Skip to main content

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 volume 60, pages 31–35 (2018)Cite this article

Abstract

Background

Italian consensus for the classification and reporting of thyroid cytology was published in 2014 and it has been used in almost all Italian institutions. To date, there are not solid data on the reliability of Italian consensus for the classification and reporting of thyroid cytology in classifying low and high risk indeterminate nodules (Tir 3A and Tir 3B, respectively). Here, we reviewed and meta-analyzed the results of published articles to obtain evidence-based information on this topic.

Research design and methods

A comprehensive literature exploration of online databases was conducted by searching all published papers citing Italian consensus for the classification and reporting of thyroid cytology. The search was updated until June 2017, and references of the retrieved articles were also screened. Only original articles reporting histologic follow-up of nodules cytologically classified as Tir 3A and Tir 3B were eligible for inclusion.

Results

The literature search revealed 62 articles and six of these were eligible for the study. All papers were retrospective and published very recently. Overall, 423 indeterminate lesions, of which 180 Tir 3A and 243 Tir 3B, were found. Of these, 29 cancers were recorded in Tir 3A and 127 in Tir 3B. The pooled rate of malignancy was 17% (95% CI = 12 to 22%) in Tir 3A and 52% (95% CI = 46 to 58%) in Tir 3B. No significant publication bias was evident.

Conclusions

Italian consensus for the classification and reporting of thyroid cytology 2014 shows high reliability in discriminating indeterminate lesions at low risk of malignancy from those at high risk.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. H. Gharib, E. Papini, R. Paschke, D.S. Duick, R. Valcavi, L. Hegedüs, P. Vitti, AACE/AME/ETA Task force on thyroid nodules. american association of clinical endocrinologists, associazione medici endocrinologi, and europeanthyroid association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr. Pract. 16, 1–43 (2010)

    Article  PubMed  Google Scholar 

  2. B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G.W. Randolph, A.M. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D.L. Steward, R.M. Tuttle, L. Wartofsky, 2015 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 26, 1–133(2016)

    Article  PubMed  PubMed Central  Google Scholar 

  3. Z.W. Baloch, S. Fleisher, V.A. LiVolsi, P.K. Gupta, Diagnosis of “follicular neoplasm”: a gray zone in thyroid fine-needle aspiration cytology. Diagn. Cytopathol. 26, 41–44 (2002)

    Article  PubMed  Google Scholar 

  4. P. Trimboli, G. Treglia, L. Guidobaldi, E. Saggiorato, G. Nigri, A. Crescenzi, F. Romanelli, F. Orlandi, S. Valabrega, R. Sadeghi, L. Giovanella, Clinical characteristics as predictors of malignancy in patients with indeterminate thyroid cytology: a meta-analysis. Endocrine 46, 52–59 (2014)

    CAS  Article  PubMed  Google Scholar 

  5. P. Trimboli, E. Condorelli, A. Catania, S. Sorrenti, Clinical and ultrasound parameters in the approach to thyroid nodules cytologically classified as indeterminate neoplasm. Diagn. Cytopathol. 37, 783–785 (2009)

    Article  PubMed  Google Scholar 

  6. A. Heinzel, D. Müller, F.F. Behrendt, L. Giovanella, F.M. Mottaghy, F.A. Verburg, Thyroid nodules with indeterminate cytology: molecular imaging with 99mTc-methoxyisobutylisonitrile (MIBI) is more cost-effective than the Afirma gene expression classifier. Eur. J. Nucl. Med Mol. Imaging 41, 1497–1500 (2014)

    Article  PubMed  Google Scholar 

  7. L. Giovanella, L. Ceriani, G. Treglia, Role of isotope scan, including positron emission tomography/computed tomography, in nodular goitre. Best. Pract. Res Clin. Endocrinol. Metab. 28, 507–518 (2014)

    Article  PubMed  Google Scholar 

  8. A. Bartolazzi, F. Orlandi, E. Saggiorato, M. Volante, F. Arecco, R. Rossetto, N. Palestini, E. Ghigo, M. Papotti, G. Bussolati, M.P. Martegani, F. Pantellini, A. Carpi, M.R. Giovagnoli, S. Monti, V. Toscano, S. Sciacchitano, G.M. Pennelli, C. Mian, M.R. Pelizzo, M. Rugge, G. Troncone, L. Palombini, G. Chiappetta, G. Botti, A. Vecchione, R. Bellocco; Italian Thyroid Cancer Study Group (ITCSG), Galectin-3-expression analysis in the surgical selection of follicular thyroid nodules with indeterminate fine-needle aspiration cytology: a prospective multicentre study. Lancet Oncol. 9, 543–549 (2008)

    CAS  Article  PubMed  Google Scholar 

  9. P. Trimboli, G. Treglia, E. Condorelli, F. Romanelli, A. Crescenzi, M. Bongiovanni, L. Giovanella, BRAF mutated carcinomas among thyroid nodules with prior indeterminate FNA report: a systematic review and meta-analysis. Clin. Endocinol 84, 315–320 (2016)

    CAS  Article  Google Scholar 

  10. P. Trimboli, G. Treglia, R. Sadeghi, F. Romanelli, L. Giovanella, Reliability of real-time elastography to diagnose thyroid nodules previously read at FNAC as indeterminate: a meta-analysis. Endocrine 50, 335–343 (2015)

    CAS  Article  PubMed  Google Scholar 

  11. P. Trimboli, A. Crescenzi, Thyroid core needle biopsy: taking stoke of the situation. Endocrine 48, 779–785 (2015)

    CAS  Article  PubMed  Google Scholar 

  12. E.K. Alexander, G.C. Kennedy, Z.W. Baloch, E.S. Cibas, D. Chudova, J. Diggans, L. Friedman, R.T. Kloos, V.A. LiVolsi, S.J. Mandel, S.S. Raab, J. Rosai, D.L. Steward, P.S. Walsh, J.I. Wilde, M.A. Zeiger, R.B. Lanman, B.R. Haugen, Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N. Engl. J. Med 367, 705–715 (2012)

    CAS  Article  PubMed  Google Scholar 

  13. P. Perros, K. Boelaert, S. Colley, C. Evans, R.M. Evans, G. Gerrard Ba, J. Gilbert, B. Harrison, S.J. Johnson, T.E. Giles, L. Moss, V. Lewington, K. Newbold, J. Taylor, R.V.Thakker, J. Watkinson, G.R.Williams British Thyroid Association Guidelines for the management of thyroid cancer. Clin. Endocrinol. 81, 1–122 (2014)

    CAS  Article  Google Scholar 

  14. E.S. Cibas, S.Z. Ali, The bethesda system for reporting thyroid cytopathology. Thyroid 19, 1159–1165 (2009)

    Article  PubMed  Google Scholar 

  15. F. Nardi, F. Basolo, A. Crescenzi, G. Fadda, A. Frasoldati, F. Orlandi, L. Palombini, E. Papini, M. Zini, A. Pontecorvi, P. Vitti, Italian consensus for the classification and reporting of thyroid cytology. J. Endocrinol. Invest 37, 593–599 (2014)

    Article  PubMed  Google Scholar 

  16. A.A. Renshaw, Should “atypical follicular cells” in thyroid fine-needle aspirates be subclassified? Cancer Cytopathol. 118, 186–189 (2010)

    Article  PubMed  Google Scholar 

  17. P.A. Vanderlaan, E. Marqusee, J.F. Krane, Usefulness of diagnostic qualifiers for thyroid, fine-needle aspirations with atypia of undetermined significance. Am. J. Clin. Pathol. 136, 572–577 (2011)

    Article  PubMed  Google Scholar 

  18. P. Straccia, E.D. Rossi, T. Bizzarro, C. Brunelli, F. Cianfrini, D. Damiani, G. Fadda, A meta-analytic review of the Bethesda System for Reporting Thyroid Cytopathology: Has the rate of malignancy in indeterminate lesions been underestimated? Cancer Cytopathol. 123, 713–722 (2015)

    Article  PubMed  Google Scholar 

  19. R. DerSimonian, N. Laird, Meta-analysis in clinical trials. Control Clin. Trials 7, 177–188 (1986)

    CAS  Article  PubMed  Google Scholar 

  20. P. Trimboli, L. Guidobaldi, S. Amendola, N. Nasrollah, F. Romanelli, D. Attanasio, G. Ramacciato, E. Saggiorato, S. Valabrega, A. Crescenzi, Galectin-3 and HBME-1 improve the accuracy of core biopsy in indeterminate thyroid nodules. Endocrine 52, 39–45 (2016)

    CAS  Article  PubMed  Google Scholar 

  21. F. Tartaglia, A. Giuliani, L. Tromba, S. Carbotta, M. Karpathiotakis, G. Tortorelli, F. Pelle, R. Merola, C. Donello, G. Carbotta, L. De Anna, G. Conzo, S. Sorrenti, S. Ulisse, Fine needle aspiration cytology of 650 thyroid nodules operated for multinodular goiter: a cyto-histological correlation based on the new Italian cytological classification (siapec 2014). J. Biol. Regul. Homeost. Agents 30, 1187–1193 (2016)

    CAS  PubMed  Google Scholar 

  22. G. Grani, L. Lamartina, V. Ascoli, D. Bosco, F. Nardi, F. D’Ambrosio, A. Rubini, L. Giacomelli, M. Biffoni, S. Filetti, C. Durante, V. Cantisani, Ultrasonography scoring systems can rule out malignancy in cytologically indeterminate thyroid nodules. Endocrine 57, 256–261 (2017)

    CAS  Article  PubMed  Google Scholar 

  23. F. Quaglino, V. Marchese, E. Mazza, C. Gottero, R. Lemini, S. Taraglio, When is thyroidectomy the right choice? comparison between fine-needle aspiration and final histology in a single institution experience. Eur. Thyroid J. 6, 94–100 (2017)

    Article  PubMed  Google Scholar 

  24. S. Ulisse, D. Bosco, F. Nardi, A. Nesca, E. D’Armiento, V. Guglielmino, C. De Vito, S. Sorrenti, D. Pironi, F. Tartaglia, S. Arcieri, A. Catania, M. Monti, A. Filippini, V. Ascoli, 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 (2017)

    Article  PubMed  PubMed Central  Google Scholar 

  25. F. Medas, E. Erdas, L. Gordini, G. Conzo, C. Gambardella, G.L. Canu, G. Pisano, A. Nicolosi, P.G. Calò, Risk of malignancy in thyroid nodules classified as TIR-3A: What therapy? Int J. Surg. 41, S60–S64 (2017)

Download references

Author information

Authors and Affiliations

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

    Pierpaolo Trimboli & Luca Giovanella

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

    Anna Crescenzi

Authors
  1. Pierpaolo Trimboli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Crescenzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luca Giovanella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pierpaolo Trimboli.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Trimboli, P., Crescenzi, A. & Giovanella, L. 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). https://doi.org/10.1007/s12020-017-1382-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-017-1382-6

Keywords

  • Fine needle aspiration (FNA)
  • Indeterminate
  • Thyroid
  • Carcinoma