title: Subclassification of the "grey zone" of thyroid cytology; a retrospective descriptive study with clinical, cytological, and histological correlation.
abstract: Undetermined thyroid cytology precludes any definitive distinction between malignant and benign lesions. Recently several classifications have been proposed to split this category into two or more cytological subcategories related to different malignancy risk rates. The current study was performed retrospectively to investigate the results obtained separating "undetermined" cytologic reports into two categories: "follicular lesion" (FL) and "atypia of undetermined significance" (AUS). Biochemical, clinical, and echographic features of each category were also retrospectively analyzed. Altogether, 316 undetermined fine-needle aspirated cytologies (FNACs) were reclassified as 74 FL and 242 AUS. Histological control leads to a diagnosis of carcinomas, adenomas, and nonneoplastic lesions, respectively, in 42.2%, 20%, and 37.8% of AUS and in 8.3%, 69.4%, and 22.2% of FL. Among biochemical, clinical, cytological, and echographic outcomes, altered thyroid autoantibodies, multiple versus single nodule, AUS versus FL, and presence of intranodular vascular flow were statistically significant to differentiate adenoma from carcinoma and from nonneoplastic lesions, whereas no significant differences were found between carcinomas and nonneoplastic lesions for these parameters. The results of this retrospective study show that undetermined FNAC category can further be subclassified in AUS and FL, the former showing higher malignancy rate. Further prospective studies are needed to confirm our results.
authors.affiliation: Department of Surgical Pathology, S. Chiara Hospital, 38100 Trento, Italy.
authors.forename: Mariella
authors.initials: M
authors.lastname: Bonzanini
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Amadori
authors.forename: Luca
authors.initials: L
authors.lastname: Morelli
authors.forename: Silvia
authors.initials: S
authors.lastname: Fasanella
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pertile
authors.forename: Angela
authors.initials: A
authors.lastname: Mattiuzzi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Marini
authors.forename: Mauro
authors.initials: M
authors.lastname: Niccolini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tirone
authors.forename: Marco
authors.initials: M
authors.lastname: Rigamonti
authors.forename: Paolo
authors.initials: P
authors.lastname: Dalla Palma