Thyroid Imaging Reporting and Data System Score Combined with the New Italian Classification for Thyroid Cytology Improves the Clinical Management of Indeterminate Nodules

Ulisse, Salvatore; Bosco, Daniela; Nardi, Francesco; Nesca, Angela; D’Armiento, Eleonora; Guglielmino, Valeria; Vito, Corrado De; Sorrenti, Salvatore; Pironi, Daniele; Tartaglia, Francesco; Arcieri, Stefano; Catania, A; Monti, Massimo; Filippini, Angelo; Ascoli, Valeria

doi:10.1155/2017/9692304

Cited by 44 publications

(43 citation statements)

References 39 publications

(32 reference statements)

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“…The new SIAPEC classification of 2014, assign to TIR3B lesions, referable to the Bethesda FN/SFN group, an higher risk of malignancy compared to TIR3A, based on the evidence of mild/focal nuclear atypia [1,2]. Features of capsule invasion and microvascular emboli move the histological diagnosis to a follicular or a follicular variant of papillary carcinoma, excluding the benign follicular adenoma or other benign conditions.…”

Section: Discussionmentioning

confidence: 99%

“…In 2014, the Italian Society for Anatomic Pathology and Cytology (SIAPEC) together with the Italian Thyroid Association (AIT) modified the previous thyroid cytology classification of 2007, by replacing the TIR3 class with two new subclasses, TIR3A and TIR3B comparable respectively to the Bethesda category AUS/FLUS and FN/SFN [1][2][3][4]. TIR3B group includes those cases with mild/focal nuclear atypia suggestive of papillary carcinoma and therefore considered to be at higher risk of malignancy compared to TIR3A [1,2]. The incidence of the TIR3B is expected to be lower than 10% with an associated malignancy rate of 20-30% [5].…”

Section: Introductionmentioning

confidence: 99%

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Follicular proliferation TIR3B: the role of total thyroidectomy vs lobectomy

et al. 2019

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Background: TIR3B thyroid nodules are considered to be at risk of malignancy (15-30%) but guidelines recommend conservative surgery with lobectomy with primary diagnostic porpoise. Risk stratification mainly based on ultrasound, elastography and genetic mutations usually may influences the surgical approach. Methods: We retrospectively analyzed 52 cases of TIR3B underwent between 2015 and 2017 total thyroidectomy (TT) and lobectomy (L), focusing mainly on the observed rate of malignancy. Chi-squared test and Fisher's exact probability test were used for analysis, considering a P values less than 0.05 as significant. Results: Out of 52 patients 49 underwent TT and 3 L. In TT group a multinodular goiter was associated in 67.3% of patients. Malignancy rate was 81.6 and 33.3% respectively after TT and L (P 0.003). Multicentric and contralateral tumors were detected respectively in 36.7% and in 32.6% of patients underwent TT. No main post-operative complications were registered. Conclusions: Ultrasound and elastography are useful to define within the TIR3B group those lesions at higher risk and therefore requiring a more radical approach. TT seems an appropriate approach to TIR3B lesions, especially in multinodular goiter, considering the incidence of malignancy with probably higher rate than previously reported.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Follicular proliferation TIR3B: the role of total thyroidectomy vs lobectomy

et al. 2019

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“…Then this author performed a scoping review of the peer‐reviewed literature in electronic databases (e‐databases) to rapidly identify articles comparing two or more UGMTNs and/or non‐UGMTNs . E‐databases included Medline (PubMed), EBSCO, Google, and Google Scholar published from 2010 to 2019 to capture articles comparing UGMTNs or non‐UGMTNs . The keyword combinations of thyroid, nodule, ultrasound, risk, comparison, guideline, malignancy, and classification returned 28 peer‐reviewed articles comparing two or more UGMTNs.…”

Section: Does a Plethora Of Ugmtns Exist?mentioning

confidence: 99%

“…Articles compared GMTNs from the ATA‐2105 (n = 22, 78%); ACR TI‐RADS‐2017 (n = 14, 50%); South Korean TI‐RADS (n = 11, 39%); European Union (aka French) TI‐RADS (n = 8, 29%), British Thyroid Association (BTA; n = 5, 17.5%), AACE/ACE/AME (n = 5, 17.5%); and European Thyroid Association (n = 2, 7%). At least one article evaluated the Italian Consensus on Thyroid Cytology (ICTC‐2014) combined with TI‐RADS (n = 1, 3%); Chilean TI‐RADS (Horvath, n = 1); Thai‐TI‐RADS (Siriraj, n = 1) and South Korean (Park, n = 1) or n = 4 or 14%. These are quantitative, country‐focused TI‐RADS‐based UGMTNs.…”

Section: Does a Plethora Of Ugmtns Exist?mentioning

confidence: 99%

US‐based risk stratification “guidelines” for thyroid nodules: Quō Vādis?

Alexander

2020

J of Clinical Ultrasound

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Purpose This rapid scoping review addresses the commentary titled the ACR TI‐RADS™: An Advance in the Management of Thyroid Nodules or Pandora's Box of Surveillance? suggesting that the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI‐RADS™‐2017) adds to a plethora of existing guidelines, incorporates an inconsistent lexicon, and potentially contradicts recommendations. Materials and Methods The author performed a rapid scoping review using a combination of English keywords to identify and review peer reviewed articles contained in electronic databases (e‐databases) comparing 2 or more guidelines for managing adult thyroid nodules (GMTNs) with (UGMTNs) and without (non‐UGMTNs) ultrasound. E‐databases included Medline (PubMed), EBSCO, Google, and Google Scholar published (2010‐2019). Results The search returned 28 articles, where the author identified 12 different guidelines. Most articles evaluated diagnostic performance (N = 26), not quality (N = 2) measures. The most commonly reviewed UGMTNs were in descending order ATA‐2015, ACR TI‐RADS™‐2017, South Korean, and EU TI‐RADS. No article reviewed all GMTNs or identified a generally accepted UGMTNs or non‐UGMTNs. Primary origin continents were: North America (U.S.A), Asia (Japan, South Korea, Thailand), Europe (France, Italy, U.K.), and South America (Chile). Conclusion A plethora of UGMTNs may exist. No guideline enjoys general acceptance and evaluations of performance and quality vary.

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“…Four years after implementation of the revised IRSTC in Italian institutions, validation studies have been limited. These studies have focused on cytohistological correlations, also in combination with thyroid imaging . However, there are no studies that specifically assess different cytological features for the purpose of classifying indeterminate FNA as either TIR3A or TIR3B.…”

Section: Introductionmentioning

confidence: 99%

Indeterminate thyroid nodules (TIR3A/TIR3B) according to the new Italian reporting system for thyroid cytology: A cytomorphological study

et al. 2019

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Objective: The Italian reporting system for thyroid cytology classifies indeterminate lesions as TIR3A (low risk) or TIR3B (high risk) and is meant to provide practical guidance rather than a detailed consideration of morphological features. We aimed to assess which cytological features have the most diagnostic value and whether they are effective in classifying nodules as either TIR3A or TIR3B and in predicting histological outcomes.Methods: Thyroid fine-needle aspirates from 111 indeterminate nodules were reviewed blinded to clinical information, TIR3A/TIR3B classification, and histology in order to assess which cytological features (pooled into artefacts, smear background, architectural and nuclear atypia, and oncocytes) differentiate TIR3A from TIR3B, and benign from malignant histological outcomes. Results:Of the cytological features examined, those specific for TIR3B included high cellularity, nuclear atypia, oncocyte predominance and transgressing vessels.Features specific for TIR3A included artefacts, low cellularity and oncocyte sparseness. Other features, such as microfollicules/trabeculae, were non-specific. Due to the different distributions of these features, three TIR3B subgroups were identifiable: follicular lesions with oncocytic changes, pure follicular lesions, and follicular lesions with nuclear atypia, whereas no subgroups were identifiable in TIR3A. Nuclear atypia was a significant indicator of malignancy, whereas oncocyte predominance was not a reliable predictor of malignancy. High cellularity and microfollicules/trabeculae were not indicative of any histological outcome. Conclusions:The majority of the assessed features were good predictors of histological outcomes. The TIR3A category included undefined nodules due to the absence of characterising features, whereas the TIR3B category included nodules with a greater number of distinguishing features. K E Y W O R D Sclassification, cytopathology, Italy, thyroid cancer, thyroid nodule

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Thyroid Imaging Reporting and Data System Score Combined with the New Italian Classification for Thyroid Cytology Improves the Clinical Management of Indeterminate Nodules

Cited by 44 publications

References 39 publications

Follicular proliferation TIR3B: the role of total thyroidectomy vs lobectomy

Follicular proliferation TIR3B: the role of total thyroidectomy vs lobectomy

US‐based risk stratification “guidelines” for thyroid nodules: Quō Vādis?

Indeterminate thyroid nodules (TIR3A/TIR3B) according to the new Italian reporting system for thyroid cytology: A cytomorphological study

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