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The Role of Cytology in the Diagnosis of Subcentimeter Thyroid Lesions

Thyroid nodules are common and typically detected by palpation and/or ultrasound (US). Guidelines have defined the management of large nodules, but controversy exists regarding nodules ≤ 1 cm. We evaluated a cohort of patients with subcentimeter nodules to determine their rate of malignancy (ROM). A...

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Autores principales: Fiorentino, Vincenzo, Dell’ Aquila, Marco, Musarra, Teresa, Martini, Maurizio, Capodimonti, Sara, Fadda, Guido, Curatolo, Mariangela, Traini, Emanuela, Raffaelli, Marco, Lombardi, Celestino Pio, Pontecorvi, Alfredo, Larocca, Luigi Maria, Pantanowitz, Liron, Rossi, Esther Diana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8230300/
https://www.ncbi.nlm.nih.gov/pubmed/34204172
http://dx.doi.org/10.3390/diagnostics11061043
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author Fiorentino, Vincenzo
Dell’ Aquila, Marco
Musarra, Teresa
Martini, Maurizio
Capodimonti, Sara
Fadda, Guido
Curatolo, Mariangela
Traini, Emanuela
Raffaelli, Marco
Lombardi, Celestino Pio
Pontecorvi, Alfredo
Larocca, Luigi Maria
Pantanowitz, Liron
Rossi, Esther Diana
author_facet Fiorentino, Vincenzo
Dell’ Aquila, Marco
Musarra, Teresa
Martini, Maurizio
Capodimonti, Sara
Fadda, Guido
Curatolo, Mariangela
Traini, Emanuela
Raffaelli, Marco
Lombardi, Celestino Pio
Pontecorvi, Alfredo
Larocca, Luigi Maria
Pantanowitz, Liron
Rossi, Esther Diana
author_sort Fiorentino, Vincenzo
collection PubMed
description Thyroid nodules are common and typically detected by palpation and/or ultrasound (US). Guidelines have defined the management of large nodules, but controversy exists regarding nodules ≤ 1 cm. We evaluated a cohort of patients with subcentimeter nodules to determine their rate of malignancy (ROM). A total of 475 thyroid FNAs of lesions ≤ 1 cm with available follow-up were identified from January 2015–December 2019. For comparative analysis, we added a control series of 606 thyroid lesions larger than 1 cm from the same reference period. All aspirates were processed with liquid-based cytology and classified according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Subcentimeter nodules were stratified as 35 category I—non-diagnostic cases (ND; 7.3%), 144 category II—benign lesions (BL; 30.3%), 12 category III—atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; 2.5%), 12 category IV—follicular neoplasm/suspicious for follicular neoplasm (FN/SFN; 2.5%), 124 category V—suspicious for malignancy (SM; 26.1%), and 148 category VI—positive for malignancy (PM; 31.1%). A total of 307 cases (64.6%) underwent subsequent surgery. Only one ND and three BLs had a malignant outcome. ROM for indeterminate lesions (III + IV) was 3.2%; with 1.6% for category III and 3.2% for category IV. ROM for the malignant categories (V + VI) was 88.2%. The control cohort of lesions demonstrated a higher number of benign histological diagnoses (67.3%). We documented that 57.2% of suspected subcentimeter lesions were malignant, with a minor proportion that belonged in indeterminate categories. There were very few ND samples, suggesting that aspirates of subcentimeter lesions yield satisfactory results. Suspected US features in subcentimeter lesions should be evaluated and followed by an interdisciplinary team for appropriate patient management.
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spelling pubmed-82303002021-06-26 The Role of Cytology in the Diagnosis of Subcentimeter Thyroid Lesions Fiorentino, Vincenzo Dell’ Aquila, Marco Musarra, Teresa Martini, Maurizio Capodimonti, Sara Fadda, Guido Curatolo, Mariangela Traini, Emanuela Raffaelli, Marco Lombardi, Celestino Pio Pontecorvi, Alfredo Larocca, Luigi Maria Pantanowitz, Liron Rossi, Esther Diana Diagnostics (Basel) Article Thyroid nodules are common and typically detected by palpation and/or ultrasound (US). Guidelines have defined the management of large nodules, but controversy exists regarding nodules ≤ 1 cm. We evaluated a cohort of patients with subcentimeter nodules to determine their rate of malignancy (ROM). A total of 475 thyroid FNAs of lesions ≤ 1 cm with available follow-up were identified from January 2015–December 2019. For comparative analysis, we added a control series of 606 thyroid lesions larger than 1 cm from the same reference period. All aspirates were processed with liquid-based cytology and classified according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Subcentimeter nodules were stratified as 35 category I—non-diagnostic cases (ND; 7.3%), 144 category II—benign lesions (BL; 30.3%), 12 category III—atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; 2.5%), 12 category IV—follicular neoplasm/suspicious for follicular neoplasm (FN/SFN; 2.5%), 124 category V—suspicious for malignancy (SM; 26.1%), and 148 category VI—positive for malignancy (PM; 31.1%). A total of 307 cases (64.6%) underwent subsequent surgery. Only one ND and three BLs had a malignant outcome. ROM for indeterminate lesions (III + IV) was 3.2%; with 1.6% for category III and 3.2% for category IV. ROM for the malignant categories (V + VI) was 88.2%. The control cohort of lesions demonstrated a higher number of benign histological diagnoses (67.3%). We documented that 57.2% of suspected subcentimeter lesions were malignant, with a minor proportion that belonged in indeterminate categories. There were very few ND samples, suggesting that aspirates of subcentimeter lesions yield satisfactory results. Suspected US features in subcentimeter lesions should be evaluated and followed by an interdisciplinary team for appropriate patient management. MDPI 2021-06-06 /pmc/articles/PMC8230300/ /pubmed/34204172 http://dx.doi.org/10.3390/diagnostics11061043 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Fiorentino, Vincenzo
Dell’ Aquila, Marco
Musarra, Teresa
Martini, Maurizio
Capodimonti, Sara
Fadda, Guido
Curatolo, Mariangela
Traini, Emanuela
Raffaelli, Marco
Lombardi, Celestino Pio
Pontecorvi, Alfredo
Larocca, Luigi Maria
Pantanowitz, Liron
Rossi, Esther Diana
The Role of Cytology in the Diagnosis of Subcentimeter Thyroid Lesions
title The Role of Cytology in the Diagnosis of Subcentimeter Thyroid Lesions
title_full The Role of Cytology in the Diagnosis of Subcentimeter Thyroid Lesions
title_fullStr The Role of Cytology in the Diagnosis of Subcentimeter Thyroid Lesions
title_full_unstemmed The Role of Cytology in the Diagnosis of Subcentimeter Thyroid Lesions
title_short The Role of Cytology in the Diagnosis of Subcentimeter Thyroid Lesions
title_sort role of cytology in the diagnosis of subcentimeter thyroid lesions
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8230300/
https://www.ncbi.nlm.nih.gov/pubmed/34204172
http://dx.doi.org/10.3390/diagnostics11061043
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