Abstract
Purpose Aim of the study was to assess the impact of the Italian Society of Anatomic Pathology and Diagnostic Cytology (SIAPEC) classification of 2014, on the treatment of indeterminate thyroid lesions (TIR3). Methods We retrospectively analyzed patients undergoing thyroid surgery for TIR3 lesions between 2013 and 2018, at the General Surgery Department of Trieste University Hospital. According to the SIAPEC classification, patients were divided into TIR3A and TIR3B groups. All patients treated before 2014 underwent surgical treatment, and surgical specimens were retrospectively classified after revision of fine-needle aspiration cytology. Starting 2014, TIR3A patients were treated only when symptomatic (i.e., coexistent bilateral thyroid goiter or growing TIR3A nodules), whereas TIR3B patients always received surgical treatment. Hemithyroidectomy (HT) was the procedure of choice. Total thyroidectomy (TT) was performed in case of concurrent bilateral goiter, autoimmune thyroid disease, and/or presence of BRAF and/or RAS mutation. Lastly, we analyzed the malignancy rate in the two groups. Results 29 TIR3A and 90 TIR3B patients were included in the study. HT was performed in 10 TIR3A patients and 37 TIR3B patients, respectively, with need for reoperation in 4 TIR3B (10.8%) patients due to histological findings of follicular thyroid carcinoma >1 cm. The malignancy rates were 17.2% in TIR3A and 31.1% in TIR3B, (p = 0.16). Predictability of malignancy was almost 89% in BRAF mutation and just 47% in RAS mutation. Conclusions The new SIAPEC classification in association with biomolecular markers has improved diagnostic accuracy, patient selection, and clinical management of TIR3 lesions.
Highlights
Aim of the study was to assess the impact of the Italian Society of Anatomic Pathology and Diagnostic Cytology (SIAPEC) classification of 2014, on the treatment of indeterminate thyroid lesions (TIR3)
In 2007, the United States National Cancer Institute (NCI) proposed the Bethesda System for Reporting yroid Cytology (BSRTC), in which indeterminate nodules were divided in class III or Atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) and class IV or FN/ SFN, with different expected malignancy rates and management options [19]
Anyway, estimated rates of cancer are less than 10% for TIR3A and 15–30% for TIR3B, which are essentially similar to those reported by the BSRTC and British yroid Association (BTA)/Royal College of Pathologists (RCPath) classifications (i.e., 5–15% rates for the AUS/FLUS and THY3a categories and 15–30% for the FN/ SFN and THY3f categories, respectively) [19, 20]
Summary
Aim of the study was to assess the impact of the Italian Society of Anatomic Pathology and Diagnostic Cytology (SIAPEC) classification of 2014, on the treatment of indeterminate thyroid lesions (TIR3). The Italian Society of Anatomic Pathology and Diagnostic Cytology (SIAPEC) modified the previous classification of TIR3 indeterminate lesions by introducing two different subclasses, namely, TIR3A (low-risk indeterminate), for which clinical and radiological follow-up may be adequate, and TIR3B (high-risk indeterminate), for which surgery is always required [21, 22]. It has to be noted that, unlike the BSRTC and BTA-RCPath systems, the 2014 SIAPEC classification extended the TIR3B category to include those cases with mild or focal nuclear atypia suggestive of papillary carcinoma, which are expected to have a higher risk of malignancy [13, 21, 22]. Several studies evaluating the BSRTC and BTA/RCPath classification systems have reported higher than expected malignancy rates [23, 24], whereas a more accurate estimate of the risk of malignancy for the indeterminate lesions have been observed with the adoption of the 2014 SIAPEC classification [25,26,27,28]
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