proportions).

Results: Twenty patients (70% female); mean (SD) age, 49.3 (15.6) years. Sonographic features of included nodules are shown in table 1. Of the nodules, 5% were ACR-TIRADS 3, 25% ACR-TIRADS 4 and 70% TIRADS 5. Application of the ACR TIRADS system’s FNA criteria would have reduced the number of biopsies performed by 10%. Of the nodules without indication of FNA, both were papillary thyroid microcarcinomas. All patients underwent surgery, 80% total thyroidectomy, and 20% hemithyroidectomy. Eighty (80%) lesions met the reference-standard criteria for malignancy: 10 papillary thyroid cancers, 4 papillary thyroid microcarcinoma, 2 Hürthle cells carcinoma. The rest: 10% (2) follicular adenoma, 5% (1) multinodular goiter and 5% (1) non-invasive follicular neoplasm with nuclear alterations of papillary carcinoma. The variable the presence of calcifications on the nodule were directly related to the malignancy/benignity of the nodule (p 0.025). In fact, microcalcifications is only present in malign pathology.

Conclusions: The percentage of patients with malignant processes of our series corresponds to the bibliography. Although the use of this category seems correct, the clinical attitude is erratic and surgical over-treatment occurs.