Mazen E Iskandar1, Giovanni Bonomo1, Vaidehi Avadhani2, Mark Persky3, David Lucido4, Beverly Wang2, Jennifer L Marti5. 1. Division of Endocrine Surgery, Department of Surgery, Icahn School of Medicine and Mount Sinai Beth Israel, Mount Sinai Health System, New York, NY. 2. Department of Pathology, Icahn School of Medicine and Mount Sinai Beth Israel, Mount Sinai Health System, New York, NY. 3. Department of Otolaryngology, Icahn School of Medicine and Mount Sinai Beth Israel, Mount Sinai Health System, New York, NY. 4. Department of Biostatistics, Icahn School of Medicine and Mount Sinai Beth Israel, Mount Sinai Health System, New York, NY. 5. Division of Endocrine Surgery, Department of Surgery, Icahn School of Medicine and Mount Sinai Beth Israel, Mount Sinai Health System, New York, NY. Electronic address: jmarti@chpnet.org.
Abstract
BACKGROUND: Several recent analyses of indeterminate thyroid nodules classified as Bethesda III (follicular lesion of undetermined significance) have reported considerably greater rates of malignancy than those initially reported by the Bethesda System for Reporting Cytopathology (BSRTC). These values, however, may be overestimates owing to several sources of bias, such as referral, selection, and publication biases. Our aim was to analyze the prevalence of malignancy in Bethesda III and IV thyroid nodules in a comprehensive health system less prone to institutional referral bias, excluding incidental carcinomas, and we examine the literature for publication bias. METHODS: We performed a retrospective analysis with pathologic re-review of 119 patients with Bethesda III/IV cytology undergoing surgery in a comprehensive health system by examining patient and nodule characteristics. A review of the literature was performed and analyzed for publication bias. RESULTS: The malignancy rate in resected thyroid nodules was 13% (6/48) for Bethesda III and 28% (20/71) for Bethesda IV. There were 9 of 119 patients (8%) with incidental microcarcinomas. Age <30 years was associated with an increased risk of malignancy (odds ratio, 25.8; P = .005). Sex, nodule size, and ultrasonographic features were not associated with risk of malignancy. Analysis of the literature was indicative of publication bias for Bethesda III cohorts, with reported rates positively skewed (P = .039). CONCLUSION: In a comprehensive health system, the rate of malignancy in Bethesda III nodules was similar to the range reported by the BSRTC. Recent reports of greater rates of malignancy may be attributable to institutional referral patterns, operative selection, inclusion of incidental microcarcinomas, and publication bias.
BACKGROUND: Several recent analyses of indeterminate thyroid nodules classified as Bethesda III (follicular lesion of undetermined significance) have reported considerably greater rates of malignancy than those initially reported by the Bethesda System for Reporting Cytopathology (BSRTC). These values, however, may be overestimates owing to several sources of bias, such as referral, selection, and publication biases. Our aim was to analyze the prevalence of malignancy in Bethesda III and IV thyroid nodules in a comprehensive health system less prone to institutional referral bias, excluding incidental carcinomas, and we examine the literature for publication bias. METHODS: We performed a retrospective analysis with pathologic re-review of 119 patients with Bethesda III/IV cytology undergoing surgery in a comprehensive health system by examining patient and nodule characteristics. A review of the literature was performed and analyzed for publication bias. RESULTS: The malignancy rate in resected thyroid nodules was 13% (6/48) for Bethesda III and 28% (20/71) for Bethesda IV. There were 9 of 119 patients (8%) with incidental microcarcinomas. Age <30 years was associated with an increased risk of malignancy (odds ratio, 25.8; P = .005). Sex, nodule size, and ultrasonographic features were not associated with risk of malignancy. Analysis of the literature was indicative of publication bias for Bethesda III cohorts, with reported rates positively skewed (P = .039). CONCLUSION: In a comprehensive health system, the rate of malignancy in Bethesda III nodules was similar to the range reported by the BSRTC. Recent reports of greater rates of malignancy may be attributable to institutional referral patterns, operative selection, inclusion of incidental microcarcinomas, and publication bias.
Authors: Jennifer L Marti; Vaidehi Avadhani; Luke A Donatelli; Sayani Niyogi; Beverly Wang; Richard J Wong; Ashok R Shaha; Ronald A Ghossein; Oscar Lin; Luc G T Morris; Allen S Ho Journal: Ann Surg Oncol Date: 2015-04-11 Impact factor: 5.344
Authors: Andrea R Marcadis; Pablo Valderrabano; Allen S Ho; Justin Tepe; Christina E Swartzwelder; Serena Byrd; Wendy L Sacks; Brian R Untch; Ashok R Shaha; Bin Xu; Oscar Lin; Ronald A Ghossein; Richard J Wong; Jennifer L Marti; Luc G T Morris Journal: Surgery Date: 2018-10-22 Impact factor: 3.982
Authors: Aly Bernard Khalil; Roberto Dina; Karim Meeran; Ali M Bakir; Saf Naqvi; Alia Al Tikritti; Nader Lessan; Maha T Barakat Journal: Eur Thyroid J Date: 2017-11-21