Prognosis of patients with differentiated thyroid carcinomas having a preoperative cytological report of indeterminate at low or high risk. A multicenter study
- 67 Downloads
Italian cytology system for thyroid fine-needle aspiration (FNA) includes indeterminate lesions at low- (Tir 3A) and high-risk (Tir 3B). The present retrospective multicenter study was undertaken to compare the histological type of cancers and disease-free survival in these two groups.
Eight institutions participated. Thyroid cancer patients diagnosed and followed-up after Tir 3A or Tir 3B were reviewed. Histological diagnosis was adopted as the gold standard. Patients were defined with cancer recurrence or no evidence of disease. Disease-free survival (DFS) was calculated. A non-parametric statistical analysis was used. DFS was estimated by Kaplan–Meier method and Hazard Ratio (HR) defined the slope of curves.
Two hundred and nine patients (median DFS 24 months) were enrolled and a 6.3% of these recurred. Tir 3B group had higher age (p = 0.014), larger cancer size (p = 0.0002), shorter DFS (p = 0.003), higher number of aggressive cancers (p = 0.006), and relapse frequency double than Tir 3A. At survival curves analysis, Tir 3B group had HR of 2.37 with respect to Tir 3A. At Cox’s proportional hazard regression analysis histology was the only significant predictor of relapse.
While patients with thyroid FNA of Tir 3B should be addressed to surgery due to high likelihood of more aggressive cancer, a diagnostic surgery could be avoided in patients with Tir 3A if concurrent unsuspicious clinical features are found.
KeywordsFine-needle aspiration (FNA) Indeterminate nodules Thyroid Carcinoma Follow-up
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 1.H. Gharib, E. Papini, R. Paschke et al. American association of clinical endocrinologists, associazione medici endocrinologi, and european thyroid association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr. Pract. 16(Suppl 1), 1–43 (2010)CrossRefGoogle Scholar
- 2.B.R. Haugen, E.K. Alexander, K.C. Bible et al. American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016(26), 1–133 (2015)Google Scholar
- 8.P. Trimboli, A. Crescenzi, L. Giovanella, Performance of Italian consensus for the classification and reporting of thyroid cytology (ICCRTC) in discriminating indeterminate lesions at low and high risk of malignancy. A systematic review and meta-analysis. Endocrine 60, 31–35 (2018)CrossRefGoogle Scholar
- 9.P. Trimboli, A. Crescenzi, M. Castellana, F. Giorgino, L. Giovanella, M. Bongiovanni, Italian consensus for the classification and reporting of thyroid cytology: the risk of malignancy between indeterminate lesions at low or high risk. A systematic review and meta-analysis. Endocrine 63(3), 430–438 (2018)CrossRefGoogle Scholar
- 11.WHO Classification of Tumours of Endocrine Organs, 4th edn., vol. 10, ed. by R.V. Lloyd, R.Y. Osamura, G. Klöppel, J. Rosai (International Agency for Research on Cancer, Lyon, 2017)Google Scholar
- 16.P. Valderrabano, L. Khazai, Z.J. Thompson, S.C. Sharpe, V.D. Tarasova, K.J. Otto, J.E. Hallanger-Johnson, J.T. Wadsworth, B.M. Wenig, C.H. Chung, B.A. Centeno, B. McIver, Cancer risk associated with nuclear atypia in cytologically indeterminate thyroid nodules: a systematic review and meta-analysis. Thyroid 28, 210–219 (2018)CrossRefGoogle Scholar
- 17.M. Bongiovanni, L. Giovanella, F. Romanelli, P. Trimboli, Cytological diagnoses associated with non-invasive follicular thyroid neoplasms with papillary-like nuclear features, (NIFTP) according to the Bethesda System for Reporting Thyroid Cytopathology: a systematic review and meta-analysis. Thyroid 29, 222–228 (2018)Google Scholar
- 18.T. Rago, M. Scutari, F. Latrofa, V. Loiacono, P. Piaggi, I. Marchetti, R. Romani, F. Basolo, P. Miccoli, M. Tonacchera et al. The large majority of 1520 patients with indeterminate thyroid nodule at cytology have a favorable outcome, and a clinical risk score has a high negative predictive value for a more cumbersome cancer disease. J. Clin. Endocrinol. Metab. 99, 3700–3707 (2014)CrossRefGoogle Scholar
- 19.P. Trimboli, M. Bongiovanni, F. Rossi, L. Guidobaldi, A. Crescenzi, L. Ceriani, G. Nigri, S. Valabrega, F. Romanelli, L. Giovanella, 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)CrossRefGoogle Scholar
- 20.M. Deandrea, F. Ragazzoni, M. Motta, B. Torchio, A. Mormile, F. Garino, G. Magliona, E. Gamarra, M.J. Ramunni, R. Garberoglio, P.P. Limone, Diagnostic value of a cytomorphological subclassification of follicular patterned thyroid lesions: a study of 927 consecutive cases with histological correlation. Thyroid 20, 1077–1083 (2010)CrossRefGoogle Scholar
- 21.S. Sciacchitano, L. Lavra, A. Ulivieri, F. Magi, T. Porcelli, S. Amendola, G.P. De Francesco, C. Bellotti, M.C. Trovato, L.B. Salehi, et al. Combined clinical and ultrasound follow-up assists in malignancy detection in Galectin-3 negative Thy-3 thyroid nodules. Endocrine 54, 139–147 (2016)CrossRefGoogle Scholar