Diagnostic Value of a Cytomorphological Subclassification of Follicular Patterned Thyroid Lesions: A Study of 927 Consecutive Cases with Histological Correlation

Deandrea, Maurilio; Ragazzoni, Federico; Motta, Manuela; Torchio, Bruno; Mormile, Alberto; Garino, Francesca; Magliona, Gabriella; Gamarra, Elena; Ramunni, M; Garberoglio, R; Limone, Paolo Piero

doi:10.1089/thy.2010.0015

Cited by 40 publications

(31 citation statements)

References 47 publications

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“…Thirteen studies in the pre-TBSRTC [13,14,15,16,17,18,19,20,21,22,23,24,25] and 8 studies in the post-TBSRTC [11,26,27,28,29,30,32,33] provided the specific histopathological diagnoses for their cases with malignant follow-up, and these are detailed in table 3. From this data, the rate of the follicular variant of papillary thyroid carcinoma (FV-PTC) as a fraction of all malignancy was equivalent, i.e.…”

Section: Resultsmentioning

confidence: 99%

‘Suspicious for Papillary Thyroid Carcinoma' before and after The Bethesda System for Reporting Thyroid Cytopathology: Impact of Standardized Terminology

Olson¹,

Boonyaarunnate²,

Atlinboga

et al. 2013

Acta Cytologica

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Background: The high-risk ‘suspicious for papillary thyroid carcinoma' (SPTC) is a clinically relevant diagnosis in the cytological interpretation of thyroid aspirates. While The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has provided invaluable terminology standardization, a performance comparison for this diagnostic category has not been performed. Therefore, this study evaluates the SPTC diagnosis before and after the introduction of TBSRTC in a large meta-analysis and at a single institution. Materials and Methods: The meta-analysis analyzed publications of SPTC or similar diagnoses before and after the introduction of TBSRTC. Similarly our own institutional experience was analyzed for the 8 years surrounding the introduction of TBSRTC. A correlation of the cytopathology and surgical pathology diagnoses was performed. Results: The introduction of TBSRTC coincided with a significant decrease in the fraction of cases called SPTC in the meta-analysis (4.5-3.1%, p < 0.00001) and in the institutional review (1.7-0.9%, p = 0.005). Meanwhile, the malignancy risk for those cases increased significantly in the meta-analysis from 62.5 to 80.5% (p < 0.00001) and trended upwards in the institutional review from 69 to 79% (p = 0.4). The follow-up rate was similar in both time periods in the meta-analysis and the institutional review. Conclusions: The introduction of TBSRTC coincided with a decrease in the fraction of cases called SPTC and an increase in the malignancy risk associated with that diagnosis.

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Section: Resultsmentioning

confidence: 99%

‘Suspicious for Papillary Thyroid Carcinoma' before and after The Bethesda System for Reporting Thyroid Cytopathology: Impact of Standardized Terminology

Olson¹,

Boonyaarunnate²,

Atlinboga

et al. 2013

Acta Cytologica

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“…The same approach has most frequently been adopted in almost all similar studies Ho et al, 2014;Hyeon et al, 2014;Nikiforov et al, 2014;Rago et al, 2014;Deniwar et al, 2015;Yoo et al, 2015), even when a second FNAB was performed (Ho et al, 2014;Rosario, 2014;Yoo et al, 2015). For our Thy 3 nodules, surgery allowed us to ascertain a low rate of thyroid cancers (19%), which is a percentage close to that reported in studies employing the BTA classification (Mihai et al, 2009;Deandrea et al, 2010;Giusti et al, 2014;Rago et al, 2014). In our study, the reclassification of Thy 3 nodules according to BTA 2014 criteria identified a significantly higher incidence of Hurtle adenomas in Thy 3f than in Thy 3a, without a very significant difference between the two sub-categories in the risk of malignancy on histology.…”

Section: Discussionmentioning

confidence: 51%

“…Deandrea et al (2010) stratified 294 Thy 3 nodules, for which the malignancy rate was 17%, into three categories: "follicular lesion of indeterminate significance", "follicular neoplasm", and "Hurtle-cell neoplasm". They found that the percentage of malignant cases in each category was significantly different (5%, 25%, and 23%, respectively).…”

Section: Introductionmentioning

confidence: 99%

Retrospective cytological evaluation of indeterminate thyroid nodules according to the British Thyroid Association 2014 classification and comparison of clinical evaluation and outcomes

Giusti¹,

Massa²,

Balestra³

et al. 2017

J. Zhejiang Univ. Sci. B

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Abstract:The cytology of 130 indeterminate nodules (Thy 3) was retrospectively reviewed according to the British Thyroid Association 2014 classification. Nodules were divided into Thy 3a (atypical features) and Thy 3f (follicular lesion) categories. Histology was available as a reference for 97 nodules. Pre-surgical evaluations comprised biochemical tests, color-Doppler ultrasonography (US), semi-quantitative elastography-US (USE), contrast-enhanced US (CEUS), and mutation analysis from cytological slides. Thyroid malignancy was the final diagnosis for 19% of surgicallytreated nodules. No statistically significant difference in the risk of malignancy was found between Thy 3a (26%) and Thy 3f (14%) nodules. Histology of the Thy 3a and Thy 3f nodules showed a higher incidence of Hurtle cell adenomas in Thy 3f (29%) than in Thy 3a (3%) nodules (P=0.01). The only pre-surgical difference concerned the BRAF V600E mutation, which was positive in some Thy 3a but not in any Thy 3f nodules (P=0.04). Receiver-operating characteristic (ROC) analysis was used to obtain cut-off values from US (score), USE (ELX 2/1 strain index), and CEUS (time-topeak index and peak index) data. The cut-off values were similar for Thy 3a and Thy 3f nodules. Data showed that malignancy can be suspected if the US score is >2, ELX 1/2 strain index >1, time-to-peak index >1, and peak index <1. In a sub-group of 24 revised nodules (12 Thy 3a and 12 Thy 3f) with histology as a reference, the diagnostic power of cumulative pre-surgical analysis by means of US, USE, and CEUS showed high positive and negative predictive values (83% and 100%, respectively) for the presence of malignancy in Thy 3a and Thy 3f nodules. In conclusion, in our series of revised Thy 3 nodules, malignancy was low and displayed no significant differences between Thy 3a and Thy 3f categories. The use of cut-offs based on histology as a reference could reduce surgery. Our data support the conviction that, in mutation-negative Thy 3a and Thy 3f nodules, observation should be the first choice when not all instrumental results are suspect.

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“…In a similar study by Deandrea et al, further classifying the Thy 3 lesions improved diagnostic accuracy. The proportions of cancers in each group were Thy 3a ("follicular lesions of indeterminate significance"), Thy 3b ("follicular neoplasm") and Thy 3c ("Hurthle-cell neoplasm") 4.95%, 25.0% and 22.77% respectively (24). Various modalities are being tried to improve the diagnostic accuracy in Thy 3 nodules and reduce the rates of diagnostic lobectomy -for example PET scan, molecular markers, oncogene detection, and ultrasound elastography.…”

Section: Discussionmentioning

confidence: 99%

The final outcome of indeterminate cytology of thyroid nodules in a District General Hospital

Doddi¹

2015

GCHIR

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Diagnostic Value of a Cytomorphological Subclassification of Follicular Patterned Thyroid Lesions: A Study of 927 Consecutive Cases with Histological Correlation

Cited by 40 publications

References 47 publications

‘Suspicious for Papillary Thyroid Carcinoma' before and after The Bethesda System for Reporting Thyroid Cytopathology: Impact of Standardized Terminology

‘Suspicious for Papillary Thyroid Carcinoma' before and after The Bethesda System for Reporting Thyroid Cytopathology: Impact of Standardized Terminology

Retrospective cytological evaluation of indeterminate thyroid nodules according to the British Thyroid Association 2014 classification and comparison of clinical evaluation and outcomes

The final outcome of indeterminate cytology of thyroid nodules in a District General Hospital

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