title: Combined clinical and ultrasound follow-up assists in malignancy detection in Galectin-3 negative Thy-3 thyroid nodules.
abstract: The use of galectin-3 ThyroTest in the preoperative evaluation of cytologically indeterminate (Thy-3) thyroid nodules has been largely validated by retrospective and prospective multicentre studies. Here we report the results of galectin-3 ThyroTest routinely applied in the management of Thy-3 nodules in combination with clinical and ultrasonography (US) examination, in which galectin-3 positive nodules were directly referred to surgery whereas galectin-3 negative lesions were considered for clinical and US long-term follow-up. A cohort of 331 patients, bearing 340 thyroid Thy-3 nodules, was enrolled and subjected to galectin-3 expression analysis. A total of 256 galectin-3 negative nodules were directed to periodical clinical and US examination, while 84 galectin-3 positive cases were referred to surgery. Excluding 63 dropout patients plus 15 patients that were operated because of clinical reasons the remaining 176 galectin-3 negative nodules were followed with clinical and US examination for an average period of 31 months. During the follow-up, the volume of galectin-3 negative nodules was unchanged in 85 cases (48 %), reduced in 47 (27 %), and increased in 44 (25 %). Based on combined clinical features and US follow-up results, a total of 36 out of 191 galectin-3 negative nodules (19 %) were referred to surgery, with a final histological finding of 28 benign lesions, three follicular tumor of uncertain malignant potential (FT-UMP), and five malignant lesions, corresponding to a 7 % false negative rate. In the group of 84 galectin-3 positive nodules, we detected 65 thyroid cancers with a prevalence of 77 %, 12 FT-UMPs, and 7 false positive lesions, corresponding to a 4 % false positive rate. A total of 150 patients were not operated and are still under clinical and US monitoring while surgery was performed in 118 patients with a final 70 thyroid cancers diagnosed, corresponding to a 59 % prevalence of malignancy detected at surgery and to a 26 % prevalence of malignancy among the entire Thy-3 nodule population. Galectin-3 ThyroTest is an easy and cheap diagnostic procedure that integrates conventional fine-needle-aspiration cytology, reduces the number of unnecessary thyroidectomies and increases the rate of malignancy at surgery. Clinical and US follow-up of galectin-3 negative lesions allows to further reduce false negative cases.
authors.affiliation: Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, 00161, Rome, Italy. ssciacchitano@hotmail.it.|Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy. ssciacchitano@hotmail.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sciacchitano
authors.affiliation: Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Lavra
authors.affiliation: Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ulivieri
authors.affiliation: Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy.
authors.forename: Fiorenza
authors.initials: F
authors.lastname: Magi
authors.affiliation: Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, 00161, Rome, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Porcelli
authors.affiliation: Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, 00161, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Amendola
authors.affiliation: Department of Oncological Science, Breast Unit, St Andrea University Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: De Francesco
authors.affiliation: Operative Unit Surgery of Thyroid and Parathyroid, Sapienza University of Rome, S. Andrea Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bellotti
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Policlinico Universitario "G. Martino", via Consolare Valeria, Gazzi, 98125, Messina, Italy.
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Trovato
authors.affiliation: Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy.|Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy.
authors.forename: Leila B
authors.initials: LB
authors.lastname: Salehi
authors.affiliation: Laboratory of Surgical and Experimental Pathology, St Andrea University Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy.|Department of Oncology-Pathology, Cancer Center Karolinska Universitetssjukhuset Solna, 17176, Stockholm, Sweden.
authors.forename: Armando
authors.initials: A
authors.lastname: Bartolazzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003581:Cytodiagnosis; D005260:Female; D005500:Follow-Up Studies; D037502:Galectin 3 / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D037502:Galectin 3
keywords: FNA cytology; FNA indeterminate; Galectin-3; Thyroid cancer diagnosis