ETD

• carcinoma papillare a cellule alte (TC-PTC)
• tall cell papillary thyroid carcinoma (TC-PTC)

Introduzione: I sottotipi del carcinoma papillare della tiroide (PTC) hanno comportamento biologico diverso. Quello a cellule alte (TC-PTC) (13% del totale) richiede un trattamento più aggressivo.
Obiettivo: Definire uno score di rischio per la gestione preoperatoria e la scelta del tipo di trattamento dei noduli TIR3B, TIR4 o TIR5.
Materiali e Metodi: 1242 pazienti tiroidectomizzati negli anni 2015-2018 per noduli a citologia TIR3B, TIR4, TIR5 (totale noduli: 1294). Sono state considerate le caratteristiche demografiche e di laboratorio dei pazienti ed ecografiche, citologiche e istologiche dei noduli.
Risultati: I DTC risultavano più frequenti nelle donne <55 anni, i PDTC negli uomini >55 anni. I PTC spesso misuravano ≤1,3 cm (41,7%) e risultavano TIR5 nel 51,8% dei casi. Il pattern ecografico ipoecogenicità+margini irregolari+microcalcificazioni era tipico dei PTC (17,8%). Il TC- PTC risultava più frequente nelle donne (80%), nei soggetti >55 anni (36%), veniva classificato TIR5 nel 72,3% dei casi ed era caratterizzato dal pattern ipoecogenicità+margini irregolari senza microcalcificazioni (42,0% vs 12,0% dei C-PTC). I linfociti nell’FNAB (in assenza di AbTg e AbTPO) erano presenti nel 29,4% dei TC-PTC e nel 15,0% dei C-PTC. Erano correlati al TC-PTC: sesso femminile (OR 2,84), citologia TIR5 (OR 3,36), linfociti (OR 2,58) e pattern ecografico (OR 6,42). La coesistenza delle 4 variabili conferiva un rischio di TC-PTC del 70%, l’assenza di tutte dell’1,0%. I microcarcinomi PTC (noduli <1,3 cm) sottotipo TC erano correlati con: linfociti (OR 3,36) e pattern ecografico (OR 4,82).
Conclusione: Questo score clinico è utile nella scelta dell’estensione della tiroidectomia e nella gestione dei microcarcinomi papillari.



Introduction: The subtypes of papillary thyroid carcinoma (PTC) exhibit different biological behaviors. The tall cell variant (TC-PTC) (13% of the total) requires more aggressive treatment.
Objective: To define a risk score for preoperative management and the choice of treatment type for nodules with TIR3B, TIR4, or TIR5 cytology.
Materials and Methods: A total of 1242 patients who underwent thyroidectomy between 2015 and 2018 for nodules with TIR3B, TIR4, or TIR5 cytology (total nodules: 1294) were evaluated. Demographic, laboratory, ultrasound, cytological, and histological characteristics of the patients and nodules were considered.
Results: Differentiated thyroid carcinomas (DTCs) were more frequent in women <55 years, while poorly differentiated thyroid carcinomas (PDTCs) were more common in men >55 years. PTCs often measured ≤1.3 cm (41.7%) and were classified as TIR5 in 51.8% of cases. The ultrasound pattern of hypoechogenicity + irregular margins + microcalcifications was typical of PTCs (17.8%). TC-PTC was more frequent in women (80%), in subjects >55 years (36%), was classified as TIR5 in 72.3% of cases, and was characterized by the ultrasound pattern of hypoechogenicity + irregular margins without microcalcifications (42.0% vs. 12.0% of C-PTC). Lymphocytes in FNAB (in the absence of AbTg and AbTPO) were present in 29.4% of TC-PTC and 15.0% of C-PTC. Factors correlated with TC-PTC included: female sex (OR 2.84), TIR5 cytology (OR 3.36), lymphocytes (OR 2.58), and ultrasound pattern (OR 6.42). The coexistence of all four variables conferred a 70% risk of TC-PTC, while the absence of all variables conferred a 1.0% risk. PTC microcarcinomas (nodules <1.3 cm) of the tall cell subtype were correlated with: lymphocytes (OR 3.36) and ultrasound pattern (OR 4.82).
Conclusion: This clinical score is useful in choosing the extent of thyroidectomy and in managing papillary microcarcinomas.