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Rivista sulle Malattie del Sistema Endocrino

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Minerva Endocrinologica 2016 Sep 02


lingua: Inglese

Micro-carcinoma: only a diagnostic epidemic?

Paolo DEL RIO 1, Chiara MONTANA MONTANA 1, Giulia MINGARDI 1, Giovanna PIVA 2, Mario SIANESI 2, Luigi CORCIONE 3

1 Unit of General Surgery and Organ Transplantation, Department of Surgical Science, University Hospital of Parma, Parma, Italy; 2 Medical School , University Hospital of Parma, Parma, Italy; 3 Department of Human Histopathology, University Hospital of Parma, Parma, Italy


BACKGROUND: The incidence of thyroid carcinoma goes from 0.5 to 10 cases on 100.000, depending on the country, the context and purpose of the study. The high incidence of differentiated thyroid tumor is continuously growing. While most malignant pathologies affect the adults, a proportion of 1-2 % of paediatric population is affected by solitary nodule, of which some are malignant cancers. Studying thyroid malignant cancer, the most sensitive and accurate imaging technique is the colorDoppler ultrasounds. Fine Needle Aspiration Cytology, correctly performed, is relevant to a correct diagnosys.
METHODS: This prospect study analyzed 1726 case of Total Thyroidectomy and lobectomy, executed between January 2004 and December 2013. The cytology sampling have been done following standard FNAC or capillary aspiration. Results have been classified in five class, following the TiR system 2008. Sensibility, specificity, accuracy, negative predictive value and positive for the evaluation of FNAC technique are the Statistic Parameters considered.
RESULTS: The outcome is aligned with what already known in literature, that FNAC has sensibility between 60-98% and specificity between 72-100%. Considering TIR 3 as a low malignancy risk category therefore not suitable for surgery, those values decrease.
CONCLUSION: Micro-carcinoma is a more represented entity than apparently suspected. Now a days, cytology is the most precise diagnostic support to the therapeutic management of thyroid node, yet it is still charged with false negatives. The evaluation of data records combined with some molecular biology techniques and applied to cytology, could help in giving more appropriate surgical indication, allowing the surgery to be therapeutic more than diagnostic.

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