Journal of Endocrinological Investigation

, Volume 42, Issue 1, pp 1–6 | Cite as

Clinical impact of the new SIAPEC-IAP classification on the indeterminate category of thyroid nodules

  • C. Sparano
  • G. Parenti
  • A. Cilotti
  • L. Bencini
  • M. Calistri
  • E. Mannucci
  • C. Biagini
  • V. Vezzosi
  • M. Mannelli
  • G. Forti
  • L. PetroneEmail author
Original Article



The increasing frequency in the diagnosis of thyroid nodules has raised a growing interest in the search for new diagnostic tools to better select patients deserving surgery. In 2014, the major Italian Societies involved in the field drafted a new cytological classification, to better stratify pre-surgical risk of thyroid cancer, especially for the indeterminate category, split into TIR3A and TIR3B subclasses, associated to different therapeutic decisions.

Materials and methods

This retrospective cross-sectional survey analyzed thyroid fine-needle aspiration biopsy performed at our outpatient clinic before and after the introduction of the new SIAPEC-IAP consensus in May 2014.


8956 thyroid nodules were included in the analysis: 5692 were evaluated according to the old classification and 3264 according to the new one. The new criteria caused the overall prevalence of TIR3 to increase from 6.1 to 20.1%. Of those, 10.7 and 9.4% were included in the TIR3A and TIR3B subgroups, respectively. Each of the 213 TIR3B nodules underwent surgery and 86 (40.4%) were diagnosed as thyroid cancer, while among the 349 TIR3A nodules, only 15 of the 60 that underwent surgery were found to be thyroid cancer.


This analysis shows that the new SIAPEC-IAC criteria significantly increased the proportion of the overall TIR3 diagnosis. The division of TIR3 nodules into two subgroups (A and B) allowed a better evaluation of the oncologic risk and a better selection of patients to be referred to surgery.


Thyroid nodules Indeterminate thyroid cytology Thyroid cancer Thyroid FNA 



All the authors would like to thank Mrs Tania Del Soldato, professional nurse, for her precious help in collecting data.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this paper.

Ethical approval

All procedures performed in our study 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.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Belfiore A, Rosa GL, Giuffrida D, Regalbuto C, Lupo L, Fiumara A, Ippolito O (1995) The management of thyroid nodules. J Endocrinol Investig 18:155–158CrossRefGoogle Scholar
  2. 2.
    Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, Cronan JJ, Doubilet PM, Evans DB, Goellner JR, Hay ID, Hertzberg BS, Intenzo CM, Jeffrey RB, Langer JE, Larsen PR, Mandel SJ, Middleton WD, Reading CC, Sherman SI, Tessler FN (2005) Society of Radiologists in Ultrasound Management of thyroid nodules detected at US: Society of Radiologists in ultrasound consensus conference statement. Radiology 237(3):794–800CrossRefGoogle Scholar
  3. 3.
    Hegedüs L (2004) Clinical practice. The thyroid nodule. N Engl J Med 351(17):1764–1771CrossRefGoogle Scholar
  4. 4.
    Tan GH, Gharib H (1997) Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 126(3):226–231CrossRefGoogle Scholar
  5. 5.
    Knobel M (2015) Etiopathology, clinical features, and treatment of diffuse and multinodular nontoxic goiters. J Endocrinol Investig. CrossRefGoogle Scholar
  6. 6.
    Siegel R, Ma J, Zou Z, Jemal A (2014) Cancer statistic 2014. CA Cancer J Clin 64:9–29CrossRefGoogle Scholar
  7. 7.
    Chen AY, Jemal A, Ward EM (2009) Increasing incidence of differentiated thyroid cancer in the United States, 1988–2005. Cancer 115(16):3801–3807CrossRefGoogle Scholar
  8. 8.
    Mazzaferri EL (1993) Management of a solitary thyroid nodule. N Engl J Med 328(8):553–559CrossRefGoogle Scholar
  9. 9.
    Ali SZ, Cibas ES (2010) The Bethesda system for reporting thyroid cytopathology: definitions, criteria and explanatory notes. Springer, New YorkCrossRefGoogle Scholar
  10. 10.
    British Thyroid Association, Royal College of Physicians (2014) Guidelines for the management of thyroid cancer. In: Perros P (ed) Report of the thyroid cancer guidelines update group, vol 3. Royal College of Physicians, LondonGoogle Scholar
  11. 11.
    Lobo C, McQueen A, Beale T, Kocjan G (2011) The UK Royal College of Pathologist thyroid fine needle aspiration diagnostic classification is a robust tool for the clinical management of abnormal thyroid nodules. Acta Cytol 55:499–506CrossRefGoogle Scholar
  12. 12.
    Kocjan G, Chandra A, Cross PA et al (2011) The interobserver reproducibility of thyroid fine needle aspiration using the UK Royal College of Pathologists’ classification system. Am J Clin Pathol 135:852–859CrossRefGoogle Scholar
  13. 13.
    Fadda G, Basolo F, Bondi A et al (2010) Cytological classification of thyroid nodules. Proposal of the SIAPEC-IAP Italian Consensus Working Group. Pathological 102:405–408Google Scholar
  14. 14.
    Nardi F, Basolo F, Crescenzi A et al (2014) Italian consensus for the classification and reporting of thyroid cytology. J Endocrinol Investig 37:593–599CrossRefGoogle Scholar
  15. 15.
    Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM (2009) American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid. Thyroid. CrossRefPubMedGoogle Scholar
  16. 16.
    Haugen BR, Alexander EK, Bible KC et al (2016) American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133CrossRefGoogle Scholar
  17. 17.
    British Thyroid Association, Royal College of Physicians (2007) Guidelines for the management of thyroid cancer. In: Perros P (ed) Report of the thyroid cancer update group, 2nd edn. Royal College of Physicians, LondonGoogle Scholar
  18. 18.
    De Lellis RA, Lloyd RV, Heitz PU, Eng C (eds) (2004) Pathology and genetics of tumors of endocrine organs. IARC Press, Lyon. World Health Organization Classification of TumorsGoogle Scholar
  19. 19.
    Edge SB (2010) American Joint Committee on Cancer: AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
  20. 20.
    Amin MB (2017) American Joint Committee on Cancer: AJCC cancer staging manual, 8th edn. Springer, New YorkCrossRefGoogle Scholar
  21. 21.
    Rullo E, Minelli G, Bosco D, Nardi F, Ascoli V (2017) Evaluation of the Italian cytological subclassiication of thyroid indeterminate nodules into TIR-3A and TIR-3B: a retrospective study of 290 cases with histological correlation from a single institution. J Endocrinol Investig.
  22. 22.
    Trimboli P, Crescenzi A, Giovanella L (2017) 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. CrossRefPubMedGoogle Scholar
  23. 23.
    Straccia P, Santoro A, Rossi ED, Brunelli C, Mosseri C, Musarra T, Pontecorvi A, Lombardi CP, Fadda G (2017) Incidence, malignancy rates of diagnoses and cyto-histological correlations in the new Italian reporting system for thyroid cytology: an institutional experience. Cytopathology. CrossRefPubMedGoogle Scholar
  24. 24.
    Ulisse S, Bosco D, Nardi F, Nesca A, D’Armiento E, Guglielmino V, De Vito C, Sorrenti S, Pironi D, Tartaglia F, Arcieri S, Catania A, Monti M, Filippini A, Ascoli V (2017) Thyroid imaging reporting and data system score combined with the new Italian classification for thyroid cytology improves the clinical management of indeterminate nodules. Int J Endocrinol 2017:9692304. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Pu RT, Yang J, Wasserman PG, Bhuiya T, Griffith KA, Michael CW (2006) Does Hurthle cell lesion/neoplasm predict malignancy more than follicular lesion/neoplasm on thyroid fine-needle aspiration? Diagn Cytopathol 34(5):330–334CrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2018

Authors and Affiliations

  • C. Sparano
    • 1
  • G. Parenti
    • 2
  • A. Cilotti
    • 2
  • L. Bencini
    • 3
  • M. Calistri
    • 3
  • E. Mannucci
    • 1
  • C. Biagini
    • 4
  • V. Vezzosi
    • 5
  • M. Mannelli
    • 1
  • G. Forti
    • 1
  • L. Petrone
    • 2
    Email author
  1. 1.Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
  2. 2.Endocrinology Unit, Medical-Geriatric DepartmentAzienda Ospedaliero-Universitaria CareggiFlorenceItaly
  3. 3.Department of Oncologic Surgery and RoboticsAzienda Ospedaliero-Universitaria CareggiFlorenceItaly
  4. 4.Ultrasound ServiceDiagnostic Center of the Pubblica Assistenza di SignaFlorenceItaly
  5. 5.Department of Histopathology and Molecular DiagnosticsAzienda Ospedaliero-Universitaria CareggiFlorenceItaly

Personalised recommendations