Impact of Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features on Revised Bethesda System Malignancy Rates at a Single Institution.

BACKGROUND: The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) standardizes thyroid cytopathology reporting in six tier diagnostic categories. In recent years, noninvasive encapsulated follicular variant of papillary thyroid carcinoma was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This study examines the impact of NIFTP on the BSRTC risk of malignancy (ROM). METHODS: This was a retrospective review of prospectively collected data from 565 patients who underwent fine needle aspiration and thyroidectomy at a single institution. ROM for each Bethesda category was analyzed and calculated with NIFTP classified as a malignant and nonmalignant lesion. Absolute and relative differences between ROM were compared. RESULTS: Of 565 patients, 19 were Bethesda I, 159 were Bethesda II, 178 were Bethesda III, 46 were Bethesda IV, 42 were Bethesda V, and 121 were Bethesda VI. ROM differences with NIFTP classified as malignant versus nonmalignant for each class were as follows: Bethesda I, no change; Bethesda II, 18%-14%; Bethesda III, 55%-48%; Bethesda IV, 50%-35%; Bethesda V, 93%-91%; and Bethesda VI, 99%-98%. Absolute ROM differences for each category were as follows: Bethesda I, 0%; Bethesda II, 4%; Bethesda III, 7%; Bethesda IV, 15%; Bethesda V, 2%; and Bethesda VI, 1%. CONCLUSIONS: A decreasing trend in absolute and relative ROM was seen in Bethesda II, III, and IV categories; however, exclusion of NIFTP as a malignant lesion did not significantly alter the ROM of BSRTC categories. Surgeons should assess their respective institution's experiences with NIFTP and the BSRTC.

Long-term outcome success after operative treatment for primary aldosteronism.

BACKGROUND: Primary aldosteronism is a common cause of secondary hypertension. Resolution of hypertension and hypokalemia after adrenalectomy for primary aldosteronism is variable. This study examines preoperative factors for persistent hypertension and long-term outcome after laparoscopic adrenalectomy in patients with primary aldosteronism. METHODS: We reviewed all patients who underwent laparoscopic resection for adrenal tumors from 2010 to 2018. Biochemical success was defined as normalization of hypokalemia and the aldosterone-to-renin ratio. Clinical success was defined as normalization of blood pressure requiring no antihypertensive medications. Descriptive statistics and binary logistic regression analysis were used. RESULTS: Of 202 patients who underwent unilateral laparoscopic adrenalectomy, 37 (18%) had biochemical and clinical confirmation of primary aldosteronism. Postoperatively, biochemical success was attained in all 37 patients with primary aldosteronism. Complete, partial, and absent clinical success was achieved in 41%, 38%, and 21% of patients, respectively. Number of antihypertensives (odds ratio, 2.30 per medication; 95% confidence interval, 1.07-4.93; P < .05), duration of hypertension (odds ratio, 1.11 per year; 95% confidence interval, 1.03-1.25; P < .05), and increased body mass index (odds ratio, 1.13; 95% confidence interval, 1.01-1.29; P < .05) were preoperative factors associated with absent clinical success. CONCLUSION: Biochemical success is more common than clinical resolution of hypertension after adrenalectomy for primary aldosteronism. The number of antihypertensive medications, longstanding hypertension, and high body mass index are preoperative factors associated with absent clinical success.