Wolde Sellasie Sium, Amendola Stefano, Guidobaldi Leo, Pedicini Francesco, Nardone Isabella, Piticchio Tommaso, Zaccaria Simona, Uccioli Luigi, Trimboli Pierpaolo
Division of Endocrinology and Diabetes, CTO Andrea Alesini Hospital, Department of Surgical Sciences, University of Rome Tor Vergata, 00153 Rome, Italy.
Ph.D. School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy.
J Clin Med. 2025 Jul 23;14(15):5206. doi: 10.3390/jcm14155206.
: Oncocyte-rich indeterminate thyroid nodules (O-ITNs) present diagnostic and management challenges due to overlapping features between benign and malignant lesions and differing cytological classifications. This study aimed primarily to assess the ultrasound (US) characteristics and US-based risk of O-ITNs using the American College of Radiology Thyroid Imaging Reporting And Data Systems (ACR TI-RADS). A secondary objective was to compare the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) and Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC) cytological systems regarding classification and clinical management implications for O-ITNs. : A retrospective study was conducted on 177 ITNs (TIR3A and TIR3B) evaluated between June 2023 and December 2024 at CTO-Alesini, Rome (Italy). Nodules were assessed with US, cytology, and histology. Oncocyte predominance was defined as >70% oncocytes on fine-needle aspiration (FNA). US features were analyzed according to ACR TI-RADS. Nodules were reclassified by BSRTC, and potential differences in clinical case management (CCM) were analyzed. : O-ITNs comprised 47.5% of the sample. Compared to non-O-ITNs, O-ITNs were larger and more frequently showed low-risk US features, including a higher prevalence of ACR TI-RADS 3 nodules. However, no progressive increase in the risk of malignancy (ROM) was observed across ACR TI-RADS classes within O-ITNs. Histological malignancy was identified in 47.1% of O-ITNs, a lower proportion compared to non-O-ITNs, though the difference was not statistically significant. Classification discordance with potential management impact was lower in O-ITNs (20.2%) than in non-O-ITNs (38.7%). : O-ITNs typically exhibit benign-appearing US features and lower classification discordance between BSRTC and ICCRTC, yet US risk stratification fails to differentiate malignancy risk within O-ITNs. A tailored approach integrating cytology and cautious US interpretation is essential for optimal O-ITN management.
富含嗜酸性细胞的甲状腺结节（O-ITN）由于良性和恶性病变特征重叠以及细胞分类不同，在诊断和管理方面存在挑战。本研究主要旨在使用美国放射学会甲状腺影像报告和数据系统（ACR TI-RADS）评估O-ITN的超声（US）特征和基于超声的风险。次要目标是比较甲状腺细胞病理学报告的贝塞斯达系统（BSRTC）和意大利甲状腺细胞分类与报告共识（ICCRTC）细胞系统在O-ITN分类和临床管理方面的影响。：对2023年6月至2024年12月在意大利罗马CTO-Alesini评估的177个ITN（TIR3A和TIR3B）进行了回顾性研究。对结节进行超声、细胞学和组织学评估。嗜酸性细胞优势定义为细针穿刺（FNA）时嗜酸性细胞>70%。根据ACR TI-RADS分析超声特征。结节由BSRTC重新分类，并分析临床病例管理（CCM）中的潜在差异。：O-ITN占样本的47.5%。与非O-ITN相比，O-ITN更大，更频繁地表现出低风险超声特征，包括ACR TI-RADS 3类结节的患病率更高。然而，在O-ITN的ACR TI-RADS类别中未观察到恶性风险（ROM）的逐步增加。在47.1%的O-ITN中发现组织学恶性，与非O-ITN相比比例较低，尽管差异无统计学意义。O-ITN中与潜在管理影响的分类不一致性（20.2%）低于非O-ITN（38.7%）。：O-ITN通常表现出良性的超声特征，并且BSRTC和ICCRTC之间的分类不一致性较低，但超声风险分层无法区分O-ITN内的恶性风险。综合细胞学和谨慎的超声解读的定制方法对于优化O-ITN管理至关重要。
