Indolent Behavior of Malignant Bethesda III Nodules Compared to Bethesda V/VI Nodules

Abstract Background The Bethesda system classifies all fine-needle aspiration specimens into 1 of 6 categories. We speculated that cancers within each Bethesda category would have distinct clinical behavior. Methods This is a retrospective analysis of patients from a single academic medical center w...

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Published in:The journal of clinical endocrinology and metabolism 2024-08, Vol.109 (9), p.2317-2324
Main Authors: Endo, Mayumi, Peng, Jing, Nabhan, Fadi A, Brock, Pamela, Azaryan, Irina, Long, Clarine, Ryan, Laura E, Ringel, Matthew D, Sipos, Jennifer A
Format: Article
Language:English
Subjects:
Cellular biology
Cytology
Diagnosis
Iodine
Metastases
Nodules
Papillary thyroid cancer
Patients
Phenotypes
Remission
Remission (Medicine)
Surgery
Thyroid cancer
Thyroxine
Triiodothyronine
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Summary:Abstract Background The Bethesda system classifies all fine-needle aspiration specimens into 1 of 6 categories. We speculated that cancers within each Bethesda category would have distinct clinical behavior. Methods This is a retrospective analysis of patients from a single academic medical center with a histologic diagnosis of thyroid cancer who had an initial diagnosis of Bethesda III, IV, V, or VI cytology. Results A total of 556 cases were included, with 87 cases of Bethesda III, 109 cases of IV, 120 cases of V, and 240 cases of VI. Bethesda III showed similarities with V/VI compared to IV with a predominance of papillary thyroid cancer. The interval from diagnosis to surgery was longer in Bethesda III compared to Bethesda V/VI (median 78 vs 41 days, P < .001) (Fig. 1). Yet, patients with Bethesda III had a higher probability of achieving remission (62% vs 46%, P < .03), a lower possibility of recurrence (8% vs 24%, P < .001), and a shorter interval to achieve remission (median 1218 vs 1682 days, P = .02) compared to Bethesda V/VI, which did not change after adjusting for age, sex, radioactive iodine therapy, mode of surgery, and tumor size. More than 70% of Bethesda III that later presented with recurrence had T3/T4 disease or distant metastasis. Figure 1. Time to surgery III vs V/VI. Conclusion Cancers with Bethesda III cytology had a less aggressive clinical phenotype with better prognosis compared to V/VI despite histological similarities. The time to remission was shorter in Bethesda III despite a longer interval between diagnosis and surgery. The initial cytological diagnosis may guide management.
ISSN:0021-972X
1945-7197
1945-7197
DOI:10.1210/clinem/dgae108