Improving the prediction of malignancy in cytologically suspicious thyroid nodules

Background: Fine needle cytology aspirates (FNA) classified as THY4 are a heterogeneous group suspicious for malignancy [papillary thyroid cancer (PTC)], which is confirmed in 50–80% of cases after surgery. Aim: To better stratify THY4 FNA specimens for the relative risk of malignancy. Methods: We r...

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Bibliographic Details
Published in:Journal of endocrinological investigation 2013-11, Vol.36 (10), p.843-847
Main Authors: Arena, S., Latina, A., Marturano, I., Muscia, V., La Rosa, G. L., Stornello, M., Squatrito, S., Italia, S., Vigneri, R.
Format: Article
Language:English
Subjects:
Adult
Aged
Biopsy, Fine-Needle
Carcinoma, Papillary - diagnosis
Carcinoma, Papillary - surgery
Cytodiagnosis
Endocrinology
Female
Follow-Up Studies
Humans
Male
Medicine
Medicine & Public Health
Metabolic Diseases
Middle Aged
Original Articles
Prognosis
Retrospective Studies
Thyroid Neoplasms - diagnosis
Thyroid Neoplasms - surgery
Thyroid Nodule - pathology
Thyroid Nodule - surgery
Thyroidectomy
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Summary:Background: Fine needle cytology aspirates (FNA) classified as THY4 are a heterogeneous group suspicious for malignancy [papillary thyroid cancer (PTC)], which is confirmed in 50–80% of cases after surgery. Aim: To better stratify THY4 FNA specimens for the relative risk of malignancy. Methods: We retrospectively analyzed 78 thyroid nodules classified as THY4 because of the presence of atypical cells, hypercellular trabeculae and/or intranuclear inclusions (ICI), in the absence of papillae. Two subgroups were identified: group 1 (38 nodules), showing ICI with (no.=17) or without (no.=21) trabeculae and cellular atypia, and group 2 (40 nodules), showing trabeculae and atypia but without ICI. Results: PTC was detected at histology in 56/78 of the patients (71.8%). Malignancy occurred in 36/38 (94.7%) of the patients in group 1 and in 20/40 (50.0%) of the patients in group 2. Therefore, the positive predictive value (PPV) for PTC was 97.3% in the ICI+ specimens (group 1), with a sensitivity of 64.3% and specificity of 95.2%. When only ICI was present, without atypia and trabeculae, the PPV and specificity were similar (95.0 and 95.2%, respectively), but the sensitivity was decreased (48.7%). In specimens without ICI (group 2), the PPV was only 50.0%; however, combined with young age (
ISSN:0391-4097
1720-8386
DOI:10.3275/8958