Giusti et al. / J Zhejiang Univ-Sci B (Biomed & Biotechnol) 2017 18(7):555-566
555
Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology) ISSN 1673-1581 (Print); ISSN 1862-1783 (Online) www.jzus.zju.edu.cn; www.springerlink.com E-mail: [email protected]
Retrospective cytological evaluation of indeterminate thyroid nodules according to the British Thyroid Association 2014 classification and comparison of clinical evaluation and outcomes Massimo GIUSTI†1, Barbara MASSA2, Margherita BALESTRA1, Paola CALAMARO2, Stefano GAY1, Simone SCHIAFFINO3, Giovanni TURTULICI3, Simonetta ZUPO4, Eleonora MONTI1, Gianluca ANSALDO5 (1Endocrinology Unit, San Martino University Hospital, I-16100 Genoa, Italy) 2
( Cytopathology and Pathology Unit, San Martino University Hospital, I-16100 Genoa, Italy) (3Radiology Unit, Evangelico Hospital, I-16100 Genoa, Italy) 4
( Molecular Diagnostic Unit, San Martino University Hospital, I-16100 Genoa, Italy) (5Endocrinology Surgery Unit, San Martino University Hospital, I-16100 Genoa, Italy) †
E-mail: [email protected]; [email protected]
Received Feb. 20, 2016; Revision accepted Aug. 9, 2016; Crosschecked June 16, 2017
Abstract: 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 ultrasonography (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 surgicallytreated 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-topeak 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-peak index >1, and peak index
555
Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology) ISSN 1673-1581 (Print); ISSN 1862-1783 (Online) www.jzus.zju.edu.cn; www.springerlink.com E-mail: [email protected]
Retrospective cytological evaluation of indeterminate thyroid nodules according to the British Thyroid Association 2014 classification and comparison of clinical evaluation and outcomes Massimo GIUSTI†1, Barbara MASSA2, Margherita BALESTRA1, Paola CALAMARO2, Stefano GAY1, Simone SCHIAFFINO3, Giovanni TURTULICI3, Simonetta ZUPO4, Eleonora MONTI1, Gianluca ANSALDO5 (1Endocrinology Unit, San Martino University Hospital, I-16100 Genoa, Italy) 2
( Cytopathology and Pathology Unit, San Martino University Hospital, I-16100 Genoa, Italy) (3Radiology Unit, Evangelico Hospital, I-16100 Genoa, Italy) 4
( Molecular Diagnostic Unit, San Martino University Hospital, I-16100 Genoa, Italy) (5Endocrinology Surgery Unit, San Martino University Hospital, I-16100 Genoa, Italy) †
E-mail: [email protected]; [email protected]
Received Feb. 20, 2016; Revision accepted Aug. 9, 2016; Crosschecked June 16, 2017
Abstract: 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 ultrasonography (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 surgicallytreated 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-topeak 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-peak index >1, and peak index
