Prediction of classical versus non classical papillary thyroid carcinoma subtypes from cytology of nodules classified according to TIRADS

Abstract

Purpose: Our purposes were: 1) to estimate the prediction performance (PP) of cytology in identifying papillary thyroid carcinoma (PTC) subtypes; 2) to explore how the PTC subtypes distribute among the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) categories.

Methods: Nodules were included if both the histology with the PTC subtype report and the cytology report with the possible PTC subtype were available. The PP was calculated by making the proportion of True positives/False positives+false negatives.

Results: 309 cytologically "suspicious for malignancy" and "malignant" thyroid nodules with PTC histology were evaluated. ACR TI-RADS categorization for classical PTC was significantly different from non-classical PTC (p-value 0.02). For the whole cohort the PP of cytologically classical cases was 0.74, while that of cytologically non classical cases was 0.41. ACR TI-RADS categorization was not significantly different for aggressive vs non-aggressive PTC subtypes (p-value 0.1). When considering only aggressive or non-aggressive PTC subtypes, the PP of cytologically classical cases was respectively 0.86 and 0.87, while that of cytologically non classical cases was respectively 0.27 and 0.22. The PP of cytologically classical cases was 0.73 and 0.79, respectively for macroPTCs and microPTCs, while that of cytologically non classical cases was 0.55 and 0.33, respectively for macroPTCs and microPTCs.

Conclusion: Cytology examination reliably performed in predicting classical PTC versus non classical PTC subtypes. ACR TI-RADS categorization was significantly different among classical PTC versus non classical PTC subtypes.

Keywords: PTC subtypes; TI-RADS; Thyroid nodules.

Fig. 1

Flowchart of patients’ selection. PTC papillary thyroid carcinoma, FNAC fine needle aspiration cytology, ACR TI-RADS American College of Radiology Thyroid Imaging Reporting and Data Systems, NIFTP non-invasive follicular thyroid neoplasm with papillary-like nuclear features, FTC follicular thyroid carcinoma, MTC medullary thyroid carcinoma, PDTC/ATC poorly differentiated and anaplastic thyroid carcinoma, TL thyroid lymphoma, Cribriform-morular thyroid carcinoma is no longer classified as a subtype of PTC [31]