open access

Vol 75, No 2 (2024)
Original paper
Submitted: 2023-12-10
Accepted: 2024-01-29
Published online: 2024-04-02
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Ultrasound and cytopathological characteristics of thyroid tumours of uncertain malignant potential — from diagnosis to treatment

Agnieszka Żyłka1, Katarzyna Dobruch-Sobczak2, Hanna Piotrzkowska-Wróblewska3, Maciej Jędrzejczyk4, Piotr Góralski1, Jacek Gałczyński1, Elwira Bakuła-Zalewska5, Marek Dedecjus1
·
Pubmed: 38646986
·
Endokrynol Pol 2024;75(2):170-178.
Affiliations
  1. Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
  2. Radiology Department II, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
  3. Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
  4. Department of Ultrasound and Mammography Diagnostics, Mazovian Brodnowski Hospital, Warsaw, Poland
  5. Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland

open access

Vol 75, No 2 (2024)
Original Paper
Submitted: 2023-12-10
Accepted: 2024-01-29
Published online: 2024-04-02

Abstract

Introduction: The latest World Health Organization (WHO) classification from 2022 distinguishes the division of low-risk thyroid neoplasms such as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), follicular tumour of uncertain malignant potential (FT-UMP), and well-differentiated tumour of uncertain malignant potential (WDT-UMP). The final diagnosis is made postoperatively according to histopathologic results. The aim of the study was the assessment of ultrasonographic and cytopathological features of borderline lesions to predict low-risk tumours preoperatively and plan the optimal treatment for that group of patients.

Material and methods: A total of 35 patients (30 women; 5 men), aged 20–81 years with a mean age of 49 years, were enrolled in the study. The study evaluated 35 focal lesions of the thyroid gland, classified as low-risk neoplasms according to the WHO 2022 classification: FT-UMP (n = 21), NIFTP (n = 7), and WDT-UMP (n = 7). Ultrasonographic features of nodules including contrast-enhanced ultrasound (CEUS) and elastography were assessed by 2 specialists, and the risk of malignancy was evaluated according to EU-TIRADS-PL classification.

Results: Of the 35 focal thyroid lesions, most were categorised as low or intermediate risk of malignancy according to EU-TIRADS-PL, with dominant category 3 [n = 13 (37.2%)] and category 4 [n = 15 (42.8%)]. High-risk category 5 was assessed in 7 lesions (20%). In cytopathology nodules were categorised as follows (Bethesda System TBSRTC 2023): Bethesda II (n = 4), Bethesda III (n = 2), Bethesda IV (n = 25), Bethesda V (n = 3), and Bethesda VI (n = 1). In the CEUS study, contrasting patterns dominated compared to the surrounding parenchyma, such as enhancement equal to the parenchyma (66.6%) or intense (28.5%), heterogeneous (61.9%), centripetal (42.8%), or diffuse (57.1%) with fast (33.3%) or compared to parenchyma contrast wash-in (42.8%) and its fast (33.3%) or comparable to thyroid parenchyma wash-out (52.3%).

Conclusions: The study indicates that lesions with uncertain malignant potential typically present features suggesting low to intermediate risk of malignancy based on EU-TIRADS-PL classification, with dominant cytopathologic Bethesda IV category. However, 20% of lesions were assessed tas EU-TIRADS-PL category 5. Low-risk tumours, including NIFTP, FT-UMP, and WDT-UMP, require careful observation and monitoring post surgical treatment due to their potential for recurrence and metastasis. The preoperatively prediction of borderline tumour may play an important role in proper treatment and follow-up.

Abstract

Introduction: The latest World Health Organization (WHO) classification from 2022 distinguishes the division of low-risk thyroid neoplasms such as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), follicular tumour of uncertain malignant potential (FT-UMP), and well-differentiated tumour of uncertain malignant potential (WDT-UMP). The final diagnosis is made postoperatively according to histopathologic results. The aim of the study was the assessment of ultrasonographic and cytopathological features of borderline lesions to predict low-risk tumours preoperatively and plan the optimal treatment for that group of patients.

Material and methods: A total of 35 patients (30 women; 5 men), aged 20–81 years with a mean age of 49 years, were enrolled in the study. The study evaluated 35 focal lesions of the thyroid gland, classified as low-risk neoplasms according to the WHO 2022 classification: FT-UMP (n = 21), NIFTP (n = 7), and WDT-UMP (n = 7). Ultrasonographic features of nodules including contrast-enhanced ultrasound (CEUS) and elastography were assessed by 2 specialists, and the risk of malignancy was evaluated according to EU-TIRADS-PL classification.

Results: Of the 35 focal thyroid lesions, most were categorised as low or intermediate risk of malignancy according to EU-TIRADS-PL, with dominant category 3 [n = 13 (37.2%)] and category 4 [n = 15 (42.8%)]. High-risk category 5 was assessed in 7 lesions (20%). In cytopathology nodules were categorised as follows (Bethesda System TBSRTC 2023): Bethesda II (n = 4), Bethesda III (n = 2), Bethesda IV (n = 25), Bethesda V (n = 3), and Bethesda VI (n = 1). In the CEUS study, contrasting patterns dominated compared to the surrounding parenchyma, such as enhancement equal to the parenchyma (66.6%) or intense (28.5%), heterogeneous (61.9%), centripetal (42.8%), or diffuse (57.1%) with fast (33.3%) or compared to parenchyma contrast wash-in (42.8%) and its fast (33.3%) or comparable to thyroid parenchyma wash-out (52.3%).

Conclusions: The study indicates that lesions with uncertain malignant potential typically present features suggesting low to intermediate risk of malignancy based on EU-TIRADS-PL classification, with dominant cytopathologic Bethesda IV category. However, 20% of lesions were assessed tas EU-TIRADS-PL category 5. Low-risk tumours, including NIFTP, FT-UMP, and WDT-UMP, require careful observation and monitoring post surgical treatment due to their potential for recurrence and metastasis. The preoperatively prediction of borderline tumour may play an important role in proper treatment and follow-up.

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Keywords

thyroid tumour; ultrasound; thyroid cancer; contrast-enhanced-ultrasound

About this article
Title

Ultrasound and cytopathological characteristics of thyroid tumours of uncertain malignant potential — from diagnosis to treatment

Journal

Endokrynologia Polska

Issue

Vol 75, No 2 (2024)

Article type

Original paper

Pages

170-178

Published online

2024-04-02

Page views

284

Article views/downloads

166

DOI

10.5603/ep.98488

Pubmed

38646986

Bibliographic record

Endokrynol Pol 2024;75(2):170-178.

Keywords

thyroid tumour
ultrasound
thyroid cancer
contrast-enhanced-ultrasound

Authors

Agnieszka Żyłka
Katarzyna Dobruch-Sobczak
Hanna Piotrzkowska-Wróblewska
Maciej Jędrzejczyk
Piotr Góralski
Jacek Gałczyński
Elwira Bakuła-Zalewska
Marek Dedecjus

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