Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Risk of Thyroid Cancer in Euthyroid Asymptomatic Patients with Thyroid Nodules with an Emphasis on Family History of Thyroid Cancer

  • Hwang, Shin Hye (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Eun-Kyung (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Moon, Hee Jung (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Yoon, Jung Hyun (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Kwak, Jin Young (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2015.03.24
  • Accepted : 2015.11.13
  • Published : 2016.04.01
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Abstract

Objective: To determine the factors associated with thyroid cancer, focusing on first-degree family history and ultrasonography (US) features, in euthyroid asymptomatic patients with thyroid nodules. Materials and Methods: This retrospective study included 1310 thyroid nodules of 1254 euthyroid asymptomatic patients who underwent US-guided fine-needle aspiration biopsy between November 2012 and August 2013. Nodule size and clinical risk factors-such as patient age, gender, first-degree family history of thyroid cancer, multiplicity on US and serum thyroid stimulating hormone (TSH) levels-were considered together with US features to compare benign and malignant nodules. Multiple logistic regression analysis was performed to assess the risk of thyroid malignancy according to clinical and US characteristics. Results: Although all of the clinical factors and US findings were significantly different between patients with benign and malignant nodules, a solitary lesion on US (p = 0.041-0.043), US features and male gender (p < 0.001) were significant independent risk factors for thyroid malignancy in a multivariate analysis. Patient age, a first-degree family history of thyroid cancer and high normal serum TSH levels did not independently significantly increase the risk of thyroid cancer. However, multicollinearity existed between US assessment and patient age, first-degree family history of thyroid cancer and serum TSH values. Conclusion: Ultrasonography findings should be the primary criterion used to decide the management of euthyroid asymptomatic patients with thyroid nodules. The concept of first-degree family history as a risk factor for thyroid malignancy should be further studied in asymptomatic patients.

Keywords

References

  1. Vriens MR, Suh I, Moses W, Kebebew E. Clinical features and genetic predisposition to hereditary nonmedullary thyroid cancer. Thyroid 2009;19:1343-1349 https://doi.org/10.1089/thy.2009.1607
  2. Alsanea O, Clark OH. Familial thyroid cancer. Curr Opin Oncol 2001;13:44-51 https://doi.org/10.1097/00001622-200101000-00009
  3. Malchoff CD, Malchoff DM. Familial nonmedullary thyroid carcinoma. Cancer Control 2006;13:106-110 https://doi.org/10.1177/107327480601300204
  4. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-2917 https://doi.org/10.1002/ijc.25516
  5. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-1214 https://doi.org/10.1089/thy.2009.0110
  6. Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A, Dottorini ME, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 2006;12:63-102
  7. Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002;178:687-691 https://doi.org/10.2214/ajr.178.3.1780687
  8. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2005;237:794-800 https://doi.org/10.1148/radiol.2373050220
  9. Choi JS, Nam CM, Kim EK, Moon HJ, Han KH, Kwak JY. Evaluation of serum thyroid-stimulating hormone as indicator for fine-needle aspiration in patients with thyroid nodules. Head Neck 2015;37:498-504 https://doi.org/10.1002/hed.23616
  10. Schneider AB, Sarne DH. Long-term risks for thyroid cancer and other neoplasms after exposure to radiation. Nat Clin Pract Endocrinol Metab 2005;1:82-91 https://doi.org/10.1038/ncpendmet0022
  11. Dal Maso L, Bosetti C, La Vecchia C, Franceschi S. Risk factors for thyroid cancer: an epidemiological review focused on nutritional factors. Cancer Causes Control 2009;20:75-86 https://doi.org/10.1007/s10552-008-9219-5
  12. Moore FD Jr. Inherited aspects of papillary thyroid carcinoma. J Surg Oncol 2006;94:719-724 https://doi.org/10.1002/jso.20692
  13. Khan A, Smellie J, Nutting C, Harrington K, Newbold K. Familial nonmedullary thyroid cancer: a review of the genetics. Thyroid 2010;20:795-801 https://doi.org/10.1089/thy.2009.0216
  14. Charkes ND. On the prevalence of familial nonmedullary thyroid cancer. Thyroid 1998;8:857-858 https://doi.org/10.1089/thy.1998.8.857
  15. Triponez F, Wong M, Sturgeon C, Caron N, Ginzinger DG, Segal MR, et al. Does familial non-medullary thyroid cancer adversely affect survival? World J Surg 2006;30:787-793 https://doi.org/10.1007/s00268-005-0398-x
  16. Hemminki K, Eng C, Chen B. Familial risks for nonmedullary thyroid cancer. J Clin Endocrinol Metab 2005;90:5747-5753 https://doi.org/10.1210/jc.2005-0935
  17. Sippel RS, Caron NR, Clark OH. An evidence-based approach to familial nonmedullary thyroid cancer: screening, clinical management, and follow-up. World J Surg 2007;31:924-933 https://doi.org/10.1007/s00268-006-0847-1
  18. Mazeh H, Sippel RS. Familial nonmedullary thyroid carcinoma. Thyroid 2013;23:1049-1056 https://doi.org/10.1089/thy.2013.0079
  19. Vriens MR, Sabanci U, Epstein HD, Ngai S, Duh QY, Siperstein AE, et al. Reliability of fine-needle aspiration in patients with familial nonmedullary thyroid cancer. Thyroid 1999;9:1011-1016 https://doi.org/10.1089/thy.1999.9.1011
  20. Alsanea O, Wada N, Ain K, Wong M, Taylor K, Ituarte PH, et al. Is familial non-medullary thyroid carcinoma more aggressive than sporadic thyroid cancer? A multicenter series. Surgery 2000;128:1043-1050; discussion 1050-1051 https://doi.org/10.1067/msy.2000.110848
  21. McDonald TJ, Driedger AA, Garcia BM, Van Uum SH, Rachinsky I, Chevendra V, et al. Familial papillary thyroid carcinoma: a retrospective analysis. J Oncol 2011;2011:948786
  22. Capezzone M, Marchisotta S, Cantara S, Busonero G, Brilli L, Pazaitou-Panayiotou K, et al. Familial non-medullary thyroid carcinoma displays the features of clinical anticipation suggestive of a distinct biological entity. Endocr Relat Cancer 2008;15:1075-1081 https://doi.org/10.1677/ERC-08-0080
  23. Park YJ, Ahn HY, Choi HS, Kim KW, Park do J, Cho BY. The long-term outcomes of the second generation of familial nonmedullary thyroid carcinoma are more aggressive than sporadic cases. Thyroid 2012;22:356-362 https://doi.org/10.1089/thy.2011.0163
  24. Hillenbrand A, Varhaug JE, Brauckhoff M, Pandev R, Haufe S, Dotzenrath C, et al. Familial nonmedullary thyroid carcinomaclinical relevance and prognosis. A European multicenter study. ESES Vienna presentation. Langenbecks Arch Surg 2010;395:851-858 https://doi.org/10.1007/s00423-010-0696-0
  25. Mazeh H, Benavidez J, Poehls JL, Youngwirth L, Chen H, Sippel RS. In patients with thyroid cancer of follicular cell origin, a family history of nonmedullary thyroid cancer in one first-degree relative is associated with more aggressive disease. Thyroid 2012;22:3-8 https://doi.org/10.1089/thy.2011.0192
  26. Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al. Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. Radiology 2008;247:762-770 https://doi.org/10.1148/radiol.2473070944
  27. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 2002;87:1941-1946 https://doi.org/10.1210/jcem.87.5.8504
  28. Amir A, Sands N, Hier M, Payne R. Gender as a risk factor of malignancy in a thyroid nodule. Otolaryngol Head Neck Surg 2010;143 suppl:P61
  29. Iribarren C, Haselkorn T, Tekawa IS, Friedman GD. Cohort study of thyroid cancer in a San Francisco Bay area population. Int J Cancer 2001;93:745-750 https://doi.org/10.1002/ijc.1377
  30. Rago T, Fiore E, Scutari M, Santini F, Di Coscio G, Romani R, et al. Male sex, single nodularity, and young age are associated with the risk of finding a papillary thyroid cancer on fineneedle aspiration cytology in a large series of patients with nodular thyroid disease. Eur J Endocrinol 2010;162:763-770 https://doi.org/10.1530/EJE-09-0895
  31. Belfiore A, La Rosa GL, La Porta GA, Giuffrida D, Milazzo G, Lupo L, et al. Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity. Am J Med 1992;93:363-369 https://doi.org/10.1016/0002-9343(92)90164-7
  32. Tuttle RM, Lemar H, Burch HB. Clinical features associated with an increased risk of thyroid malignancy in patients with follicular neoplasia by fine-needle aspiration. Thyroid 1998;8:377-383 https://doi.org/10.1089/thy.1998.8.377
  33. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994;97:418-428 https://doi.org/10.1016/0002-9343(94)90321-2
  34. Jonklaas J, Nogueras-Gonzalez G, Munsell M, Litofsky D, Ain KB, Bigos ST, et al. The impact of age and gender on papillary thyroid cancer survival. J Clin Endocrinol Metab 2012;97:E878-E887 https://doi.org/10.1210/jc.2011-2864
  35. Barroeta JE, Wang H, Shiina N, Gupta PK, Livolsi VA, Baloch ZW. Is fine-needle aspiration (FNA) of multiple thyroid nodules justified? Endocr Pathol 2006;17:61-65 https://doi.org/10.1385/EP:17:1:61
  36. Kumar H, Daykin J, Holder R, Watkinson JC, Sheppard MC, Franklyn JA. Gender, clinical findings, and serum thyrotropin measurements in the prediction of thyroid neoplasia in 1005 patients presenting with thyroid enlargement and investigated by fine-needle aspiration cytology. Thyroid 1999;9:1105-1109 https://doi.org/10.1089/thy.1999.9.1105
  37. Franklyn JA, Daykin J, Young J, Oates GD, Sheppard MC. Fine needle aspiration cytology in diffuse or multinodular goitre compared with solitary thyroid nodules. BMJ 1993;307:240 https://doi.org/10.1136/bmj.307.6898.240
  38. McCall A, Jarosz H, Lawrence AM, Paloyan E. The incidence of thyroid carcinoma in solitary cold nodules and in multinodular goiters. Surgery 1986;100:1128-1132
  39. Bouhabel S, Payne RJ, Mlynarek A, Hier M, Caglar D, Tamilia M. Are solitary thyroid nodules more likely to be malignant? J Otolaryngol Head Neck Surg 2012;41:119-123
  40. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab 2006;91:3411-3417 https://doi.org/10.1210/jc.2006-0690

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