For the last few decades, the main indication for surgery in asymptomatic and hormonally inactive thyroid disease is only neoplastic cytological reports. A follicular thyroid tumor (Bethesda IV) has become the most common indication for thyroid surgery. The study aims to evaluate changes in treatment needs over the past decade and identify effective strategies for altering treatment tactics.
Materials and Methods:
Two consecutive samples were taken to estimate the rate of Bethesda IV reports.
The first included 40696 patients who underwent FNAB at the SPbU Hospital between 2010 and 2012. A total of 49419 nodes were punctured.
The second included 72,997 patients with FNAB in 2019-2022. They underwent a puncture of 98974 thyroid nodules.
To evaluate the histologic findings, we formed two continuous samples of patients who were operated on Bethesda IV nodes.
A sample of 3514 patients was operated on in 2010-2012, and a sample of 4399 patients was operated on in 2020-2021.
Results:
In 2010-2012, follicular neoplasms (Bethesda IV) incidence was 7.11% (3514 of 49419). In 2019-2022, it was 13.74% (13478 of 98974). The difference is significant Chi^2=1418 p<0.0000001. The incidence of malignant neoplasms has also increased. While only 15.9% of final histologies became malignant in 2010-2012, the rate was 29.77% in 2020-2012. The difference is significant Chi^2=33.56, p<0.0000001. Meanwhile, the incidence of Bethesda VI was 3.01% in 2010-2012 and 3.07% in 2019-2022. Thus, this is not due to the blurring of the definition boundaries.
We found no significant differences in demographics.
This marked increase in the number of masses is an indication for surgical treatment,
We performed ROC analysis to determine the marginal size of FOs and the risk of missing aggressive thyroid cancer (AUC=0.84).
With a node diameter of 2 cm, the sensitivity was 0.84 (0.68 to 0.96), and the specificity was 0.6 (0.59 to 0.62). The NPV was 0.9983 (0.9966 to 0.9996).
A nodule diameter of 3 cm showed a sensitivity of 0.8 (0.64 – 0.92) and a specificity of 0.79 (0.78 – 0.81) for the risk of aggressive cancer.
The NPV was 0.9984 (0.9971 to 0.9994).
Conclusions:
We have observed a significant rise in the requirement of surgical care for follicular neoplasia. Moreover, we have seen an increase in the percentage of malignant tumors in the final histology. Genetic assessment and selective active surveillance offer a better balance between the augmented chances of complications of surgical treatment and the risk of tumor progression. It is advised to consider active surveillance for nodules less than 3 cm in size