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

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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.

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Authors and Affiliations

  1. Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Pierpaolo Trimboli, Gaetano Paone & Luca Giovanella

  2. Units of Endocrinology and Diabetes, Department of Medicine, University Hospital Campus Bio Medico, Rome, Italy

    Andrea Palermo

  3. Endocrinology, Diabetes, and Metabolism Unit, A.O. Ordine Mauriziano di Torino, “Umberto I” Hospital, Turin, Italy

    Maurilio Deandrea, Lavinia Monte, Cecilia Crosetto & Paolo Limone

  4. Nuclear Medicine Department, Galliera Hospital, Genoa, Italy

    Arnoldo Piccardo, Gianluca Bottoni & Giulia Ferrarazzo

  5. Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy

    Alfredo Campennì & Sergio Baldari

  6. Department of Medical and Surgical Sciences, Ospedale S. Andrea, Sapienza University, Rome, Italy

    Stefano Valabrega & Giuliano Santolamazza

  7. Department of Traslational and Precision Medicine, Sapienza University, Rome, Italy

    Giorgio Grani, Valeria Ramundo & Cosimo Durante

  8. Oncological Endocrinology Unit, IRCCS—Regina Elena National Cancer Institute, Rome, Italy

    Agnese Barnabei, Rosa Lauretta, Alfonsina Chiefari, Sebastiano Vottari & Marialuisa Appetecchia

  9. Unit of Endocrinology, Department of Clinical and Experimental Medicine, “G. Martino” University Hospital, University of Messina, Messina, Italy

    Rosaria Maddalena Ruggeri

  10. Departments of Clinical and Molecular Medicine, Sapienza University, St. Andrea Hospital, Rome, Italy

    Enrico Giarnieri

  11. Section of Pathology, University Hospital Campus Bio Medico, Rome, Italy

    Eleonora Perrella & Anna Crescenzi

Authors
  1. Pierpaolo Trimboli
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  2. Andrea Palermo
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  3. Maurilio Deandrea
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  4. Arnoldo Piccardo
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  5. Alfredo Campennì
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  9. Gianluca Bottoni
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  10. Agnese Barnabei
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  11. Valeria Ramundo
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  13. Lavinia Monte
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  14. Giulia Ferrarazzo
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  16. Cecilia Crosetto
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  17. Rosaria Maddalena Ruggeri
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  18. Sergio Baldari
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  19. Alfonsina Chiefari
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  20. Sebastiano Vottari
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  21. Enrico Giarnieri
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  22. Eleonora Perrella
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  23. Paolo Limone
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  24. Cosimo Durante
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  25. Luca Giovanella
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  26. Marialuisa Appetecchia
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  27. Anna Crescenzi
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Corresponding author

Correspondence to Pierpaolo Trimboli.

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Trimboli, P., Palermo, A., Deandrea, M. et al. Prognosis of patients with differentiated thyroid carcinomas having a preoperative cytological report of indeterminate at low or high risk. A multicenter study. Endocrine 66, 557–562 (2019). https://doi.org/10.1007/s12020-019-02013-9

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  • DOI: https://doi.org/10.1007/s12020-019-02013-9

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