Positive central lymph-nodes are underdiagnosed in patients with Bethesda V cytology in an endemic goiter region

Lindsay Hargitai; Stephanie Strobl; Oskar Koperek; Susanne Urach; Wolfgang Raber; Anton Staudenherz; Christian Scheuba; Philipp Riss

doi:10.21037/gs.2020.02.07

Positive central lymph-nodes are underdiagnosed in patients with Bethesda V cytology in an endemic goiter region

Gland Surg. 2020 Apr;9(2):252-260. doi: 10.21037/gs.2020.02.07.

Authors

Lindsay Hargitai¹, Stephanie Strobl¹, Oskar Koperek², Susanne Urach³, Wolfgang Raber⁴, Anton Staudenherz⁵, Christian Scheuba¹, Philipp Riss¹

Affiliations

¹ Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
² Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.
³ Center for Medical Statistics, Informatics, and Intelligent Systems, Institute of Medical Statistics, Vienna, Austria.
⁴ Section of Endocrinology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
⁵ Clinical Institute for Nuclear Medicine, Molecular Imaging and Special Endocrinology, University Hospital St. Pölten, St. Pölten, Austria.

Abstract

Background: Fine needle aspiration (FNA) is a significant diagnostic procedure for detecting malignancy in patients with nodular thyroid disease. A high proportion of patients with cytological diagnosed follicular neoplasia (Bethesda IV and V) ultimately have thyroid cancer. The aim of this study was to evaluate the incidence of preoperatively undiagnosed central lymph node metastasis in patients with multinodular goiter (MNG).

Methods: Patients who underwent FNA and were classified as Bethesda IV/V were included. Applying a radical approach, all patients underwent (hemi)thyroidectomy and prophylactic unilateral central neck dissection.

Results: During our study period 2009-2013, 60 patients (19.7%) were classified as Bethesda IV and 21 (6.9%) Bethesda V. Final histopathological results revealed malignancy in 35 (43.2%) of 81 Bethesda IV/V nodules. Of the nodules classified as Bethesda IV, 20 (33.3%) showed malignancy in the final histology. Ten patients (16.7%) had papillary micro-carcinoma (mPTC, <10 mm), 4 (6.6%) PTC and 6 (10%) follicular thyroid cancer. Fifteen of 21 (71.4%) Bethesda V nodules were revealed as PTC of whom seven (33.3%) patients also had lymph-node metastases.

Conclusions: While 33.3% of the patients with PTC, preoperatively classified as Bethesda V, had previously undetected positive lymph-nodes, only one patient with Bethesda IV had lymph-node metastasis.

Keywords: Bethesda; Fine needle aspiration (FNA); central neck dissection; follicular neoplasia; lymph node.