Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo-Patologiche, Università Sapienza, Viale Regina Elena, 324, 00161, Rome, Italy.
Unità di Statistica, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy.
J Endocrinol Invest. 2018 May;41(5):531-538. doi: 10.1007/s40618-017-0763-2. Epub 2017 Sep 25.
The Italian consensus to classify thyroid cytology has provided a standardized reporting scheme, including the subdivision of indeterminate for malignancy TIR-3 category into TIR-3A (low-risk) and TIR-3B (high-risk). We aimed to present our experience on this subclassification by evaluating risks of malignancy and the validity in sorting nodules with dissimilar risks. Another aim was to compare our performance against the Bethesda system.
Fine-needle aspirates of 290 TIR-3 that underwent thyroid surgery at our hospital (2008-2013) were reviewed and divided into TIR-3A or TIR-3B, and AUS/FLUS or FN/SFN. Cytological diagnoses were then correlated to histology. Results were evaluated using univariate analysis.
The subclassification into TIR-3A and TIR-3B differentiated hyperplastic nodules (p = 0.000) but not adenomas (p = 0.090). Rates of malignancy were significantly different between TIR-3A (10.2%) and TIR-3B (43.8%); TIR-3B malignancies were often papillary carcinomas (83%). TIR-3A/TIR-3B accounted for high sensitivity (84.5%; CI 79.7-88.4%), accuracy (64.1%; CI 58.6-69.6%) and NPV (89.8%; CI 85.6-93.0%) as opposed to modest specificity (55.8%; CI 49.9-61.6%) and PPV (43.8%; CI 38.1-49.8%). The rate of malignancy in AUS-FLUS was higher than in TIR-3A (p = 0.007), whereas it was not different between FN/SFN and TIR-3B (p = 0.337). Sensitivity of the Bethesda system was significantly lower respect to the Italian system.
The study supports the Italian consensus showing a different risk of malignancy for TIR-3A as compared to TIR-3B. TIR-3A/TIR-3B subclassification is valid to sort out benign nodules (high NPV) and malignancies (high sensitivity) but not adenomas (modest specificity, low PPV). In our experience, sensitivity is the main difference between Italian and Bethesda systems.
意大利共识对甲状腺细胞学的分类提供了一个标准化的报告方案，包括将恶性不确定的 TIR-3 类别细分为 TIR-3A（低风险）和 TIR-3B（高风险）。我们旨在通过评估恶性风险和对不同风险结节进行分类的有效性来介绍我们在这一分级上的经验。另一个目的是将我们的表现与 Bethesda 系统进行比较。
回顾了我院（2008-2013 年） 290 例 TIR-3 细针抽吸的甲状腺手术，分为 TIR-3A 或 TIR-3B、AUS/FLUS 或 FN/SFN。然后将细胞学诊断与组织学相关联。使用单变量分析评估结果。
TIR-3A 和 TIR-3B 的亚分类可区分增生性结节（p=0.000），但不能区分腺瘤（p=0.090）。TIR-3A（10.2%）和 TIR-3B（43.8%）之间的恶性肿瘤发生率有显著差异；TIR-3B 恶性肿瘤通常为乳头状癌（83%）。TIR-3A/TIR-3B 具有较高的敏感性（84.5%；95%CI 79.7-88.4%）、准确性（64.1%；95%CI 58.6-69.6%）和阴性预测值（89.8%；95%CI 85.6-93.0%），而非特异性（55.8%；95%CI 49.9-61.6%）和阳性预测值（43.8%；95%CI 38.1-49.8%）适中。AUS-FLUS 的恶性肿瘤发生率高于 TIR-3A（p=0.007），而 FN/SFN 与 TIR-3B 之间无差异（p=0.337）。与意大利系统相比，Bethesda 系统的敏感性显著降低。
该研究支持意大利共识，表明 TIR-3A 与 TIR-3B 的恶性风险不同。TIR-3A/TIR-3B 亚分类可有效区分良性结节（高阴性预测值）和恶性肿瘤（高敏感性），但不能区分腺瘤（特异性适中，阳性预测值低）。根据我们的经验，敏感性是意大利和 Bethesda 系统之间的主要区别。
