MALIGNANCY INCIDENCE IN SOLITARY NODULE THYROID
DOI:
https://doi.org/10.22159/ajpcr.2025v18i5.54366Keywords:
Adenomatous nodule, Papillary carcinoma thyroid, follicular carcinoma thyroid, Solitary nodule thyroid, thyroiditisAbstract
Objectives: The incidence of thyroid cancer is rising in the state of Kerala. This study aimed to determine the incidence of malignancy in solitary nodule thyroid (SNT) cases operated on at our tertiary care hospital.
Methods: This is a retrospective register based study. All patients operated for SNT over 8 years from 2013 to 2020 were listed and pathological findings were evaluated.
Results: A total of 319 patients with SNT were included, with 75.5% being female. The mean age of patients was 42 years (standard deviation=±12.6). Histopathological analysis revealed malignancy in 16% (n=51) of cases. Other most common pathology observed in SNT cases was nodular colloid goiter (67.8%), followed by thyroid adenoma (13.2%), adenomatous nodule (1.9%), and thyroiditis. Among the 51 malignant cases, 70.5% were papillary carcinoma, 25.5% were follicular carcinoma, and one case each of medullary and poorly differentiated carcinoma was identified. A statistically significant association was found between age and malignancy diagnosis (p=0.011, Independent samples t-test). In addition, females had a higher incidence of cancer, with a p=0.021 and an odds ratio of 2.7 (Chi-square test).
Conclusion: A solitary nodule has a 16% chance of malignancy, with papillary thyroid carcinoma being the most common type.
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Usha Menon VU, Sundaram KR, Unnikrishnan AG, Jayakumar RV, Nair V, Kumar H. High prevalence of undetected thyroid disorders in an iodine sufficient adult South Indian population. J Indian Med Assoc. 2009 Feb;107(2):72-7, PMID: 19585813
Haridas TV, Bindhu V, Vinodh M. Clinicopathological characteristics of solitary nodule of thyroid- a cross-sectional study in a tertiary center. J Evid Based Med Healthc. 2017 Jan;4(28):1630-2. doi: 10.18410/ jebmh/2017/318
Monib S, Farkas N, Abdelaziz MI. A prospective observational study assessing the relationship between solitary thyroid nodule size and incidence of malignancy. Cureus. 2020 Nov;12(11):e11422. doi: 10.7759/cureus.11422, PMID: 33312818
Sekkath Veedu J, Wang K, Lei F, Chen Q, Huang B, Mathew A. Trends in thyroid cancer incidence in India. J Clin Oncol. 2018 May;36(15-Suppl):e18095. doi: 10.1200/JCO.2018.36.15-suppl.e18095
HBCR Report; 2017. Available from: https://www.rcctvm.gov.in/ pdf/annualreports/hbcr%20report%202017.pdf [Last accessed on 2023 Jun 28].
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016 Jan;26(1):1-133. doi: 10.1089/thy.2015.0020, PMID: 26462967
Geothe J, Poulose KP. Histologic pattern of thyroid disorders in Southern Kerala. Thyroid Res Pract. 2017 Jan;14(1):25-7. doi: 10.4103/0973- 0354.200566
Pemayun TG. Current diagnosis and management of thyroid nodules. Acta Med Indones. 2016 Jul;48(3):247-57. PMID: 27840362
Rehman AU, Ehsan M, Javed H, Ameer MZ, Mohsin A, Aemaz Ur Rehman M, et al. Solitary and multiple thyroid nodules as predictors of malignancy: A systematic review and meta-analysis. Thyroid Res. 2022 Dec;15(1):22. doi: 10.1186/s13044-022-00140-6, PMID: 36464691
Brito JP, Yarur AJ, Prokop LJ, McIver B, Murad MH, Montori VM. Prevalence of thyroid cancer in multinodular goiter versus single nodule: A systematic review and meta-analysis. Thyroid. 2013 Apr;23(4):449-55. doi: 10.1089/thy.2012.0156, PMID: 23067375
Wong KT, Ahuja AT. Ultrasound of thyroid cancer. Cancer Imaging. 2005 Dec;5(1):157-66. doi: 10.1102/1470-7330.2005.0110, PMID: 16361145
Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: A step in establishing better stratification of cancer risk. Radiology. 2011 Sep;260(3):892-9. doi: 10.1148/radiol.11110206, PMID: 2177195913. Zhang F, Russell YX, Guber HA. Transverse and longitudinal ultrasound location of thyroid nodules and risk of thyroid cancer. Endocr Pract. 2021 Jul;27(7):682-90. doi: 10.1016/j.eprac.2021.01.009, PMID: 33642256
Ramundo V, Lamartina L, Falcone R, Ciotti L, Lomonaco C, Biffoni M, et al. Is thyroid nodule location associated with malignancy risk? Ultrasonography. 2019 Jul;38(3):231-5. doi: 10.14366/usg.18050, PMID: 30690963
Khan SA, Gafur MA, Khan MK, Karim MR, Mohiuddin M, Islam MS. Pattern of malignancy in clinically solitary thyroid nodule. Mymensingh Med J. 2012 Jan;21(1):1-7. PMID: 22314446
Hoang J. Thyroid nodules and evaluation of thyroid cancer risk. Australas J Ultrasound Med. 2010 Nov;13(4):33-6. doi: 10.1002/ j.2205-0140.2010.tb00177.x, PMID: 28191095
Yan HX, Pang P, Wang FL, Tian W, Luo YK, Huang W, et al. Dynamic profile of differentiated thyroid cancer in male and female patients with thyroidectomy during 2000-2013 in China: A retrospective study. Sci Rep. 2017 Nov;7(1):15832. doi: 10.1038/s41598-017-14963-z, PMID: 29158505
Amir A, Sands N, Hier M, Payne R. Gender as a risk factor of malignancy in a thyroid nodule. Otolaryngol Head Neck Surg. 2010 Aug;143(S2):P61. doi: 10.1016/j.otohns.2010.06.068
Rahbari R, Zhang L, Kebebew E. Thyroid cancer gender disparity. Future Oncol. 2010 Nov;6(11):1771-9. doi: 10.2217/fon.10.127, PMID: 21142662
McDermott MT. Hypothyroidism. Ann Intern Med. 2020 Jul;173(1):ITC1-16. doi: 10.7326/AITC202007070, PMID: 32628881
Hu X, Chen Y, Shen Y, Tian R, Sheng Y, Que H. Global prevalence and epidemiological trends of Hashimoto’s thyroiditis in adults: A systematic review and meta-analysis. Front Public Health. 2022;10:1020709. doi: 10.3389/fpubh.2022.1020709, PMID: 36311599
Caleo A, Vigliar E, Vitale M, Di Crescenzo V, Cinelli M, Carlomagno C, et al. Cytological diagnosis of thyroid nodules in Hashimoto thyroiditis in elderly patients. BMC Surg. 2013;13(Suppl 2):S41. doi: 10.1186/1471- 2482-13-S2-S41, PMID: 24266923
Yildirim D, Gurses B, Gurpinar B, Ekci B, Colakoglu B, Kaur A. Nodule or pseudonodule? Differentiation in Hashimoto’s thyroiditis with sonoelastography. J Int Med Res. 2011;39(6):2360-9. doi: 10.1177/147323001103900636, PMID: 22289555
Tam S, Amit M, Boonsripitayanon M, Busaidy NL, Cabanillas ME, Waguespack SG, et al. Effect of tumor size and minimal extrathyroidal extension in patients with differentiated thyroid cancer. Thyroid. 2018 Aug;28(8):982-90. doi: 10.1089/thy.2017.0513, PMID: 29936892
Mitchell AL, Gandhi A, Scott-Coombes D, Perros P. Management of thyroid cancer: United Kingdom national multidisciplinary guidelines. J Laryngol Otol. 2016 May;130(S2):S150-60. doi: 10.1017/ S0022215116000578, PMID: 27841128
Dideban S, Abdollahi A, Meysamie A, Sedghi S, Shahriari M. Thyroid papillary microcarcinoma: Etiology, clinical manifestations, diagnosis, follow-up, histopathology and prognosis. Iran J Pathol. 2016 Winter;11(1):1-19. PMID: 26870138
Gao R, Jia X, Liang Y, Fan K, Wang X, Wang Y, et al. Papillary thyroid micro carcinoma: The incidence of high-risk features and its prognostic implications. Front Endocrinol (Lausanne). 2019 Feb;10:74. doi: 10.3389/fendo.2019.00074, PMID: 30828316
Suster S. Controversies regarding the interpretation of follicular thyroid nodules. Arch Pathol Lab Med. 2019 Dec;143(12):1472-6. doi: 10.5858/arpa.2019-0301-RA, PMID: 31556698
Namba H, Matsuo K, Fagin JA. Clonal composition of benign and malignant human thyroid tumors. J Clin Invest. 1990 Jul;86(1):120-5. doi: 10.1172/JCI114673, PMID: 1973172
Hicks DG, LiVolsi VA, Neidich JA, Puck JM, Kant JA. Clonal analysis of solitary follicular nodules in the thyroid. Am J Pathol. 1990 Sep;137(3):553-62. PMID: 1975986
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