Cancer Rate of the Indeterminate Lesions at Low or High Risk According to Italian System for Reporting of Thyroid FNA.

Stefano Valabrega,Maria R Giovagnoli,Francesco D'Angelo,Luciano Izzo,Giuliano Santolamazza,Paolo Aurello,Francesco Romanelli,Pierpaolo Trimboli,Carlo Bellotti,Giorgia Scapicchio

doi:10.3389/fendo.2018.00371

Abstract

Background: Italian consensus for the classification and reporting of thyroid cytology (ICCRTC) has been used in almost all Italian institutions since 2014. High reliability of ICCRTC in classifying low and high risk indeterminate nodules (Tir 3A and Tir 3B, respectively) was demonstrated. Here we reviewed our casuistry of thyroid indeterminate lesions to analyze the histologic outcome.Methods: All lesions undergone FNA and final histology at S. Andrea Hospital of Rome after a cytologic assessment of Tir 3A and Tir 3B, according to ICCRTC, were included in the study.Results: A number of 157 indeterminate FNA was found after the introduction of ICCRTC. Of these, 75 undergone surgery and were finally included for the study. At histology we found a 33.3% of cancers and a 67.7% of benign lesions. Out of the overall series, 25 were classified as Tir 3A and 50 as Tir 3B. Cancer rate observed in Tir 3A (1/25, 4%) was significantly (p = 0.0002) lower than that of Tir 3B (24/50, 48%). No significant difference was found in age and size between the two subcategories.Conclusions: We confirm in our series that Italian consensus for the classification and reporting of thyroid cytology allows to discriminate indeterminate lesions at low and high risk of malignancy.

Highlights

Cytology from fine-needle aspiration (FNA) is recognized as the pivotal evaluation of thyroid nodules to detect malignancy and benign lesions [1, 2]
We initially searched in our database all nodules cytologically classified as indeterminate after the systematic introduction of ICCRTC at our institute (December 2014) and the last search was performed on 30 April 2018
Thyroid nodules with indeterminate FNA report are generally addressed to surgery in presence of ultrasound or clinical features suspicious for malignancy or when they are within a large goiter with compressive symptoms

Summary

Introduction

Cytology from fine-needle aspiration (FNA) is recognized as the pivotal evaluation of thyroid nodules to detect malignancy and benign lesions [1, 2]. The most significant limit of FNA is represented by indeterminate cytologic report which occurs in up to 20–25% of all FNA. Out of these cases, only a rate of one in four or one in three is expected to be a cancer at final histology. To preoperatively diagnose thyroid nodules cytologically classified as indeterminate has represented one major challenge [3]. Italian consensus for the classification and reporting of thyroid cytology (ICCRTC) has been used in almost all Italian institutions since 2014. High reliability of ICCRTC in classifying low and high risk indeterminate nodules (Tir 3A and Tir 3B, respectively) was demonstrated. We reviewed our casuistry of thyroid indeterminate lesions to analyze the histologic outcome

Methods

Results

Conclusion