Prognosis of patients with differentiated thyroid carcinomas having a preoperative cytological report of indeterminate at low or high risk. A multicenter study

Pierpaolo Trimboli, Andrea Palermo, Maurilio Deandrea, Arnoldo Piccardo, Alfredo Campennì, Stefano Valabrega, Giorgio Grani, Giuliano Santolamazza, Gianluca Bottoni, Agnese Barnabei, Valeria Ramundo, Rosa Lauretta, Lavinia Monte, Giulia Ferrarazzo, Gaetano Paone, Cecilia Crosetto, Rosaria Maddalena Ruggeri, Sergio Baldari, Alfonsina Chiefari, Sebastiano VottariEnrico Giarnieri, Eleonora Perrella, Paolo Limone, Cosimo Durante, Luca Giovanella, Marialuisa Appetecchia, Anna Crescenzi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Italian cytology system for thyroid fine-needle aspiration (FNA) includes indeterminate lesions at low- (Tir 3A) and high-risk (Tir 3B). The present retrospective multicenter study was undertaken to compare the histological type of cancers and disease-free survival in these two groups. Methods: Eight institutions participated. Thyroid cancer patients diagnosed and followed-up after Tir 3A or Tir 3B were reviewed. Histological diagnosis was adopted as the gold standard. Patients were defined with cancer recurrence or no evidence of disease. Disease-free survival (DFS) was calculated. A non-parametric statistical analysis was used. DFS was estimated by Kaplan–Meier method and Hazard Ratio (HR) defined the slope of curves. Results: Two hundred and nine patients (median DFS 24 months) were enrolled and a 6.3% of these recurred. Tir 3B group had higher age (p = 0.014), larger cancer size (p = 0.0002), shorter DFS (p = 0.003), higher number of aggressive cancers (p = 0.006), and relapse frequency double than Tir 3A. At survival curves analysis, Tir 3B group had HR of 2.37 with respect to Tir 3A. At Cox’s proportional hazard regression analysis histology was the only significant predictor of relapse. Conclusions: While patients with thyroid FNA of Tir 3B should be addressed to surgery due to high likelihood of more aggressive cancer, a diagnostic surgery could be avoided in patients with Tir 3A if concurrent unsuspicious clinical features are found.

Original languageEnglish
Pages (from-to)557-562
Number of pages6
JournalEndocrine
Volume66
Issue number3
DOIs
Publication statusPublished - Dec 1 2019

Keywords

  • Carcinoma
  • Fine-needle aspiration (FNA)
  • Follow-up
  • Indeterminate nodules
  • Thyroid

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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