Malignancy risk in Bethesda class IV thyroid nodules in an iodine deficient region

• Published in: Gland surgery 2023-07, Vol.12 (7), p.884-893
• Main Authors: Loderer, Tommaso, Bonati, Elena, Donato, Valentina, Viani, Lorenzo, Cozzani, Federico, Rio, Paolo Del
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2227-684X; 2227-8575
• DOI: 10.21037/gs-22-491

BackgroundAccording to the latest guidelines, in patients with high-risk nodules with indeterminate cytology, diagnostic lobectomy should be the preferable surgical approach in the absence of factors that suggest a total thyroidectomy.MethodsThis retrospective observational study has as its main aim the evaluation of the cases that underwent surgery, for Bethesda class IV nodules in our iodocarent geographical area. Particular attention was paid to carcinoma incidence, preoperative nodule size, histological characteristics of the neoplasm, surgical approach and eventual need of radiometabolic treatment. A total of 320 patients were included that underwent surgery for Bethesda IV nodules, between January 2010 and December 2020, at the General Surgical Clinic of the University Hospital of Parma, Italy.ResultsA total of 230 total thyroidectomies (71.9%) and 90 lobectomies (28.1%) were performed. Our data showed a strong impact of the 2015 ATA Guidelines on the surgical approach choice, with a progressive propensity towards a conservative approach and an increase of lobectomies from 7.2% to 41.5% after the new guidelines introduction. However, in our sample the percentage of lobectomies remains below 50%; this data is certainly influenced by the number of cases of multinodular pathology, often bilateral, in our geographical area. The nodules malignancy rate resulted 28.8%. Our data showed that increasing size correlated with an increasing malignancy rate (P