HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Boi, F Articles by Mariotti, S Search for Related Content PubMed PubMed Citation Articles by Boi, F Articles by Mariotti, S

High prevalence of suspicious cytology in thyroid nodules associated with positive thyroid autoantibodies

Endocrinology, Department of Medical Sciences ‘M. Arescu’ and ¹ Department of Public Health, University of Cagliari, Strada Statale 554-bivio Sestu I-09042 Monserrato, Cagliari, Italy and ² Department of Cytomorphology, San Giovanni di Dio Hospital, Via Ospedale 46 I-09124, Cagliari, Italy

(Correspondence should be addressed to S Mariotti; Email: mariotti{at}pacs.unica.it)

Objective: We assessed the association between thyroid autoimmunity and thyroid cancer in a retrospective series of unselected thyroid nodules submitted to fine-needle aspiration cytology (FNAC) to avoid the selection bias of surgical series.

Subjects and methods: Ultrasound (US)-guided FNACs were obtained from 590 unselected consecutive patients with single thyroid nodules and positive (ATA + , n = 197) or negative (ATA – , n = 393) serum anti-thyroid antibody (ATA). Cytological results were classified in three classes of increased risk of malignancy: low risk or benign (class II); indeterminate risk (class III); and suspect or malignant (class IV).

Results: A higher prevalence of class III (28.9% vs 21.4%, P < 0.05) and class IV (18.8% vs 9.2%, P < 0.001) and lower prevalence of class II (52.3% vs 69.5%, P < 0.001) were found in ATA + vs ATA – nodules respectively. By multivariate logistic regression analysis ATA + conferred a significant risk (odds ratio (OR): 2.29 (95% confidence interval (CI): 1.39–3.76)) for class IV cytology independently from age and sex. In 106 patients where thyroidectomy was carried out, thyroid cancer was found in 54/61 (88.5%) patients with class IV nodules (with similar positive predictive value for cancer in ATA + (96.4%) and ATA– (81.8%) nodules), in 6/31 (19.3%) of class III nodules (all ATA – ) and in none of 14 class II nodules. Non-specific cytological atypias from hyperplastic nodules in lymphocytic thyroiditis probably accounted for the different prevalence of cancer in class III ATA + and ATA – nodules. Histologically proven thyroid cancer (mostly papillary) was then observed in a higher proportion (27/197 = 13.7%) of ATA + , when compared with ATA – nodules (33/393 = 8.4%, P = 0.044), but the significance of this finding is limited by the low number of class II nodules operated on.

Conclusions: The presence of ATA + confers an increased risk of suspicious or malignant cytology in unselected thyroid nodules. Since ATA + is not responsible for increased false- positive class IV FNAC, our study provides indirect evidence supporting a significant association between thyroid carcinoma and thyroid autoimmunity, although further studies with a different design are needed for a definitive histological proof.

This article has been cited by other articles:

				F. Boi, I. Maurelli, G. Pinna, F. Atzeni, M. Piga, M. L. Lai, and S. Mariotti Calcitonin Measurement in Wash-Out Fluid from Fine Needle Aspiration of Neck Masses in Patients with Primary and Metastatic Medullary Thyroid Carcinoma J. Clin. Endocrinol. Metab., June 1, 2007; 92(6): 2115 - 2118. [Abstract] [Full Text] [PDF]