Ultrasound Parameters Can Accurately Predict the Risk of Malignancy in Patients with "Indeterminate TIR3b" Cytology Nodules: A Prospective Study.
Valentina Guarnotta, Roberta La Monica, Vincenza Rita Ingrao, Claudia Di Stefano, Riccardo Salzillo, Giuseppe Pizzolanti, Antonino Giulio Giannone, Piero Luigi Almasio, Pierina Richiusa, Carla Giordano
Author Information
Valentina Guarnotta: Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy.
Roberta La Monica: Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy.
Vincenza Rita Ingrao: Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy.
Claudia Di Stefano: Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy.
Riccardo Salzillo: Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy. ORCID
Giuseppe Pizzolanti: Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy. ORCID
Antonino Giulio Giannone: Pathologic Anatomy Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy. ORCID
Piero Luigi Almasio: Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy.
Pierina Richiusa: Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy.
Carla Giordano: Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy. ORCID
The increase in the incidence of thyroid nodules with cytological findings of TIR3b requires the identification of predictive factors of malignancy. We prospectively evaluated 2160 patients from January 2018 to June 2022 and enrolled 103 patients with indeterminate cytology TIR3b nodules who underwent total (73 patients) and hemi-thyroidectomy (30 patients). Among them, 61 had a histological diagnosis of malignancy (30 classic papillary thyroid carcinoma, 19 had follicular papillary thyroid carcinoma variant, 3 had Hurtle cell carcinoma and 9 had follicular thyroid carcinoma), while 42 had a benign histology. Clinical, ultrasonographic and cytological characteristics were recorded. In addition, BRAF mutation was analysed. Patients with a histological diagnosis of malignancy had a higher frequency of nodule diameter ≤11 mm ( = 0.002), hypoechogenicity ( < 0.001), irregular borders ( < 0.001), peri- and intralesional vascular flows ( = 0.004) and microcalcifications ( = 0.001) compared to patients with benign histology. In contrast, patients with benign histology had more frequent nodules with a halo sign ( = 0.012) compared to patients with histological diagnosis of malignancy. No significant differences were found in BRAF mutation between the two groups. Our study suggests that the combination of ultrasonographic and cytological data could be more accurate and reliable than cytology alone in identifying those patients with TIR3b cytology and a histology of malignancy to be referred for thyroidectomy, thus reducing the number of patients undergoing thyroidectomy for benign thyroid disease.
