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Predictors of malignancy in high-risk indeterminate (TIR3B) cytopathology thyroid nodules

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Abstract

Purpose

The classification of indeterminate cytopathology at thyroid fine-needle-aspiration (FNA) has been updated to reduce the number of unnecessary surgery; the 2014 Italian classification introduced the low-risk (TIR3A) and high-risk (TIR3B) subcategories. Aim of this study was to identify the ultrasonographic (US), clinical and cytological predictors of malignancy among TIR3B nodules from a single institution.

Methods

A prospective observational study including 1844 patients who underwent thyroid FNA from June 2014 to January 2019. Ultrasonographic, clinical and cytological features were recorded. All TIR3B diagnoses were referred to surgery. According to final histology, patients were divided into thyroid cancer (TC) or benign nodules. Chi-square test, or Fisher exact test when appropriate, were used to compare groups and logistic regression analyses were used to determine independent predictors of malignancy.

Results

Of 1844 FNAs, 96 (5.2%) were TIR3B. Histology report was available in 65. Among them, 25 (38.5%) were TC. Predictors of TC were nodule size < 20 mm [Odds Ratio (OR) = 5.88, 95% CI 1.91–18.11, p = 0.002], absence or weak intralesional flow [OR = 0.3, 95% CI 0.09–0.77, p = 0.015], microcalcifications [OR = 6.5, 95% CI 1.90–21.93, p = 0.003] at US; nuclear inclusions [OR = 25.3, 95% CI 1.34–476.07, p = 0.031] and chromatin clearing [OR = 3.7, 95% CI 1.27–10.99, p = 0.017] at cytopathology. Patients aged < 55 years had a significantly higher risk of TC [OR = 9.7, 95% CI 2.79–34.07, p < 0.001]. In multivariate analysis, age < 55 and nodule size < 20 mm resulted as independent risk factors.

Conclusions

Patients < 55 years receiving a diagnosis TIR3B on nodules < 20 mm, with microcalcifications, showing specific nuclear atypia at cytopathology are more likely to have TC. Combining US, cytological and clinical features could help determining which patients with a TIR3B diagnosis should be referred to surgery.

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Acknowledgements

The authors wish to thank Daniela Bosco for providing cytopathology diagnosis and the staff at the Interdepartmental Experimental and Molecular Medicine Library (bmedsper) of Sapienza University of Rome for their help in the bibliographic search.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AC, RP, AP, CP, ER and ES. All authors drafted the article and revised it critically for important intellectual content and final approval of the version to be published.

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Correspondence to A. M. Isidori.

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Cozzolino, A., Pozza, C., Pofi, R. et al. Predictors of malignancy in high-risk indeterminate (TIR3B) cytopathology thyroid nodules. J Endocrinol Invest 43, 1115–1123 (2020). https://doi.org/10.1007/s40618-020-01200-0

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  • DOI: https://doi.org/10.1007/s40618-020-01200-0

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