“Análise dos fatores preditores de malignidade em nódulos tireoidianos submetidos a tireoidectomia e a correlação com os sistemas de classificação diagnóstica: um estudo retrospectivo”

Authors

  • Gustavo Humberto Webber
  • Gabriel Cavalheiro Lessack
  • Rodrigo Ribeiro e Silva
  • Leonora Zozula Blind Pope
  • Manuella Zattar Medeiros

DOI:

https://doi.org/10.46919/archv4n3-013

Keywords:

nódulos da glândula tireoide, tireoidectomia, neoplasias da glândula tireoide

Abstract

Introdução: o manejo das neoplasias de tireoide é muitas vezes difícil pela incerteza do risco de malignidade. Quando suspeita-se de um nódulo tireoidiano, exames ultrassonográficos (USG) e punção aspirativa de agulha fina (PAAF) auxiliam a conduta, avaliando a necessidade da excisão cirúrgica. Objetivo: analisar os fatores predisponentes à nódulos tireoidianos malignos em pacientes tireoidectomizados e discutir a conduta realizada com base na classificação ACR-TIRADS e sistema Bethesda. Metodologia: estudo retrospectivo com base nos dados de 2011 a 2021 em um Hospital Privado do sul do Brasil em pacientes submetidos a Tireoidectomia que realizaram PAAF e USG. Calculou-se a razão de chance (RC) com intervalo de confiança de 95% e os valores foram considerados significativos quando P<0,05. Resultados: dos 360 pacientes, houve taxa de malignidade de 60,5%, com maior incidência no sexo masculino (RC 1,997). Em relação as características dos nódulos malignos, esses apresentaram tamanho de 1,00 a 2,50 cm, composição sólida e margens mal definidas, porém essas características foram descartadas no cálculo de RC bruta. Entre os nódulos malignos, 36,7% deles eram TI-RADS 5 (RC 1,772) e 11,5% TI-RADS 3 (RC 0,411), 3,2% Bethesda IV (RC 0,261), 42,2% Bethesda V (RC 9,638) e 35,8% Bethesda VI (RC 75,557). Conclusão: os resultados ultrassonográficos isolados não se confirmaram confiáveis para a análise do padrão de agressividade dos nódulos tireoidianos. A citologia por PAAF e análise histopatológica demonstrou que nódulos classificados em Bethesda V e Bethesda VI foram associados à altos índices de malignidade, enquanto os padrões intermediários esses resultados não se confirmaram.

References

Giovanella L, Piccardo A. A “new/old method” for TSH stimulation: could a third way to prepare DTC patients for 131I remnant ablation possibly exist?. European Journal of Nuclear Medicine and Molecular Imaging. 2015 Nov 17;43(2):221–3.

Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS. The Diagnosis and Management of Thyroid Nodules. JAMA [Internet]. 2018 Mar 6 ;319(9):914. Disponível em: https://jamanetwork.com/journals/jama/fullarticle/2673975

Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, et al. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES – 2016 UPDATE. Endocrine Practice. 2016 Mai;22(Supplement 1):1–60.

Cabanillas ME, McFadden DG, Cosimo Durante. Thyroid cancer. The Lancet [Internet]. 2016;388(10061):2783–95. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30172-6/fulltext

Jinih M, Faisal F, Abdalla K, Majeed M, Achakzai AA, Heffron C, et al. Association between thyroid nodule size and malignancy rate. Annals of the Royal College of Surgeons of England [Internet]. 2020 Jan 1;102(1):43–8. Disponível em: https://pubmed.ncbi.nlm.nih.gov/31865760/

Singaporewalla RM, Hwee J, Lang TU, Desai V. Clinico-pathological Correlation of Thyroid Nodule Ultrasound and Cytology Using the TIRADS and Bethesda Classifications. World journal of surgery [Internet]. 2017;41(7):1807–11. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/28251273

Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, et al. An Ultrasonogram Reporting System for Thyroid Nodules Stratifying Cancer Risk for Clinical Management. The Journal of Clinical Endocrinology & Metabolism. 2009 Mai 1;94(5):1748–51.

Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid Imaging Reporting and Data System for US Features of Nodules: A Step in Establishing Better Stratification of Cancer Risk. Radiology. 2011 Set;260(3):892–9.

Nair D, Kandiah S, Rourke T, Corbridge R, Nagala S. Malignancy rates and initial management of Thy3 thyroid nodules in a district general hospital: The “Reading” experience. Endocrinology, Diabetes & Metabolism. 2021 Fev 24;4(3)

Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid : official journal of the American Thyroid Association [Internet]. 2017 ;27(11):1341–6. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/29091573

Kraus-Fischer G, Alvarado-Bachmann R, Rienzo-Madero B de, Núñez-García E, Peña M de la V la, Zerrweck-López C. Correlación entre el sistema Bethesda de nódulos tiroideos y el diagnóstico histopatológico postiroidectomía. Revista Médica del Instituto Mexicano del Seguro Social [Internet]. 2020;58(2):114–21. Disponível em: https://www.redalyc.org/journal/4577/457767703008/html/

Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid: official journal of the American Thyroid Association [Internet]. 2016;26(1):1–133. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/26462967

Valderrabano P, Khazai L, Thompson ZJ, Otto KJ, Hallanger-Johnson JE, Chung CH, et al. Association of Tumor Size With Histologic and Clinical Outcomes Among Patients With Cytologically Indeterminate Thyroid Nodules. JAMA otolaryngology-- head & neck surgery [Internet]. 2018 Set 1;144(9):788–95. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30027226/

NCCN.org NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ® ) Thyroid Carcinoma [Internet]. 2018. Disponível em: http://medi-guide.meditool.cn/ymtpdf/3AE75298-2AC7-A12E-A9B8-35EF2F95FDD2.pdf

Paschou SΑ, Vryonidou A, Goulis DG. Thyroid nodules: Α guide to assessment, treatment and follow-up. Maturitas. 2017 Fev;96:1–9.

Yaprak Bayrak B, Eruyar AT. Malignancy rates for Bethesda III and IV thyroid nodules: a retrospective study of the correlation between fine-needle aspiration cytology and histopathology. BMC Endocrine Disorders. 2020 Abr 15;20(1).

Wang M, Sun P, Zhao X, Sun Y. Ultrasound Parameters of Thyroid Nodules and the Risk of Malignancy: A Retrospective Analysis. Cancer Control. 2020 Jan 1;27(1):107327482094597.

Meko JB, Norton JA. Large cystic/solid thyroid nodules: a potential false-negative fine-needle aspiration. Surgery [Internet]. 1995 Dec 1. Disponível em: https://pubmed.ncbi.nlm.nih.gov/7491545/

McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery [Internet]. 2007 Dez 1;142(6). Disponível em: https://pubmed.ncbi.nlm.nih.gov/18063065/

Mehanna R, Murphy M, McCarthy J, O’Leary G, Tuthill A, Murphy MS, et al. False negatives in thyroid cytology: Impact of large nodule size and follicular variant of papillary carcinoma. The Laryngoscope. 2013 Jan 4;123(5):1305–9.

Koo DH, Song K, Kwon H, Bae DS, Kim J, Min HS, et al. Does Tumor Size Influence the Diagnostic Accuracy of Ultrasound-Guided Fine-Needle Aspiration Cytology for Thyroid Nodules? International Journal of Endocrinology [Internet]. 2016;2016:3803647. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5059591/

Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, et al. An Ultrasonogram Reporting System for Thyroid Nodules Stratifying Cancer Risk for Clinical Management. The Journal of Clinical Endocrinology & Metabolism. 2009 Mai 1;94(5):1748–51.

Shi H, Bobanga I, McHenry CR. Are large thyroid nodules classified as benign on fine needle aspiration more likely to harbor cancer? American Journal of Surgery [Internet]. 2017 Mar 1;213(3):464–6. Disponível em: https://pubmed.ncbi.nlm.nih.gov/28057295/

McHenry CR, Huh ES, Machekano RN. Is nodule size an independent predictor of thyroid malignancy? Surgery [Internet]. 2008 Dez 1;144(6):1062–8; discussion 1068-1069. Disponível em: https://pubmed.ncbi.nlm.nih.gov/19041019/

Tepeoğlu M, Bilezikçi B, Bayraktar SG. A histological assessment of the Bethesda system for reporting thyroid cytopathology (2010) abnormal categories: a series of 219 consecutive cases. Cytopathology. 2013 Fev 26;25(1):39–44.

Lin JS, Bowles EJA, Williams SB, Morrison CC. Screening for Thyroid Cancer. JAMA. 2017 Mai 9;317(18):1888.

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Published

2023-09-06

How to Cite

WEBBER, G. H.; LESSACK, G. C.; E SILVA, R. R.; POPE, L. Z. B.; MEDEIROS, M. Z. “Análise dos fatores preditores de malignidade em nódulos tireoidianos submetidos a tireoidectomia e a correlação com os sistemas de classificação diagnóstica: um estudo retrospectivo”. Journal Archives of Health, [S. l.], v. 4, n. 3, p. 877–890, 2023. DOI: 10.46919/archv4n3-013. Disponível em: https://ojs.latinamericanpublicacoes.com.br/ojs/index.php/ah/article/view/1340. Acesso em: 3 mar. 2024.

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