'Indeterminate for malignancy' (Tir3/Thy3 in the Italian and British systems for classification) thyroid fine needle aspiration (FNA) cytology reporting: Morphological criteria and clinical impact

F. Pagni, M. Prada, P. Goffredo, G. Isimbaldi, S. Crippa, C. Di Bella, B. E. Leone, Maurizio Capra, Manuela Colombo, Rita Perego, Angela Ida Pincelli, Mario Perotti, Guido Grassi, Giovanni Colombo, Paolo Giannobi, Marcella Scardilli, Vittorio Giardini

Research output: Contribution to journalArticle

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Abstract

Background: The British system (Thy1-5), the Bethesda system for reporting thyroid cytopathology (BSRTC) and the Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification represent the most important international classifications for thyroid cytopathology. Irrespective of the system used, the 'indeterminate' categories are still debated among cytopathologists, particularly with regard to diagnostic criteria, clinical impact of subclassification and role of molecular techniques. Aim: We aimed to find answers to the following questions: Are there shared criteria in cytological preparations that allow the division of indeterminate follicular lesions into subcategories? What is the true clinical impact of this possible subclassification? Methods: Among 1150 consecutive thyroid fine needle aspiration (FNA) specimens, 80 patients had nodules with a final cytological report of Tir3 (SIAPEC)/Thy3. These 80 cases were re-evaluated and subclassified according to morphological criteria into three groups: pure follicular proliferations, Hürthle cell follicular lesions and atypical proliferations. Results: Sixteen (20%) cases were categorized as pure follicular proliferations, 40 (50%) as Hürthle cell follicular lesions and 24 (30%) as atypical proliferations. Surgery was performed in 57 cases (71%). Cyto-histological correlation showed that follicular adenoma was the most frequent final diagnosis in the cases treated by surgery (24/57, 42%). The overall malignancy rate in the Tir3 category was 28% (16/57). Atypical proliferations were more often malignant than either of the follicular groups (53% versus 19%, P = 0.019). Conclusions: A five-tiered classification, subdividing the 'indeterminate for malignancy' class into 'follicular proliferations' and 'atypical lesions' could be adopted. As a result of their higher risk of malignancy, surgical management of the atypical lesions would be justified. In future, the introduction of a genetic panel might contribute to their stratification, to the determination of a more accurate risk of malignancy of the atypical lesions and to the verification of follicular proliferations that are benign.

Original languageEnglish
Pages (from-to)170-176
Number of pages7
JournalCytopathology
Volume25
Issue number3
DOIs
Publication statusPublished - 2014

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Fine Needle Biopsy
Cell Biology
Thyroid Gland
Neoplasms
Adenoma
Cell Proliferation
Pathology

Keywords

  • Fine needle aspiration
  • FNA
  • Follicular lesions
  • Indeterminate cytology
  • Systems for reporting thyroid cytopathology
  • Thy3
  • Thyroid tumours
  • Tir3

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology
  • Medicine(all)

Cite this

'Indeterminate for malignancy' (Tir3/Thy3 in the Italian and British systems for classification) thyroid fine needle aspiration (FNA) cytology reporting : Morphological criteria and clinical impact. / Pagni, F.; Prada, M.; Goffredo, P.; Isimbaldi, G.; Crippa, S.; Di Bella, C.; Leone, B. E.; Capra, Maurizio; Colombo, Manuela; Perego, Rita; Pincelli, Angela Ida; Perotti, Mario; Grassi, Guido; Colombo, Giovanni; Giannobi, Paolo; Scardilli, Marcella; Giardini, Vittorio.

In: Cytopathology, Vol. 25, No. 3, 2014, p. 170-176.

Research output: Contribution to journalArticle

Pagni, F, Prada, M, Goffredo, P, Isimbaldi, G, Crippa, S, Di Bella, C, Leone, BE, Capra, M, Colombo, M, Perego, R, Pincelli, AI, Perotti, M, Grassi, G, Colombo, G, Giannobi, P, Scardilli, M & Giardini, V 2014, ''Indeterminate for malignancy' (Tir3/Thy3 in the Italian and British systems for classification) thyroid fine needle aspiration (FNA) cytology reporting: Morphological criteria and clinical impact', Cytopathology, vol. 25, no. 3, pp. 170-176. https://doi.org/10.1111/cyt.12085
Pagni, F. ; Prada, M. ; Goffredo, P. ; Isimbaldi, G. ; Crippa, S. ; Di Bella, C. ; Leone, B. E. ; Capra, Maurizio ; Colombo, Manuela ; Perego, Rita ; Pincelli, Angela Ida ; Perotti, Mario ; Grassi, Guido ; Colombo, Giovanni ; Giannobi, Paolo ; Scardilli, Marcella ; Giardini, Vittorio. / 'Indeterminate for malignancy' (Tir3/Thy3 in the Italian and British systems for classification) thyroid fine needle aspiration (FNA) cytology reporting : Morphological criteria and clinical impact. In: Cytopathology. 2014 ; Vol. 25, No. 3. pp. 170-176.
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abstract = "Background: The British system (Thy1-5), the Bethesda system for reporting thyroid cytopathology (BSRTC) and the Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification represent the most important international classifications for thyroid cytopathology. Irrespective of the system used, the 'indeterminate' categories are still debated among cytopathologists, particularly with regard to diagnostic criteria, clinical impact of subclassification and role of molecular techniques. Aim: We aimed to find answers to the following questions: Are there shared criteria in cytological preparations that allow the division of indeterminate follicular lesions into subcategories? What is the true clinical impact of this possible subclassification? Methods: Among 1150 consecutive thyroid fine needle aspiration (FNA) specimens, 80 patients had nodules with a final cytological report of Tir3 (SIAPEC)/Thy3. These 80 cases were re-evaluated and subclassified according to morphological criteria into three groups: pure follicular proliferations, H{\"u}rthle cell follicular lesions and atypical proliferations. Results: Sixteen (20{\%}) cases were categorized as pure follicular proliferations, 40 (50{\%}) as H{\"u}rthle cell follicular lesions and 24 (30{\%}) as atypical proliferations. Surgery was performed in 57 cases (71{\%}). Cyto-histological correlation showed that follicular adenoma was the most frequent final diagnosis in the cases treated by surgery (24/57, 42{\%}). The overall malignancy rate in the Tir3 category was 28{\%} (16/57). Atypical proliferations were more often malignant than either of the follicular groups (53{\%} versus 19{\%}, P = 0.019). Conclusions: A five-tiered classification, subdividing the 'indeterminate for malignancy' class into 'follicular proliferations' and 'atypical lesions' could be adopted. As a result of their higher risk of malignancy, surgical management of the atypical lesions would be justified. In future, the introduction of a genetic panel might contribute to their stratification, to the determination of a more accurate risk of malignancy of the atypical lesions and to the verification of follicular proliferations that are benign.",
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T2 - Morphological criteria and clinical impact

AU - Pagni, F.

AU - Prada, M.

AU - Goffredo, P.

AU - Isimbaldi, G.

AU - Crippa, S.

AU - Di Bella, C.

AU - Leone, B. E.

AU - Capra, Maurizio

AU - Colombo, Manuela

AU - Perego, Rita

AU - Pincelli, Angela Ida

AU - Perotti, Mario

AU - Grassi, Guido

AU - Colombo, Giovanni

AU - Giannobi, Paolo

AU - Scardilli, Marcella

AU - Giardini, Vittorio

PY - 2014

Y1 - 2014

N2 - Background: The British system (Thy1-5), the Bethesda system for reporting thyroid cytopathology (BSRTC) and the Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification represent the most important international classifications for thyroid cytopathology. Irrespective of the system used, the 'indeterminate' categories are still debated among cytopathologists, particularly with regard to diagnostic criteria, clinical impact of subclassification and role of molecular techniques. Aim: We aimed to find answers to the following questions: Are there shared criteria in cytological preparations that allow the division of indeterminate follicular lesions into subcategories? What is the true clinical impact of this possible subclassification? Methods: Among 1150 consecutive thyroid fine needle aspiration (FNA) specimens, 80 patients had nodules with a final cytological report of Tir3 (SIAPEC)/Thy3. These 80 cases were re-evaluated and subclassified according to morphological criteria into three groups: pure follicular proliferations, Hürthle cell follicular lesions and atypical proliferations. Results: Sixteen (20%) cases were categorized as pure follicular proliferations, 40 (50%) as Hürthle cell follicular lesions and 24 (30%) as atypical proliferations. Surgery was performed in 57 cases (71%). Cyto-histological correlation showed that follicular adenoma was the most frequent final diagnosis in the cases treated by surgery (24/57, 42%). The overall malignancy rate in the Tir3 category was 28% (16/57). Atypical proliferations were more often malignant than either of the follicular groups (53% versus 19%, P = 0.019). Conclusions: A five-tiered classification, subdividing the 'indeterminate for malignancy' class into 'follicular proliferations' and 'atypical lesions' could be adopted. As a result of their higher risk of malignancy, surgical management of the atypical lesions would be justified. In future, the introduction of a genetic panel might contribute to their stratification, to the determination of a more accurate risk of malignancy of the atypical lesions and to the verification of follicular proliferations that are benign.

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KW - Systems for reporting thyroid cytopathology

KW - Thy3

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