AI Summary & Key Takeaways
AI InsightIt could also assist in the prediction of risk of malignancyand management decisions when the cytology is indeterminate
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Abstract
We aimed to determine whether the ratio of thyrotropin (TSH) to thyroglobulin (Tg) (TSH/Tg) would be able to assist in predicting malignancy in thyroid nodules.Material and Methods: Euthyroid patients operated betweenthe year 2007 and 2014 were retrospectively reviewed. Patientswho previously had thyroid disease or surgery and those with increased levels of anti-thyroglobulin antibodies were excludedfrom this study. Clinicopathological features, as well as serumTSH, Tg, and TSH/Tg were compared between histopathologically benign and malignant groups.Results: Data related to 370 (60.3%) benign and 244 (39.7%)malignant patients were analyzed. The malignant patients exhibited significantly higher TSH, TSH/Tg, and total thyroid volume, anda lower Tg compared to the benign patients (p<0.001 for each).There were 924 (74.2%) benign and 321 (25.8%) malignant nodules. Cytological distribution of the nodules was observed to beas follows: 343 (27.6%) nondiagnostic, 637 (51.2%) benign, 121(9.7%) atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 39 (3.1%) follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 64 (5.1%)suspicious for malignancy (SM), and 41 (3.3%) malignant. TSH,Tg, and TSH/Tg were significantly different in different Bethesdacategories (p<0.001 for each). Median TSH/Tg was the lowest inbenign (0.013), and highest in SM (0.054) and malignant (0.086)cytologies. TSH/Tg was significantly higher in the malignant nodules compared to benign nodules, in AUS/FLUS, FN/SFN, and SMcategories (p=0.001, p<0.001, and p=0.003, respectively). In theregression analysis, TSH/Tg demonstrated higher diagnostic performance compared to TSH and Tg (p<0.001).Discussion: Preoperative TSH/Tg could be used as a novel marker for differentiating between benign and malignant thyroid nodules. It could also assist in the prediction of risk of malignancyand management decisions when the cytology is indeterminate
Özet
Malign ve benign tiroid nodüllerinin ayırımında yeni birprediktif markır olarak tirotropin (TSH) tiroglobulin (Tg) oranınıaraştırmayı amaçladık.Gereç ve Yöntemler: 2007 ve 2014 arasında opere edilenötiroid hastalar retrospektif olarak değerlendirildi. Tiroid hastalığı veya cerrahi öyküsü olanlar ve artmış anti-tiroglobulinantikorları olanlar dışlandı.Histopatolojik olarak benign ve malign gruplar klinikopatolojik özellikler ve serum TSH, Tg,TSH/Tg oranı açısından karşılaştırıldı.Bulgular: 370 (%60.3) benign ve 244 (%39.7) malignhasta vardı.Benign hastalara göre malign hastalarda anlamlıolarak yüksek TSH, TSH/Tg ve total tiroid hacmi ve düşük Tgvardı (her biri için, p<0.001). (%74.2) benign ve 321 (%25.8)malign nodül vardı. Sitopatalojik dağılım şöyleydi; 343(%27.6) nondiagnostik, 637 (%51.2) benign, 121 (%9.7)önemi belirlenemeyen atipi/önemi belirlenemeyen folliküler lezyon (ÖBA/ÖBFL), 39 (%3.1) folliküler neoplazi/follikülerneoplazi şüphesi (FN/FNŞ), 64 (%5.1) malignite şüphesi(MŞ) ve 41 (%3.3) malign. TSH, Tg ve TSH/Tg Bethesdakategorilerinde anlamlı olarak farklıydı (her biri için p<0.001).Median TSH/Tg benignde (0.013) en düşük ve MŞ (0.054)ve malign sitolojilerde (0.086) en yüksekti. ÖBA/ÖBFL,FN/FNŞ ve MŞ kategorilerinde, TSH/Tg oranı malign nodüllerde benign nodüllere göre yüksek bulundu (sırasıyla,p=0.001, p<0.001 ve p=0.003). Regresyon analizindeTSH/Tg; TSH ve Tg'ye göre daha yüksek tanısal performansasahipti (p<0.001).Tartışma: TSH/Tg ameliyat öncesinde benign ve maligntiroid nodüllerinin ayırımında yeni bir marker olarak kullanılabilir. Ayrıca indetermine sitolojisi olan nodüllerde malignite riskinin belirlenmesine ve yönetimine yardımcı olabilir