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Focal Lymphocytic Thyroiditis Nodules Share the Features of Papillary Thyroid Cancer on Ultrasound

 Sena Hwang  ;  Dong Yeob Shin  ;  Eun Kyung Kim  ;  Woo Ick Yang  ;  Jung Woo Byun  ;  Su Jin Lee  ;  Gyuri Kim  ;  Soo Jung Im  ;  Eun Jig Lee 
 YONSEI MEDICAL JOURNAL, Vol.56(5) : 1338-1344, 2015 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Autoantibodies ; Biopsy, Fine-Needle/methods* ; Calcinosis ; Carcinoma/pathology* ; Carcinoma, Papillary ; Female ; Hashimoto Disease ; Humans ; Hyperplasia/pathology* ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; Thyroglobulin/blood ; Thyroid Diseases ; Thyroid Neoplasms/pathology* ; Thyroid Nodule/pathology* ; Thyroiditis, Autoimmune/pathology* ; Thyrotropin/blood
Differential diagnosis ; focal lymphocytic thyroiditis ; papillary thyroid cancer
Purpose: It is often difficult to discriminate focal lymphocytic thyroiditis (FLT) or adenomatous hyperplasia (AH) from thyroid cancer if they both have suspicious ultrasound (US) findings. We aimed to make a predictive model of FLT from papillary thyroid cancer (PTC) in suspicious nodules with benign cytologic results. Materials and Methods: We evaluated 214 patients who had undergone fine-needle aspiration biopsy (FNAB) and had shown thyroid nodules with suspicious US features. PTC was confirmed by surgical pathology. FLT and AH were confirmed through more than two separate FNABs. Clinical and biochemical findings, as well as US features, were evaluated. Results: Of 214 patients, 100 patients were diagnosed with PTC, 55 patients with FLT, and 59 patients with AH. The proportion of elevated thyrotropin (TSH) levels (p=0.014) and thyroglobulin antibody (Tg-Ab) or thyroid peroxidase antibody (TPO-Ab) positivity (p<0.001) in the FLT group was significantly higher than that in the PTC group. Regarding US features, absence of calcification (p=0.006) and “diffuse thyroid disease” (DTD) pattern on US (p<0.001) were frequently seen in the FLT group. On multivariate analysis, Tg-Ab positivity, presence of a DTD pattern on US, and absence of calcification in nodules were associated with FLT with the best specificity of 99% and positive predictive value of 96%. In contrast, a taller than wide shape of nodules was the only variable significant for differentiating AH from PTC. Conclusion: Suspicious thyroid nodules with cytologic benign results could be followed up with US rather than repeat FNAB, if patients exhibit Tg-Ab positivity, no calcifications in nodules, and a DTD pattern on US.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Gyuri(김규리)
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Byun, Jung Woo(변정우)
Shin, Dong Yeob(신동엽) ORCID logo https://orcid.org/0000-0003-1048-7978
Yang, Woo Ick(양우익) ORCID logo https://orcid.org/0000-0002-6084-5019
Lee, Su Jin(이수진) ORCID logo https://orcid.org/0000-0002-7325-2538
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
Hwang, Se Na(황세나)
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