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Fiorentino V, Dell’ Aquila M, Musarra T, Martini M, Capodimonti S, Fadda G, Curatolo M, Traini E, Raffaelli M, Lombardi CP, Pontecorvi A, Larocca LM, Pantanowitz L, Rossi ED. The Role of Cytology in the Diagnosis of Subcentimeter Thyroid Lesions. Diagnostics (Basel) 2021; 11:diagnostics11061043. [PMID: 34204172 PMCID: PMC8230300 DOI: 10.3390/diagnostics11061043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
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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Affiliation(s)
- Vincenzo Fiorentino
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Marco Dell’ Aquila
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Teresa Musarra
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Mariangela Curatolo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Emanuela Traini
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (E.T.); (M.R.); (C.P.L.)
| | - Marco Raffaelli
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (E.T.); (M.R.); (C.P.L.)
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (E.T.); (M.R.); (C.P.L.)
| | - Alfredo Pontecorvi
- Division of Endocrinology-Fondazione, Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy;
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Liron Pantanowitz
- Department of Pathology & Clinical Labs, University of Michigan, Ann Arbor, MI 48103, USA;
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
- Correspondence: ; Tel.: +39-06-3015-4433
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