Surgical approach to TIR3 cytology class A prospective evaluation

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COD: 05_1026_2234 Categorie: ,

Nicola D’Alessandro, Giovanni Michele Fasano, Francesco Gilio, Giovanni Iside, Maria Lucia Izzo, Andrea Loffredo, Margherita Pinto, Salvatore Tramontano, Giuseppe Tramutola, Giuseppe Citro

Ann. Ital. Chir., 2014 85: 537-543

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AIM: 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.
MATERIAL AND 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.

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