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International Journal of Endocrinology
Volume 2017, Article ID 9692304, 8 pages
Research Article

Thyroid Imaging Reporting and Data System Score Combined with the New Italian Classification for Thyroid Cytology Improves the Clinical Management of Indeterminate Nodules

1Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
2Department of Radiological, Oncological and Anatomo-Pathological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
3Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy
4Department of Public Health and Infectious Disease, “Sapienza” University of Rome, 00161 Rome, Italy

Correspondence should be addressed to Salvatore Ulisse; ti.1amorinu@essilu.erotavlas

Received 5 September 2016; Revised 7 November 2016; Accepted 26 December 2016; Published 1 March 2017

Academic Editor: Giorgio Iervasi

Copyright © 2017 Salvatore Ulisse et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The new Italian cytological classification (2014) of thyroid nodules replaced the TIR3 category of the old classification (2007) with two subclasses, TIR3A and TIR3B, with the aim of reducing the rate of surgery for benign diseases. Moreover, thyroid imaging reporting and data system (TI-RADS) score appears to ameliorate the stratification of the malignancy risk. We evaluated whether the new Italian classification has improved diagnostic accuracy and whether its association with TI-RADS score could improve malignancy prediction. We retrospectively analyzed 70 nodules from 70 patients classified as TIR3 according to the old Italian classification who underwent surgery for histological diagnosis. Of these, 51 were available for cytological revision according to the new Italian cytological classification. Risk of malignancy was determined for TIR3A and TIR3B, TI-RADS score, and their combination. A different rate of malignancy () between TIR3A (13.04%) and TIR3B (44.44%) was observed. Also TI-RADS score is significantly () associated with malignancy. By combining cytology and TI-RADS score, patients could be divided into three groups with low (8.3%), intermediate (21.4%), and high (80%) risk of malignancy. In conclusion, the new Italian cytological classification has an improved diagnostic accuracy. Interestingly, the combination of cytology and TI-RADS score offers a better stratification of the malignancy risk.