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

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2017年第7期18卷 555-566页

作者： Massimo GIUSTI Barbara MASSA Margherita BALESTRA Paola CALAMARO Stefano GAY Simone SCHIAFFINO Giovanni TURTULICI simonetta zupo Eleonora MONTI Gianluca ANSALDO Endocrinology Unit San Martino University Hospital I-16100 Genoa Italy Cytopathology and Pathology Unit San Martino University Hospital I-16100 Genoa Italy Radiology Unit Evangelico Hospital I-16100 Genoa Italy Molecular Diagnostic Unit San Martino University Hospital I-16100 Genoa Italy Endocrinology Surgery Unit San Martino University Hospital I-16100 Genoa Italy

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 ultrasonogrephy （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 surgically- treated 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-to- peak 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-peakindex 〉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 Th

关键词： Indeterminate thyroid nodules British Thyroid Association 2014 classification Clinical evaluation Outcome

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