Analysis of factors that help to Predict Malignancy in patients with Thyroid Nodules presenting to the General Surgery Out- patient department in Christian Medical College, Vellore

Vimalin, Samuel (2013) Analysis of factors that help to Predict Malignancy in patients with Thyroid Nodules presenting to the General Surgery Out- patient department in Christian Medical College, Vellore. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION: Thyroid nodules are considered common , as they are found in more than 7 percent of the adult population. However, this incidence goes up even higher if ultra sound is used as a screening tool. Among patients presenting with thyroid nodules, 5%–15% will be malignant depending upon age, sex, radiation exposure history, family history and other factors. Differentiated thyroid cancer (DTC), which includes papillary and follicular cancer, comprises of the vast majority(90%) of all thyroid cancers. The increasing level of detection may be due to the increasing patient awareness, use of neck ultrasonography and early diagnosis and treatment. These are the trends that are changing the initial treatment and follow-up for many patients with thyroid cancer. The difficult bit is in identifying the thyroid nodules that are malignant and the challenge to the surgeon lies in deciding which nodules require surgical excision. AIMS AND OBJECTIVES: In patients presenting with any nodule of the thyroid, to assess with clinical criteria, Ultra sound neck and FNAC so as to predict the likelihood of malignancy: a) using a triple assessment , consisting of: - history and examination, - FNAC of the nodule, - ultra sound neck. b) Predict the percentage likelihood of nodules diagnosed as non-malignant on FNAC, to be malignant on histopathology. c) To look also at independent risk factors, in ultra sound and FNAC for diagnosis of malignancy. d) To form a treatment protocol based on triple assessment for any thyroid nodule. METHODS: All patients presenting with newly diagnosed nodule of thyroid were included in this study. Patients having external cytology / ultrasound were reassessed if agreeable to participate. Slide reviews were accepted if smears were considered adequate by the pathologists. All ultrasounds were repeated as the information that was required for this study maybe be inadequately reported from ultra sounds elsewhere. Ultra sound guided FNACs were done if the clinicians felt it was required. Performa was filled either in the out patient department or after admission to the ward. The clinical assessment was done by a senior consultant. Most ultra sonograms were done by the designated radiologist, before the FNACs were done. Cytology was reported as per the Bethesda criteria. The gold standard for diagnosis in this study was taken as the histopathology result. The study was conducted in the time period between May 2011 and June 2012. There were 102 cases with malignant histopathology versus 93 cases of benign histopathology. The following clinical criteria were used to indicate increased risk of malignancy: • Age >40 Yrs, • Male gender, • Family history of thyroid malignancy, • Persistent dysphonia, dysphagia or cough, • Consistency - hard, • Fixed swelling. FNAC Criteria: • I. Non diagnostic or Unsatisfactory • II. Benign • III. Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance • IV. Follicular Neoplasm or Suspicious for a Follicular Neoplasm • V. Suspicious for Malignancy • VI. Malignant ULTRA SOUND Criteria: • Punctate micro calcifications, • Hypoechogenicity, • Irregular margins or no halo, • Solid/cystic/mixed, • Intra nodule vascularity, • More tall than wide, • Lymph nodes - cystic. The information was entered into Epi Data and analysed using SPSS after conversion to an excel spreadsheet. SUMMARY: The evaluation of a thyroid nodule often posts a challenge to the treating surgeon. If allowed to borrow a term from the evaluation of breast cancers, triple assessment would be the right terminology to use to describe thyroid nodule assessment. A clear understanding of the clinical features, ultrasound findings and the implications of a FNA report is essential to the management of the thyroid nodule. CONCLUSIONS: 1. Older age and male gender were not risk factors for malignancy. 2. Features of compression was not a risk factor for malignancy. 3. Hard consistency, fixity were definite risk factors for malignancy. 4. The Bethesda system will need further validation among the Indian population. 5. FNACs have better yield and clinical value when done ultra sound guided than manually. 6. Ultra sound features that are significant are punctuate micro calcifications, hypo echogenicity, intra nodule vascularity, solid consistency and significant lymph nodes. 7. Size was not a risk factor for malignancy in this study.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Predict Malignancy ; Thyroid Nodules ; General Surgery Out- patient department ; Christian Medical College ; Vellore.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 04 May 2018 04:23
Last Modified: 04 May 2018 07:02

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