The Impact of Hashimoto Thyroiditis on Thyroid Nodule Cytology and Risk of Thyroid Cancer
| Autor: | Nancy L. Cho, Jochen H. Lorch, Mary C. Frates, Haixia Guan, Edmund S. Cibas, Zhihong Wang, Nathalie Anne de Oliveira e Silva de Morais, Carol B. Benson, Trevor E. Angell, Mathew I. Kim, Justine A. Barletta, Jessica Stuart, Caroline A Alexander, Ellen Marqusee, Mathew A Nehs, Erik K. Alexander |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism Gastroenterology Thyroiditis 03 medical and health sciences 0302 clinical medicine Thyroid peroxidase Internal medicine medicine thyroid cancer Neoplastic transformation Hashimoto Disease Thyroid cancer Clinical Research Articles Thyroid biology Hashimoto disease business.industry Nodule (medicine) medicine.disease medicine.anatomical_structure FNA 030220 oncology & carcinogenesis thyroid nodule biology.protein medicine.symptom business Lymphocytic Thyroiditis |
| Zdroj: | Journal of the Endocrine Society |
| ISSN: | 2472-1972 |
| Popis: | Context The impact of Hashimoto thyroiditis (HT) on the risk of thyroid cancer and its accurate detection remains unclear. The presence of a chronic lymphocytic infiltration imparts a logical mechanism potentially altering neoplastic transformation, while also influencing the accuracy of diagnostic evaluation. Methods We performed a prospective, cohort analysis of 9851 consecutive patients with 21,397 nodules ≥1 cm who underwent nodule evaluation between 1995 and 2017. The definition of HT included (i) elevated thyroid peroxidase antibody (TPOAb) level and/or (ii) findings of diffuse heterogeneity on ultrasound, and/or (iii) the finding of diffuse lymphocytic thyroiditis on histopathology. The impact of HT on the distribution of cytology and, ultimately, on malignancy risk was determined. Results A total of 2651 patients (27%) were diagnosed with HT, and 3895 HT nodules and 10,168 non-HT nodules were biopsied. The prevalence of indeterminate and malignant cytology was higher in the HT vs non-HT group (indeterminate: 26.3% vs 21.8%, respectively, P < 0.001; malignant: 10.0% vs 6.4%, respectively, P < 0.001). Ultimately, the risk of any nodule proving malignant was significantly elevated in the setting of HT (relative risk, 1.6; 95% CI, 1.44 to 1.79; P < 0.001), and was maintained when patients with solitary or multiple nodules were analyzed separately (HT vs non-HT: 24.5% vs 16.3% solitary; 22.1% vs 15.4% multinodular; P < 0.01). Conclusion HT increases the risk of thyroid malignancy in any patient presenting for nodule evaluation. Diffuse sonographic heterogeneity and/or TPOAb positivity should be used for risk assessment at time of evaluation. |
| Databáze: | OpenAIRE |
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