title: Surgical approach to TIR3 cytology class A prospective evaluation.
abstract: OBJECTIVE
  Fine-needle aspiration (FNA) has proven to be a safe and reliable method of investigation of thyroid lesions. Referencing to European classification, the associated risk of malignancy for TIR3, category reserved for aspirates that contain architectural and/or nuclear atypia, is variable in such studies. Aims of study were evaluating safety of surgical approach, assessing perioperative parameters surgically related, and estimating neoplastic rate for TIR3 group.
  
  
  METHODS
  A prospective evaluation of all TIR3 submitted to thyroidectomy was conducted by assessing histopatohologic results between January 2005 and December 2012, considering two categories, positive (neoplastic) and negative (not neoplastic) group. Intraoperative and complication rate was analyzed on TIR3 population.
  
  
  RESULTS
  A total of 1514 total thyroidectomy was performed from 2005 to 2012: a total of 148 cases was considered on TIR3 group. Positive cases amounted to 64 (43.2%), 29 of which were carcinoma (19.6% of total population) and 35 of which were adenoma, while negative cases amounted to 84 (56.8%). Sensitivity and specificity of TIR3 as neoplastic screening was 43.2% and 82.1%. A total of 32 linfectomies was performed (21.6% of group). Positive group presented a significant lower mean age than negative group (42.1 vs 56.2 years)
  
  
  CONCLUSIONS
  TIR3 group represents a various category, with probably different malignancy risk. Our results and neoplasms rate confirmed that surgical option should be gold standard, in order to define atypical pattern and reduce delayed diagnoses. Choice of a second FNA or a imaging monitoring should be adopted for specific condition.
  
  
  BACKGROUND
  Fine-needle aspiration, Thyroidectomy, TIR3, Thyroid cancer.
authors.forename: Nicola
authors.initials: N
authors.lastname: D'Alessandro
authors.forename: Giovanni Michele
authors.initials: GM
authors.lastname: Fasano
authors.forename: Francesco
authors.initials: F
authors.lastname: Gilio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Iside
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Izzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Loffredo
authors.forename: Margherita
authors.initials: M
authors.lastname: Pinto
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tramontano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tramutola
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Citro
mesh_terms: D000236:Adenoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D000328:Adult; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D003581:Cytodiagnosis / Q000379:methods; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013961:Thyroid Gland / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy