title: Thyroid Imaging Reporting and Data System Score Combined with the New Italian Classification for Thyroid Cytology Improves the Clinical Management of Indeterminate Nodules.
abstract: The new Italian cytological classification (2014) of thyroid nodules replaced the TIR3 category of the old classification (2007) with two subclasses, TIR3A and TIR3B, with the aim of reducing the rate of surgery for benign diseases. Moreover, thyroid imaging reporting and data system (TI-RADS) score appears to ameliorate the stratification of the malignancy risk. We evaluated whether the new Italian classification has improved diagnostic accuracy and whether its association with TI-RADS score could improve malignancy prediction. We retrospectively analyzed 70 nodules from 70 patients classified as TIR3 according to the old Italian classification who underwent surgery for histological diagnosis. Of these, 51 were available for cytological revision according to the new Italian cytological classification. Risk of malignancy was determined for TIR3A and TIR3B, TI-RADS score, and their combination. A different rate of malignancy (p= 0.0286) between TIR3A (13.04%) and TIR3B (44.44%) was observed. Also TI-RADS score is significantly (p= 0.003) associated with malignancy. By combining cytology and TI-RADS score, patients could be divided into three groups with low (8.3%), intermediate (21.4%), and high (80%) risk of malignancy. In conclusion, the new Italian cytological classification has an improved diagnostic accuracy. Interestingly, the combination of cytology and TI-RADS score offers a better stratification of the malignancy risk.
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Salvatore
authors.identifier: 0000-0002-7573-0759
authors.initials: S
authors.lastname: Ulisse
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Bosco
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nardi
authors.affiliation: Department of Experimental Medicine, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Nesca
authors.affiliation: Department of Experimental Medicine, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: D'Armiento
authors.affiliation: Department of Experimental Medicine, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Guglielmino
authors.affiliation: Department of Public Health and Infectious Disease, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: De Vito
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sorrenti
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Pironi
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tartaglia
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Arcieri
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Catania
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Monti
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Filippini
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Ascoli