Is there a relationship between preoperative cytological diagnosis and evolution in patients with differentiated thyroid carcinoma? A retrospective study

Colenci, Renato; Minicucci, Marcos Ferreira; Soares, Carlos Segundo Paiva; Oliveira, Cristiano Claudino de; Marques, Mariângela Esther de Alencar; Tagliarini, José Vicente; Mazeto, Gláucia Maria Ferreira da Silva

doi:10.20945/2359-3997000000458

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Original Article • Arch. Endocrinol. Metab. 66 (2) • Mar-Apr 2022 • https://doi.org/10.20945/2359-3997000000458 copy

Is there a relationship between preoperative cytological diagnosis and evolution in patients with differentiated thyroid carcinoma? A retrospective study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

Cytological analysis and Bethesda classification of thyroid nodules is the standard method of diagnosing differentiated thyroid carcinoma (DTC). However, even for nodules with a non-malignant cytological diagnosis, there is a not insignificant risk of cancer. There are doubts whether this lack of certainty would influence patient prognosis. Our aim was to compare patients with DTC, classified according to the preoperative cytological diagnosis, regarding their evolution.

Subjects and methods:

A retrospective study was carried out with 108 DTC patients submitted to total thyroidectomy (TT) between 2009 and 2015, divided into three groups according to preoperative cytological diagnosis (Bethesda classification): classes I/II, III/IV, and V/VI. Groups were compared for evolution considering response to treatment at last evaluation as well as time disease free. Statistical analysis used ANOVA, chi squared, and Kaplan-Meier curves with p<0.05 considered significant.

Results:

Groups differed for time between nodule puncture and TT [in months; V/VI (2.35 ± 2.48) < III/IV (7.32 ± 6.34) < I/II (13.36 ± 8.9); p < 0.0001]. There was no significant difference between groups for evolution at final evaluation (disease free status; classes I/II: 71.4%; classes III/IV: 60%; classes V/VI: 66.6%; p = 0.7433), as well as time disease free (in months; classes I/II: 34.57 ± 25.82; classes III/IV: 38.04 ± 26.66; classes V/VI: 30.84 ± 26.34; p = 0.3841).

Conclusions:

DTC patients classified according to preoperative cytological diagnosis did not differ for evolution. Although patients with non-malignant cytological diagnoses were submitted to TT later, this did not affect the evolution of the cases.

Keywords
Fine-needle biopsy; cytology; thyroid neoplasms; prognosis

General data (n = 108)
Female ^† † n (%);		94 (87.0)
Age (years) ^§ § means ± standard deviation.		49.62 ± 15.6
Cytologic diagnosis (Bethesda category) ^† † n (%);
	I	3 (2.8)
	II	11 (10.2)
	III	12 (11.1)
	IV	13 (12.0)
	V	31 (28.7)
	VI	38 (35.2)
Time elapsed between FNAB and TT (months) ^§ § means ± standard deviation.		4.95 ± 6.1
Lymphadenectomy ^† † n (%);		61 (56.5)
Histologic subtype ^† † n (%);
	Follicular carcinoma, oncocytic variant	4 (3.7)
	Follicular carcinoma	3 (2.8)
	Papillary carcinoma, follicular variant	39 (36.1)
	Papillary carcinoma, classic variant	57 (52.8)
	Papillary carcinoma, oncocytic variant	4 (3.7)
	Papillary carcinoma, solid variant	1 (0.9)
Lymphocytic thyroiditis ^† † n (%);		42 (38.9)
	Tumor diameter (cm) ^§ § means ± standard deviation.	1.90 ± 1.5
	Multicentricity ^† † n (%);	60 (55.6)
	Tumoral capsule ^† † n (%);	25 (23.2)
	Tumoral capsule invasion ^† † n (%);	13 (12.0)
	Vascular invasion ^† † n (%);	25 (23.1)
	Perineural invasion ^† † n (%);	4 (3.7)
	Soft tissues invasion ^† † n (%);	20 (18.5)
	Nodal metastasis ^† † n (%);	31 (28.7)
AJCC/TNM staging (7^th edition) ^† † n (%);
	I	73 (67.6)
	II	13 (12.0)
	III	14 (13.0)
	IV	8 (7.4)
Recurrence risk (ATA 2015) ^† † n (%);
	Low	59 (54.6)
	Intermediary	31 (28.7)
	High	18 (16.7)
First STg (ng/mL) ^§ § means ± standard deviation.		19.10 ± 61.5
First detectable TgAb ^† † n (%);		18 (16.7)
First post-operative WBS ^† † n (%);
	Negative uptake	11 (10.2)
	Positive cervical uptake	90 (83.3)
	Positive cervical and distance uptake	6 (5.6)
First RIT dose (mCi) ^§ § means ± standard deviation.		145.36 ± 55.3
Cumulative RIT dose (mCi) ^§ § means ± standard deviation.		152.76 ± 83.4
Metastasis ^† † n (%);
	Nodal	26 (24.1)
	Nodal and lung	2 (1.9)
	Nodal. lung and spleen	1 (0.9)
	Lung	2 (1.9)
Total time of follow up (months) ^§ § means ± standard deviation.		49.06 ± 16.7
Deaths ^† † n (%);		1 (0.9)
DF in the last evaluation ^† † n (%);		71 (65.7)
DF along all the follow up period ^† † n (%);		54 (50.0)
DF total time (months) ^* * Total time of follow up: time between total thyroidectomy to last evaluation. ^§ § means ± standard deviation.		32.99 ± 26.3
DF % of time ^ % of time free of disease: percentage of time free of disease considering the total time of follow up. AJCC: American Joint Committee on Cancer; cm: centimeters; DF: disease-free; FNAB: fine needle aspiration biopsy; mCi: miliCurie; RIT: radioiodine therapy; STg: thyroglobulin stimulated by endogenous thyrotropin; TgAb: antithyroglobulin antibody; TT: total thyroidectomy; WBS: whole body scan. ^§ § means ± standard deviation.		63.7 ± 43.2

		Cytologic group ^† † n (%);
Variables	I/II 14 (13)	III/IV 25 (23.1)	V/VI 69 (63.9)	p
Female ^† † n (%);	11 (78.5)	20 (80)	63 (91.3)	0.2122
Age (years) ^§ § means ± standard deviation;	49.93 ± 18.68	48.68 ± 16.42	49.9 ± 14.92	0.9439
Papillary carcinoma ^† † n (%);	13 (92.8)	21 (84)	67 (97.1)	0.074
Lymphocytic thyroiditis ^† † n (%);	5 (35.7)	13 (52)	24 (57.1)	0.3077
Tumor diameter (cm) ^§ § means ± standard deviation;	1.98 ± 2.14	2.12 ± 1.81	1.81 ± 1.2	0.6292
Multicentricity ^† † n (%);	8 (61.5)	12 (48)	40 (59.7)	0.5669
Tumoral capsule ^† † n (%);	3 (21.43)	9 (36)	13 (18.8)	0.2161
Tumoral capsule invasion ^† † n (%);	2 (14.3)	3 (12)	8 (11.6)	0.9609
Vascular invasion ^† † n (%);	3 (21.4)	6 (24)	16 (23.2)	0.9834
Perineural invasion ^† † n (%);	2 (14.3)	0 (0)	2 (2.9)	0.0645
Soft tissues invasion ^† † n (%);	3 (21.4)	1 (4)	16 (23.2)	0.1019
Nodal metastasis ^† † n (%);	3 (21.4)	4 (16)	24 (34.8)	0.1670
AJCC/TNM stage I or II ^† † n (%);	12 (85.7)	21 (84)	53 (76.8)	0.6213
Low risk of recurrence ^† † n (%);	9 (64.2)	17 (68)	33 (47.8)	0.3002
First detectable STg ^§ § means ± standard deviation;	10 (83.3)	18 (85.7)	45 (77.5)	0.6955
First detectable TgAb ^† † n (%);	2 (15.3)	4 (16)	12 (17.4)	0.9767
First post-operative WBS with positive cervical uptake ^† † n (%);	11 (78.5)	18 (72)	62 (89.8)	0.2703
First RIT dose (mCi) ^§ § means ± standard deviation;	171.43 ± 80.18	134 ± 45	144.18 ± 51.81	0.1226
Cumulative RIT dose (mCi) ^§ § means ± standard deviation;	171.43 ± 80,18	134 ± 45	155.78 ± 93.74	0.1626
Distant metastasis ^† † n (%);	1 (7.1)	0 (0)	4 (5.8)	0.4433
Time between FNAB and TT (months) ^§ § means ± standard deviation;	13.36 ± 8.9 ^c a, b, c difference in proportion test between the groups compared by columns (c>b>a). Significance: p<0.05. AJCC: American Joint Committee on Cancer; DF: disease-free; FNAB: fine needle aspiration biopsy; mCi: miliCurie; RIT: radioiodine therapy; STg: thyroglobulin stimulated by endogenous thyrotropin; TgAb: antithyroglobulin antibody; TT: total thyroidectomy; WBS: whole body scan.	7.32 ± 6.34 ^b a, b, c difference in proportion test between the groups compared by columns (c>b>a). Significance: p<0.05. AJCC: American Joint Committee on Cancer; DF: disease-free; FNAB: fine needle aspiration biopsy; mCi: miliCurie; RIT: radioiodine therapy; STg: thyroglobulin stimulated by endogenous thyrotropin; TgAb: antithyroglobulin antibody; TT: total thyroidectomy; WBS: whole body scan.	2.35 ± 2.48 ^a a, b, c difference in proportion test between the groups compared by columns (c>b>a). Significance: p<0.05. AJCC: American Joint Committee on Cancer; DF: disease-free; FNAB: fine needle aspiration biopsy; mCi: miliCurie; RIT: radioiodine therapy; STg: thyroglobulin stimulated by endogenous thyrotropin; TgAb: antithyroglobulin antibody; TT: total thyroidectomy; WBS: whole body scan.	<0.0001
Total time of follow up (months) ^§ § means ± standard deviation;	51.78 ± 17.73	50.44 ± 16.74	48.01 ± 16.64	0.6699
DF in the last evaluation ^† † n (%);	10 (71.4)	15 (60)	46 (66.7)	0.7433
DF total time (months) ^§ § means ± standard deviation;	34.57 ± 25.82	38.04 ± 26.66	30.84 ± 26.34	0.3841
DF % of time considering the total time of follow up ^§ § means ± standard deviation;	65.53 ± 41.83	70.15 ± 43.72	61.12 ± 43.68	0.6485

		Status in the last evaluation ^† † n (%);		p
		Disease free 71 (65.7)	Non-disease free 37 (34.3)	p
Female ^† † n (%);		61 (85.9)	33 (89.1)	0.6307
Age (years) ^§ § means ± standard deviation;		52.56 ± 11.97	43.97 ± 19.96	0.0062
Cytologic diagnosis (Bethesda) ^† † n (%);
	I / II	10 (14)	4 (10.8)	0.618
	III / IV	15 (21.1)	10 (37.0)	0.501
	V / VI	46 (64.7)	23 (62.1)	0.788
Papillary carcinoma ^† † n (%);		68 (95.7)	33 (89.1)	0.1871
Lymphocytic thyroiditis ^† † n (%);		33 (46.4)	9 (24.3)	0.025
Tumor diameter (cm) ^§ § means ± standard deviation;		1.86 ± 1.62	1.99 ± 1.22	0.6254
Multicentricity ^† † n (%);		39 (54.9)	21 (56.7)	0.8561
Tumoral capsule ^† † n (%);		14 (19.7)	11 (29.7)	0.2417
Tumoral capsule invasion ^† † n (%);		8 (11.2)	5 (13.5)	0.7335
Vascular invasion ^† † n (%);		12 (16.9)	13 (35.1)	0.033
Perineural invasion ^† † n (%);		1 (1.4)	3 (8.1)	0.0802
Soft tissue invasion ^† † n (%);		7 (9.8)	13 (35.1)	0.0013
Nodal metastasis ^† † n (%);		10 (14)	21 (56.7)	<0.0001
AJCC/TNM stage I or II ^† † n (%);		57 (80.2)	29 (78.3)	0.8157
Recurrence risk ^† † n (%);
	Low	46 (64.7)	13 (35.1)	0.002
	Intermediary	20 (28.1)	11 (29.7)	0.866
	High	5 (7)	13 (35.1)	0.001
First detectable STg ^§ § means ± standard deviation;		43 (70.4)	30 (100)	0.0009
First detectable TgAb ^† † n (%);		10 (14)	8 (22.2)	0.2877
First post-operative WBS with positive cervical uptake ^† † n (%);		64 (90.1)	29 (87.8)	0.7398
First RIT dose (mCi) ^§ § means ± standard deviation;		130.99 ± 39.7	172.93 ± 70.3	<0.0001
Cumulative RIT dose (mCi) ^§ § means ± standard deviation;		130.99 ± 39.7	194.55 ± 122.35	<0.0001
Distant metastasis ^† † n (%);		0 (0.0)	5 (13.5)	0.0015
Time between FNAB and TT (months) ^§ § means ± standard deviation;		5.63 ± 6.69	3.68 ± 4.75	<0.0001
Total time (months) of follow up ^§ § means ± standard deviation;		50.75 ± 17.5	45.84 ± 14.75	0.1291
DF Total time (months) ^§ § means ± standard deviation;		46.35 ± 19.91	7.35 ± 15.95	<0.0001
DF % of time considering the total time of follow up ^§ § means ± standard deviation;		90.2 ± 21.1	13.2 ± 26.2	<0.0001

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[1] Correspondence to: Gláucia Maria Ferreira da Silva Mazeto g.mazeto@unesp.br