Endocrine Abstracts (2009) 20 P101

Thyroid node pathology: correlation between cytology, histology and radiology using a new cytological classification

Ignasi Castells, Nuria Pardo, Guzman Franch, Olga Simo, Asumpta Recasens, Xavier Guirao & Gabriel Gimenez

Hospital General de Granollers, Granollers, Barcelona, Spain.

Introduction: A modification of the cytological classification from the ‘British Thyroid Association – Royal College of Physicians’ has been adapted for reporting fine-needle-puncture (FNP) cytology results since 2004 (Thy score). Five diagnostic categories have been agreed by our multidisciplinary committee: Thy1, inadequate sample; Thy2, benign; Thy3 indeterminate; Thy4, suspicious; Thy5, malignant.

Aim: Evaluate the correlation between cytology reports (Thy score), definitive histology and radiology findings. The new score specially aims to discriminate the former unspecific category of ‘follicular lesion’ reports into 2 new categories (TIhy3 and Thy4) for more accurately selecting those cases advisable for surgical treatment (follicular adenomas and differentiated carcinoma).

Methods: All FPN cases undertaken between January 2004 and February 2007 later on surgically treated have been included. Correlation and discordances between Thy score and definitive histology has been studied. Available ultrasound information is also evaluated for the presence of suspicious criteria.

Results: Surgical treatment was undertaken in 132 patients with one o more previous FNP with the following reporting results: Thy1 8.5%, Thy2 42.4%, Thy3 16.6%, Thy4 16.6% and Thy5 15.9%. All cases with Thy2 and Thy5 were congruent with definitive histology reports (benign no neoplastic and malign respectively). Unspecific categories (Thy3 and Thy4) had less congruent results, with a rate of neoplasia (benign or malign but advisable for surgery) of 36.3% and 77.2% respectively. Ultrasound malignity suspicious criteria increased the congruence of Thy4 cases to 90%. Ultrasound findings do not improve congruence in Thy3 cases.

Conclusions: Thyroid nodules Thy scoring system stratifies the risk of malignity and facilitates the communication and understanding between the members of the multidisciplinary committee when therapeutic decision have to be taken.

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