Risk of malignancy in the various categories of the UK Royal College of Pathologists Thy terminology for thyroid FNA cytology: A systematic review and meta‐analysis

Poller, David; Bongiovanni, Massimo; Trimboli, Pierpaolo

doi:10.1002/cncy.22201

Cited by 42 publications

(47 citation statements)

References 32 publications

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“…In a separate analysis at a single centre in Italy, 75 lesions with indeterminate FNAC underwent surgery with corresponding final histology; the PPV in TIR 3A was 4% and in TIR 3B was 48% . Comparing these results to both the meta‐analysis by Poller et al and our own results, there are notable differences in the reported malignancy rates; this may reflect environmental factors and different epidemiology of thyroid cancer between countries and local populations.…”

Section: Discussionsupporting

confidence: 59%

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Improving our departmental reporting of thyroid cytology specimens against national guidelines: A two‐cycle retrospective audit

et al. 2020

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Thyroid nodules are common and are described as discrete lesions, distinguishable from adjacent thyroid parenchyma. 1 They are found on clinical examination in 4%-8% of adults and in up to 10%-40% of adults when using ultrasound. 2 The prevalence of thyroid nodules increases with age. 2 The vast majority (95%) are benign and only a small proportion represent malignancy. 1 Assessment of patients with thyroid nodules should follow a systematic approach with a thorough history and examination, review of

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Section: Discussionsupporting

confidence: 59%

“…A recent systematic review and meta‐analysis assessed the risk of malignancy across different Thy categories . Thirteen articles were included, which totalled 3911 nodules.…”

Section: Discussionmentioning

confidence: 99%

Improving our departmental reporting of thyroid cytology specimens against national guidelines: A two‐cycle retrospective audit

et al. 2020

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“…A meta‐analysis of the risk of malignancy for patients with preoperative FNAC classified according to the UK Thy terminology showed comparable results to meta‐analyses of other internationally recognised reporting terminologies for pooled risk of malignancy for surgically excised nodules. The results for pooled risk of malignancy were Thy 1 12%, Thy 2 5%, Thy 3 22%, Thy 3a 25%, Thy 3f 31%, Thy 4 79% and Thy 5 98% . Hence, the performance of the UK Thy terminology appears similar to TBSRTC and other terminologies, although the range of reported Thy 1 rates in the published literature is perhaps higher than would be expected.…”

Section: Discussionmentioning

confidence: 72%

Rates of Thy 1‐non‐diagnostic thyroid fine needle aspiration using the UK Royal College of Pathologists Thy Terminology. A systematic review of the literature comparing patients who undergo rapid on‐site evaluation and those who do not

et al. 2020

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Introduction: The UK Royal College of Pathologists (RCPath) Thy terminology is an internationally recognised system for reporting thyroid fine needle aspiration. The terminology has been used throughout the UK and Ireland, in some parts of Italy and Switzerland, and elsewhere in the world. There is no systematic review of the literature specifically addressing the use of the non-diagnostic for cytological diagnosis-Thy1/Thy 1c category in the UK RCPath terminology. Methods: A comprehensive literature search of online databases was conducted in October 2019 specifically examining overall reported rates of Thy1 and Thy1c in aspirates classified according to the UK Thy terminology. Results: Twenty-five articles were identified showing a Thy1 rate of 13.4% (2540/18 920). The studies were then stratified according to whether or not the patients underwent rapid on-site evaluation (ROSE): 6.0% (353/5841; range 3.0%-10.9%) of ROSE aspirates were Thy1 whereas 18.5% (2072/11 204; range 7.9%-43.3%) of non-ROSE patients were Thy1; (P < .05). Three studies from 2016 reported Thy1c rates of 5.4%, 6.5% and 10.6%, respectively, implying Thy1 rates excluding Thy1c aspirates of 20.9%, 8.7% and 12.7%, respectively. Conclusion: This systematic review of the literature shows relatively high rates of aspirates non-diagnostic for cytological diagnosis-Thy1 in the peer-reviewed published literature using the UK terminology. Utilisation of ROSE appears to produce lower rates of Thy1 aspirates and ROSE should be considered if rates of non-diagnostic for cytological diagnosis-Thy1/Thy 1c are high.

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“…As no case of malignancy was found in our study, our data were not able to directly address this question. By way of comparison, a similar rate of malignancy was found in nodules classified as benign on cytology 30,32 . Unless there is a high level of clinical or US suspicion of thyroid cancer, no FNA should be performed in these nodules, and only clinical and sonographic follow‐up, or no follow‐up, is recommended 3,36,37 .…”

Section: Discussionmentioning

confidence: 86%

Ultrasound systems for risk stratification of thyroid nodules prompt inappropriate biopsy in autonomously functioning thyroid nodules

Castellana

Virili

Paone

et al. 2020

Clinical Endocrinology

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Objective Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine‐needle aspiration (FNA) biopsies in patients with thyroid nodules. Autonomously functioning thyroid nodules (AFTN) account for 5%‐10% of palpable lesions and are very rarely malignant. The present study was undertaken to investigate how RSSs classify AFTNs and whether RSSs are able to avoid unnecessary FNA biopsies in such cases. Methods Patients with AFTN who had undergone US, scintigraphy and thyroid function evaluation from December 2016 to December 2017 were selected. US images were retrospectively reviewed and AFTN reclassified according to AACE/ACE/AME, ACR‐TIRADS, ATA, BTA, EU‐TIRADS, K‐TIRADS and TIRADS. Risk class and indication for FNA were assessed. Results A number of 87 AFTNs from 85 consecutive patients were enrolled. A median diameter of 22 mm (range 10‐59) was found, with an ovoid isoechoic nodule being the most frequent US presentation. When AFTNs were reclassified according to US RSSs, the most common categories were low and intermediate risk. AFTNs were assessed as being at high risk/high suspicion/malignant in 1%‐9%, with good agreement among AACE/ACE/AME, ATA, EU‐TIRADS, K‐TIRADS and TIRADS. Remarkably, FNA was indicated in 27%‐90% of AFTNs. A statistically significant difference among the systems was found; 8% of cases were nonclassifiable by one or more US RSS. Conclusions Ultrasound RSSs prompt inappropriate FNA in a significant number of patients with AFTN.

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Risk of malignancy in the various categories of the UK Royal College of Pathologists Thy terminology for thyroid FNA cytology: A systematic review and meta‐analysis

Cited by 42 publications

References 32 publications

Improving our departmental reporting of thyroid cytology specimens against national guidelines: A two‐cycle retrospective audit

Improving our departmental reporting of thyroid cytology specimens against national guidelines: A two‐cycle retrospective audit

Rates of Thy 1‐non‐diagnostic thyroid fine needle aspiration using the UK Royal College of Pathologists Thy Terminology. A systematic review of the literature comparing patients who undergo rapid on‐site evaluation and those who do not

Ultrasound systems for risk stratification of thyroid nodules prompt inappropriate biopsy in autonomously functioning thyroid nodules

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