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Differentiated thyroid cancer patients with a previous indeterminate (Thy 3) cytology have a better prognosis than those with suspicious or malignant FNAC reports

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Abstract

The prognosis of differentiated thyroid cancers (DTC) read at cytology as indeterminate and classified as Thy 3 according to the British Thyroid Association has recently been suggested to be good. To obtain robust information about this potential novelty, in this study we retrospectively reviewed DTC with a prior fine-needle aspiration cytology (FNAC) of Thy 3, Thy 4 or Thy 5 presently followed up at two institutes. Patients with no FNAC before surgery were excluded and a series of 284 DTC was enrolled in the study. Of these, 53 had Thy 3, 108 Thy 4, and 123 had Thy 5 prior to surgery. At histology, 280 (98.6 %) papillary and 4 follicular (1.4 %) cancers were found. Overall, the less aggressive cancer forms were prevalent in all three groups. The lower TNM stages (I and II) were more frequent in the Thy 3 group (96.2 %) than in the other cases (76.6 %) (p < 0.001). Neck lymph node metastasis at diagnosis was found in 3.8 % of Thy 3, 18.5 % of Thy 4, and 26 % of Thy 5 cases. At follow-up, a 16.2 % recurrence rate was recorded, ranging from 1.9 % in Thy 3 group to 19.5 % for Thy 4 and Thy 5 (p < 0.001). According to the Kaplan–Meier curve, Thy 3 was thus a favorable prognostic factor compared with Thy 4 and Thy 5 (OR = 0.079, p < 0.001, 95 %CI 0.01–0.59). At multivariate analysis, Thy 3 was an independent predictor of good prognosis (OR = 0.06, p = 0.03, 95 %CI 0.01–0.80). In conclusion, DTC with a preoperative Thy 3 cytology have a better prognosis than those with Thy 4 and Thy 5 due to less aggressive tumor types and lower TNM stage at diagnosis.

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Authors and Affiliations

  1. Section of Endocrinology and Diabetology, Ospedale Israelitico, Via Fulda, 14, 00148, Rome, Italy

    Pierpaolo Trimboli & Fabio Rossi

  2. Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

    Pierpaolo Trimboli, Luca Ceriani & Luca Giovanella

  3. Institute of Pathology, University Hospital, Lausanne, Switzerland

    Massimo Bongiovanni

  4. Section of Pathology, Ospedale Israelitico, Rome, Italy

    Leo Guidobaldi

  5. Section of Pathology, University Hospital Campus Bio Medico, Rome, Italy

    Anna Crescenzi

  6. Department of Medical and Surgical Sciences, Ospedale S. Andrea, Sapienza University, Rome, Italy

    Giuseppe Nigri & Stefano Valabrega

  7. Department of Experimental Medicine, Sapienza University, Rome, Italy

    Francesco Romanelli

Authors
  1. Pierpaolo Trimboli
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  2. Massimo Bongiovanni
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  3. Fabio Rossi
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  4. Leo Guidobaldi
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  5. Anna Crescenzi
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  6. Luca Ceriani
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  7. Giuseppe Nigri
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  8. Stefano Valabrega
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  9. Francesco Romanelli
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  10. Luca Giovanella
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Correspondence to Pierpaolo Trimboli.

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Trimboli, P., Bongiovanni, M., Rossi, F. et al. Differentiated thyroid cancer patients with a previous indeterminate (Thy 3) cytology have a better prognosis than those with suspicious or malignant FNAC reports. Endocrine 49, 191–195 (2015). https://doi.org/10.1007/s12020-014-0453-1

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  • DOI: https://doi.org/10.1007/s12020-014-0453-1

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