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Sparano C, Puccioni M, Adornato V, Zago E, Fibbi B, Badii B, Bencini L, Mannelli G, Vezzosi V, Maggi M, Petrone L. Improving the TIR3B oncological stratification: try to bridge the gap through a comprehensive presurgical algorithm. J Endocrinol Invest 2024; 47:633-643. [PMID: 37736856 PMCID: PMC10904402 DOI: 10.1007/s40618-023-02182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Indeterminate cytology still puzzles clinicians, due to its wide range of oncological risks. According to the Italian SIAPEC-IAP classification, TIR3B cytology holds up to 30% of thyroid cancer, which justifies the surgical indication, even if more than half of cases do not result in a positive histology. The study aim is to identify potential clinical, ultrasound or cytological features able to improve the surgical indication. METHODS Retrospective analysis. A consecutive series of TIR3B nodules referred to the Endocrine Unit of Careggi Hospital from 1st May 2014 to 31st December 2021 was considered for the exploratory analysis (Phase 1). Thereafter, a smaller confirmatory sample of consecutive TIR3B diagnosed and referred to surgery from 1st January 2022 to 31st June 2022 was considered to verify the algorithm (Phase 2). The main clinical, ultrasound and cytological features have been collected. A comprehensive stepwise logistic regression was applied to build a prediction algorithm. The histological results represented the final outcome. RESULTS Of 599 TIR3B nodules referred to surgery, 451 cases were included in the exploratory analysis. A final score > 14.5 corresponded to an OR = 4.98 (95% CI 3.24-7.65, p < 0.0001) and showed a PPV and NPV of 57% and 79%, respectively. The Phase 2 analysis on a confirmatory sample of 58 TIR3B cytology confirmed that a threshold of 14.5 points has a comparable PPV and NPV of 53% and 80%, respectively. CONCLUSIONS A predictive algorithm which considers the main clinical, US and cytological features can significantly improve the oncological stratification of TIR3B cytology.
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Affiliation(s)
- C Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - M Puccioni
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - V Adornato
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - E Zago
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - B Fibbi
- Endocrinology Unit, Medical-Geriatric Department, Careggi University Hospital, Viale Pieraccini 18, 50139, Florence, Italy
| | - B Badii
- Unit of Endocrine Surgery, Careggi University Hospital, Florence, Italy
| | - L Bencini
- Division of General Surgery, Department of Oncology and Robotic Surgery, Careggi University Hospital, Florence, Italy
| | - G Mannelli
- Head and Neck Oncology and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
| | - V Vezzosi
- Department of Histopathology and Molecular Diagnostics, Careggi University Hospital, Florence, Italy
| | - M Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
- Consorzio I.N.B.B, 00136, Rome, Italy
| | - L Petrone
- Endocrinology Unit, Medical-Geriatric Department, Careggi University Hospital, Viale Pieraccini 18, 50139, Florence, Italy.
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Croce L, Teliti M, Chytiris S, Sparano C, Coperchini F, Villani L, Calì B, Petrone L, Magri F, Trimboli P, Rotondi M. The American Thyroid Association risk classification of papillary thyroid cancer according to presurgery cytology. Eur J Endocrinol 2024; 190:165-172. [PMID: 38298148 DOI: 10.1093/ejendo/lvae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/22/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE To compare the American Thyroid Association (ATA) risk staging of histologically proven papillary thyroid cancer (PTC) in patients who received a presurgery cytologic result of either indeterminate thyroid nodules (ITNs, Bethesda III/IV) or suspicious for malignancy/malignant (TIR 4/5, Bethesda V/VI). METHODS Clinical, ultrasonographic, cytological data from patients with histologically diagnosed PTC were retrospectively collected. RESULTS Patients were stratified according to the preoperative fine-needle aspiration cytology into 2 groups: 51 ITNs (TIR3A/3B) and 118 suspicious/malignant (TIR 4/5). Male/female ratio, age, and presurgery TSH level were similar between the 2 groups. At ultrasound, TIR 4/5 nodules were significantly more frequently hypoechoic (P = .037), with irregular margins (P = .041), and with microcalcifications (P = .020) and were more frequently classified as high-risk according to the European Thyroid Imaging and Reporting Data System (EU-TIRADS; P = .021). At histology, the follicular PTC subtype was significantly more prevalent among ITNs while classical PTC subtype was more frequent in TIR 4/5 group (P = .002). In TIR 4/5 group, a higher rate of focal vascular invasion (P < .001) and neck lymph node metastasis (P = .028) was observed. Intermediate-risk category according to ATA was significantly more frequent in TIR 4/5 group while low-risk category was more frequently found among ITNs (P = .021), with a higher number of patients receiving radioiodine in TIR 4/5 group (P = .002). At multivariate logistic regression, having a TIR 4/5 cytology was associated with a significant risk of having a higher ATA risk classification as compared to ITN (OR 4.6 [95% CI 1.523-14.007], P = .007), independently from presurgery findings (nodule size at ultrasound, sex, age, and EU-TIRADS score). CONCLUSIONS Papillary thyroid cancers recorded among ITNs are likely less aggressive and are generally assessed as at lower risk according to ATA classification.
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Affiliation(s)
- Laura Croce
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, PV 27100, Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, PV 27100, Italy
| | - Marsida Teliti
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, PV 27100, Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, PV 27100, Italy
| | - Spyridon Chytiris
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, PV 27100, Italy
| | - Clotilde Sparano
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, FI 50134, Italy
| | - Francesca Coperchini
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, PV 27100, Italy
| | - Laura Villani
- Pathology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, PV 27100, Italy
| | - Benedetto Calì
- Department of General and Minimally Invasive Surgery, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, PV 27100, Italy
| | - Luisa Petrone
- Endocrinology Unit, Medical-Geriatric Department, Careggi Hospital, Florence, FI 50134, Italy
| | - Flavia Magri
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, PV 27100, Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, PV 27100, Italy
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Mario Rotondi
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, PV 27100, Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, PV 27100, Italy
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Bayraktaroğlu T, Barut F, Çakmak GK. Editorial: Subclassification of AUS/FLUS category for thyroid nodules: trials and evidence-based clinical management. Front Endocrinol (Lausanne) 2023; 14:1209776. [PMID: 37383392 PMCID: PMC10298178 DOI: 10.3389/fendo.2023.1209776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- Taner Bayraktaroğlu
- Divison of Endocrinology and Metabolism, Department of Internal Medicine, Zonguldak, Türkiye
| | - Figen Barut
- Department of Pathology, Faculty of Medicine, Zonguldak, Türkiye
| | - Güldeniz Karadeniz Çakmak
- Department of General Surgery, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Türkiye
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Guarnotta V, La Monica R, Ingrao VR, Di Stefano C, Salzillo R, Pizzolanti G, Giannone AG, Almasio PL, Richiusa P, Giordano C. Ultrasound Parameters Can Accurately Predict the Risk of Malignancy in Patients with "Indeterminate TIR3b" Cytology Nodules: A Prospective Study. Int J Mol Sci 2023; 24:ijms24098296. [PMID: 37176002 PMCID: PMC10179280 DOI: 10.3390/ijms24098296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/20/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
The increase in the incidence of thyroid nodules with cytological findings of TIR3b requires the identification of predictive factors of malignancy. We prospectively evaluated 2160 patients from January 2018 to June 2022 and enrolled 103 patients with indeterminate cytology TIR3b nodules who underwent total (73 patients) and hemi-thyroidectomy (30 patients). Among them, 61 had a histological diagnosis of malignancy (30 classic papillary thyroid carcinoma, 19 had follicular papillary thyroid carcinoma variant, 3 had Hurtle cell carcinoma and 9 had follicular thyroid carcinoma), while 42 had a benign histology. Clinical, ultrasonographic and cytological characteristics were recorded. In addition, BRAF mutation was analysed. Patients with a histological diagnosis of malignancy had a higher frequency of nodule diameter ≤11 mm (p = 0.002), hypoechogenicity (p < 0.001), irregular borders (p < 0.001), peri- and intralesional vascular flows (p = 0.004) and microcalcifications (p = 0.001) compared to patients with benign histology. In contrast, patients with benign histology had more frequent nodules with a halo sign (p = 0.012) compared to patients with histological diagnosis of malignancy. No significant differences were found in BRAF mutation between the two groups. Our study suggests that the combination of ultrasonographic and cytological data could be more accurate and reliable than cytology alone in identifying those patients with TIR3b cytology and a histology of malignancy to be referred for thyroidectomy, thus reducing the number of patients undergoing thyroidectomy for benign thyroid disease.
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Affiliation(s)
- Valentina Guarnotta
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Roberta La Monica
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Vincenza Rita Ingrao
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Claudia Di Stefano
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Riccardo Salzillo
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Giuseppe Pizzolanti
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Antonino Giulio Giannone
- Pathologic Anatomy Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Piero Luigi Almasio
- Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Pierina Richiusa
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Carla Giordano
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
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Hu T, Li Z, Peng C, Huang L, Li H, Han X, Long X, Huang W, Zou R. Nomogram to differentiate benign and malignant thyroid nodules in the American College of Radiology Thyroid Imaging Reporting and Data System level 5. Clin Endocrinol (Oxf) 2023; 98:249-258. [PMID: 36138550 DOI: 10.1111/cen.14824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To develop and validate a nomogram for differentiating benign and malignant thyroid nodules of American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) level 5 (TR5) and improving the performance of the guideline. METHODS From May 2018 to December 2019, 640 patients with TR5 nodules were retrospectively included in the primary cohort. Univariate and multivariable analyses were performed to determine the risk factors for thyroid cancer. A nomogram was established on the basis of multivariable analyses; the performance of the nomogram was evaluated with respect to discrimination, calibration, and clinical usefulness. The nomogram model was also compared to the ACR score model. External validation was performed and the independent validation cohort contained 201 patients from April 2021 to January 2022. RESULTS Multivariable analyses showed that age, tumour location, multifocality, concomitant Hashimoto's disease, neck lymph node status reported by ultrasound (US) and ACR score were the independent risk factors for thyroid cancer (all p < .05). The nomogram showed good discrimination, with an area under the curve (AUC) of 0.786 (95% confidence interval [CI]: 0.742-0.830) and 0.712 (95% CI: 0.615-0.809) in the primary cohort and external validation cohort, respectively. Decision curve analysis demonstrated the clinical usefulness of the model. Compared to the ACR score model, the nomogram showed higher AUC (0.786 vs. 0.626, p < .001) and specificity (0.783 vs. 0.391). CONCLUSIONS The presented nomogram model, based on age, tumour features and ACR score, can differentiate benign and malignant thyroid nodules in TR5 and had a high specificity.
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Affiliation(s)
- Ting Hu
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangdong, China
| | - Zhengyi Li
- Department of Ultrasound, Shenzhen Second People's Hospital, Guangdong, China
| | - Chuan Peng
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangdong, China
| | - Libing Huang
- Department of Ultrasound, Shenzhen Second People's Hospital, Guangdong, China
| | - Huifang Li
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangdong, China
| | - Xu Han
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangdong, China
| | - Xingzhang Long
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangdong, China
| | - Wei Huang
- Division of Minimally Invasive Interventional, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ruhai Zou
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangdong, China
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Wu W, Fang X, Li J, Zhang A, Zou Y, Zheng X. Application of dual-source computed tomography in the diagnosis of thyroid cancer and evaluation of biological behaviors. J Clin Ultrasound 2023; 51:195-202. [PMID: 36539919 DOI: 10.1002/jcu.23413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/23/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Thyroid cancer (TC) is an extremely prevailing malignant endocrine tumor. Therefore, effective diagnostic tools are necessary. This study explored the application value of dual-source computed tomography (DSCT) in TC diagnosis and biological behavior assessment. METHODS This study retrospectively selected 68 TC patients and another 74 benign patients with thyroid adenoma, nodular goiter, or adenomatous hyperplasia. All patients were confirmed by pathological examination and underwent DSCT examination. The iodine concentration (IC) obtained from plain computed tomography (CT) scanning and normalized iodine concentration (NIC) in the arterial phase and venous phase were recorded. The positive expression rates of estrogen receptor alpha (ERα), estrogen receptors beta (ERβ), and Ki67 in pathological tissues were determined by immunohistochemistry, and their correlation with IC in plain CT was assessed by Pearson correlation analysis, respectively. The diagnostic values of IC in plain CT and venous phase NIC in TC patients were evaluated using the receiver operating characteristic curve. RESULTS Malignant patients had lower IC in plain DSCT scanning, venous phase NIC, and ERβ, and higher ERα and Ki67 than benign patients. IC level in plain DSCT scanning was inversely-correlated with ERα and Ki-67 positive expression rates, but positively-related to ERβ to different degrees. For the diagnosis of TC patients, the AUC of IC level in plain DSCT was 0.771, with a cut-off value of 1.250 (97.06% sensitivity and 41.89% specificity), and the AUC of venous phase NIC was 0.738, with a cut-off value of 0.825 (100% sensitivity and 43.24% specificity). CONCLUSION The IC level obtained from DSCT scanning could assist in the differential diagnosis of malignant and benign thyroid nodules and evaluation of biological behaviors.
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Affiliation(s)
- Wenhui Wu
- Department of Radiology, Dongguan People's Hospital, Dongguan, China
| | - Xuewen Fang
- Department of Radiology, Dongguan People's Hospital, Dongguan, China
| | - Jianming Li
- Department of Radiology, Dongguan People's Hospital, Dongguan, China
| | - An Zhang
- Department of Radiology, Dongguan People's Hospital, Dongguan, China
| | - Yujian Zou
- Department of Radiology, Dongguan People's Hospital, Dongguan, China
| | - Xiaolin Zheng
- Department of Radiology, Kanghua Hospital, Dongguan, China
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Cozzolino A, Filardi T, Simonelli I, Grani G, Virili C, Stramazzo I, Santaguida MG, Locantore P, Maurici M, Gianfrilli D, Isidori AM, Durante C, Pozza C. Diagnostic accuracy of ultrasonographic features in detecting thyroid cancer in the transition age: a meta-analysis. Eur Thyroid J 2022; 11:e220039. [PMID: 35521998 PMCID: PMC9254313 DOI: 10.1530/etj-22-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022] Open
Abstract
Context Significant uncertainty exists about the diagnostic accuracy of ultrasonographic (US) features used to predict the risk of thyroid cancer in the pediatric population. Moreover, there are no specific indications for thyroid nodule evaluation in patients during the transition age. Objective The meta-analysis aimed to address the following question: which thyroid nodule US features have the highest accuracy in predicting malignancy in the transition age. Methods We performed a meta-analysis of observational/cohort/diagnostic accuracy studies dealing with thyroid nodule sonography, reporting US features, and using histology as a reference standard for the diagnosis of malignancy and histology or cytology for the diagnosis of benignity in the transition age (mean/median age 12-21 years). Results The inclusion criteria were met by 14 studies, published between 2005 and 2020, including 1306 thyroid nodules (mean size 17.9 mm) from 1168 subjects. The frequency of thyroid cancer was 36.6%. The US features with the highest diagnostic odds ratio (DOR) for malignancy were the presence of suspicious lymph nodes (DOR: 56.0 (95% CI: 26.0-119.0)), a 'taller than wide' shape of the nodule (6.0 (95% CI: 2.0-16.0)), the presence of microcalcifications (13.0 (95% CI: 6.0-29.0)) and irregular margins (9.0 (95% CI: 5.0-17.0)). Heterogeneity among the studies was substantial. Conclusions Following the diagnosis of a thyroid nodule in the transition age, a thorough US examination of the neck is warranted. The detection of suspicious lymph nodes and/or thyroid nodules with a 'taller than wide' shape, microcalcifications, and irregular margins is associated with the highest risk of malignancy in the selection of nodules candidates for biopsy.
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Affiliation(s)
- Alessia Cozzolino
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Tiziana Filardi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Ilaria Simonelli
- Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Camilla Virili
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy
| | - Ilaria Stramazzo
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy
| | - Maria Giulia Santaguida
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy
| | - Pietro Locantore
- Endocrinology Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - on behalf of TALENT Group
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy
- Endocrinology Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Tuli G, Munarin J, Agosto E, Matarazzo P, Quaglino F, Mormile A, de Sanctis L. Predictive factors of malignancy in pediatric patients with thyroid nodules and performance of the Italian classification (SIAPEC 2014) in the outcome of the cytological FNA categories. Endocrine 2021; 74:365-374. [PMID: 34128176 PMCID: PMC8497296 DOI: 10.1007/s12020-021-02784-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE The rate of malignancy (ROM) among pediatric studies using the Bethesda System is 39.5% and 41.5% for atypia of undetermined significance/follicular lesion of undetermined significance and for suspected follicular neoplasm, respectively. Data reported on the basis of Bethesda System showed lower ROM in adults with indeterminate nodules (30.5 and 28.9% respectively). Studies on adults based on the Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification, report ROM of 14.2% for TIR3a and 44.6% for TIR3b category, showing greater sensitivity in detecting malignancy. To date, no performance data are available about SIAPEC classification in pediatric age. METHODS Retrospective data were collected from 200 pediatric subjects with thyroid nodules in the period 2000-2020. RESULTS The distribution of cytological categories after fine needle aspiration biopsy (FNAB) was 7 TIR1, 4 TIR1c, 22 TIR2, 14 TIR3a, 9 TIR3b, 3 TIR4, and 16 TIR5. The surgical approach was performed in 40/200 subjects, with total ROM of 65% (0% for TIR1-TIR3a, 77.8% for TIR3b, and 100% for TIR4-TIR5). Total FNAB accuracy was 95%, while the sensibility and specificity were 92.3 and 92.6%, respectively. CONCLUSIONS The reported data seem to confirm a greater sensitivity of SIAPEC classification to identify malignancy within the indeterminate category also in pediatric age and not only in adulthood. This finding may orient clinicians toward clinical follow-up for the indeterminate TIR3a group and toward surgical approach with total thyroidectomy in the indeterminate TIR3b group, although this indication should be confirmed in further national multicenter studies including larger cohorts.
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Affiliation(s)
- Gerdi Tuli
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy.
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - Jessica Munarin
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Erica Agosto
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Patrizia Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Francesco Quaglino
- Department of General Surgery, "Maria Vittoria" Hospital ASL Città di Torino, Turin, Italy
| | - Alberto Mormile
- Endocrinology, Diabetes and Metabolism Department and Center for Thyroid Diseases, Ordine Mauriziano Hospital, Turin, Italy
| | - Luisa de Sanctis
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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Celletti I, Fresilli D, De Vito C, Bononi M, Cardaccio S, Cozzolino A, Durante C, Grani G, Grimaldi G, Isidori AM, Catalano C, Cantisani V. TIRADS, SRE and SWE in INDETERMINATE thyroid nodule characterization: Which has better diagnostic performance? Radiol Med 2021; 126:1189-200. [PMID: 34129178 DOI: 10.1007/s11547-021-01349-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/20/2021] [Indexed: 12/16/2022]
Abstract
Purpose To assess Strain Ratio (SRE) and Shear Wave Elastography (SWE) accuracy alone and with TIRADS classification, for the risk stratification of indeterminate thyroid nodules. Materials and methods 128 Patients with 128 indeterminate nodules candidates for thyroidectomy underwent preoperative staging neck ultrasound and were classified according to K-TIRADS score. After TIRADS evaluation, semi-quantitative (SRE) and quantitative (SWE expressed in kPa) elastosonography were performed and relative diagnostic performances, alone and in combination, were compared through ROC curves analysis. In order to maximize the SRE and SWE sensitivity and specificity, their cut-off values were calculated using the Liu test. Bonferroni test was used to evaluate statistically significant differences with a p value < 0.05. Results Sensitivity, specificity, PPV and NPV were, respectively, 71.4%, 82.4%, 62.5%, 87.5% for K-TIRADS baseline US, 85.7%, 94.1%, 85.7%, 94.1% for SRE and 57.1%, 79.4%, 53.3%, 81.8% for SWE (kPa expressed). SRE evaluation showed the best diagnostic accuracy compared to the SWE (kPa expressed) (p < 0.05) and to the K-TIRADS (p > 0.05). The association of SRE with conventional ultrasound with K-TIRADS score increased sensitivity (92.9% vs 71.4%) but decreased the specificity than conventional US alone (76.5% vs 82.4%). Conclusion Strain Elastosonography can be associated with K-TIRADS US examination in the thyroid nodule characterization with indeterminate cytology; in fact, adding the SRE to K-TIRADS assessment significantly increases its sensitivity and negative predictive value. However, further multicenter studies on larger population are warranted.
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Massa F, Caraci P, Sapino A, De Rosa G, Volante M, Papotti M. Outcome and diagnostic reproducibility of the thyroid cytology "indeterminate categories" SIAPEC/SIE 2014 in a consecutive series of 302 cases. J Endocrinol Invest 2021; 44:803-809. [PMID: 32797379 PMCID: PMC7946669 DOI: 10.1007/s40618-020-01377-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/28/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE The clinical impact of the SIAPEC/SIE 2014 classification for thyroid cytology has been addressed in few studies that evaluated the malignancy rate and the relative prevalence of each category. No study analyzed its intra-observer and inter-observer reproducibility, so far. METHODS We retrospectively collected all "indeterminate" lesions diagnosed before (2011-2014) and after (2015-2018) the application of the SIAPEC/SIE 2014 classification at our Institution. Their relative malignancy risks were calculated based on available histological diagnoses. Cytological and clinical features of TIR3A were compared with the surgical outcome. Finally, a large set of samples was re-evaluated in blind of the original cytological and histological diagnoses by two pathologists, independently. RESULTS The prevalence of "indeterminate" diagnoses increased in years 2015-2018 (302/1482, 21% with 14% of TIR3A and 7% TIR3B categories) compared to years 2011-2014 (261/1680, 16%). Surgery was performed in 27% TIR3A and in 97% TIR3B cases. Malignancy rates were 40% for TIR3B and 17% for TIR3A, but were greatly influenced by the adoption of the WHO 2017 re-classification of encapsulated follicular-patterned lesions (decreasing to 28% and 6%, respectively). No criteria except for tumor size were associated to malignancy in TIR3A category. Intra-observer agreement of the experienced pathologist was 122/141 (86%), whereas inter-observer agreement between the expert and in-training pathologist was 95/141 (67%). CONCLUSIONS In this real-life experience, the sub-classification of TIR3A and TIR3B slightly increased the overall prevalence of "indeterminate" diagnoses. Malignancy rates were higher than estimated for both TIR3A and TIR3B categories. Agreement among observers highly depended on pathologist's training.
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Affiliation(s)
- F Massa
- Department of Oncology, University of Turin and Pathology Unit, San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - P Caraci
- Internal Medicine Unit, San Luigi Hospital, Orbassano, Turin, Italy
| | - A Sapino
- Department of Medical Sciences, University of Turin, Turin, Italy
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - G De Rosa
- Pathology Unit, Mauriziano Hospital, Turin, Italy
| | - M Volante
- Department of Oncology, University of Turin and Pathology Unit, San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy.
| | - M Papotti
- Department of Oncology, University of Turin, and Pathology Unit, "Città della Salute e della Scienza" Hospital, Turin, Italy
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Giuliano S, Mirabelli M, Chiefari E, Vergine M, Gervasi R, Brunetti FS, Innaro N, Donato G, Aversa A, Brunetti A. Malignancy Analyses of Thyroid Nodules in Patients Subjected to Surgery with Cytological- and Ultrasound-Based Risk Stratification Systems. Endocrines 2020; 1:102-18. [DOI: 10.3390/endocrines1020010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The fine needle aspiration (FNA) cytology is the gold standard for the preoperative diagnosis of thyroid cancer. However, up to 30% of FNA examinations yield nondiagnostic or indeterminate results and this complicates patient management. Clinical features and ultrasound (US) patterns, including US risk stratification systems, could be useful in the preoperative diagnostic workup and prediction of malignancy, but the evidences are not univocal. Methods: 400 consecutive patients subjected to thyroid surgery were retrospectively enrolled at our institution in Calabria, Southern Italy. Preoperative US and FNA cytological descriptions, formulated according to the “Italian consensus for reporting thyroid fine-needle aspiration cytology” (ICCRTC) classification and three US risk stratification systems (those developed by the American Association of Clinical Endocrinologists, American College of Endocrinology and Associazione Medici Endocrinologi (AACE/ACE/AME), American Thyroid Association (ATA), and American College of Radiology (ACR-TIRADS)), were collected, along with histological results. Results: 147 thyroid cancer cases, in large majority papillary carcinomas, were detected on final histological examination. Almost two-thirds of patients subjected to thyroid surgery for either benign or malignant lesions were female. Patient’s age ≤20 years and between 21–30 years were clinical features associated with increased risk of thyroid cancer in logistic regression analyses. US features associated with thyroid cancer included irregular margins, solid composition, microcalcifications, and marked hypoechogenicity. The AACE/ACE/AME, ATA, and ACR-TIRADS risk categories, corresponding to specific US patterns, were strong predictors of malignancy in both genders, but not in nodules with indeterminate cytology. A measured difference between the longitudinal (L) and the anteroposterior (AP) diameter >5 mm, a proxy for a parallel-oriented oval shape of a nodule, emerged as a robust protective factor against thyroid cancer (OR 0.288 (95%CI 0.817–0.443); p < 0.001), regardless of cytological risk. Conclusions: Some, but not all, well-established predictors of TC have been confirmed in this study. Controversy surrounds the diagnostic performance of US risk stratification systems for the detection of thyroid cancer in the subgroup of nodules with indeterminate cytology, suggesting their use only to set the thresholds for FNA. A measured difference between L and AP diameters >5 mm may represent an additional and practical tool for ruling out malignancy in thyroid nodules, with the potential to reduce unnecessary surgical procedures.
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