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Terzi NK, Terzi T. Thyroid fine-needle aspiration cytology: malignancy rate in the category of indeterminate significant atypia/indeterminate significant follicular lesion. Ann Saudi Med 2024; 44:31-38. [PMID: 38311867 PMCID: PMC10839452 DOI: 10.5144/0256-4947.2024.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/09/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Fine needle aspiration cytology (FNAC) is a standard preoperative diagnostic modality for thyroid nodules. The Bethesda Thyroid Cytopathology Reporting System (TBSRTC) defines the FNAC atypia group as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS). OBJECTIVES Determine the risk of malignancy after surgical resection in patients with AUS/FLUS. DESIGN Retrospective. SETTING Pathology department of a tertiary care center. PATIENTS AND METHODS All thyroid FNACs between 2015 and 2023 that were diagnosed as AUS/FLUS in Turkey. Patient demographics, preoperative ultrasonographic features, and follow-up data were collected. MAIN OUTCOME MEASURES Relationship between AUS/FLUS diagnosis and final histopathological diagnosis. SAMPLE SIZE 562. RESULTS In total, 562 thyroid nodules were diagnosed as AUS/FLUS, and 267 (47.5%) were surgically excised. A malignant histopathological diagnosis was given in 28 cases (10.4%). Malignancy risk sensitivity of AUS/FLUS diagnosis was 75.68% (95% CI=58.80-88.23%), specificity was 55.24% (95% CI=50.91-59.52%), positive predictive value was 10.49% (95% CI=8.71-12.58%), and negative predictive value was 97.04% (95% CI=94.86-98.31%). In the ultrasonographic data, having symptomatic nodules, nodule calcification, and irregular nodule borders were all statistically significant signs of cancer in a one-variable analysis (P<.01). The presence of a family history emerged as a statistically significant prognostic marker for malignancy (P=.012). Although not statistically significant, the malignancy rate for nodules with nuclear atypia was 11.9%, significantly higher than the rate of 8.3% for nodules with architectural atypia only (P=0.32). CONCLUSIONS The diagnosis of AUS/FLUS has a high rate of predicting the risk of malignancy and should continue to be offered. In addition to cytopathological features, ultrasound data and family history should be taken into consideration when evaluating the case. LIMITATIONS Retrospective design and no molecular studies.
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Affiliation(s)
- Neslihan Kaya Terzi
- From the Department of Pathology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Tolga Terzi
- From the Clinic of Anesthesiology and Reanimation, Lapseki Public Hospital, Canakkale, Turkey
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Rossi ED, Tralongo P, Fiorentino V, Curatolo M, Bruno C, De Crea C, Raffaelli M, Pontecorvi A, Larocca LM. Approach to FNA of Thyroid Gland Cysts. Adv Anat Pathol 2022; 29:358-364. [PMID: 35918293 DOI: 10.1097/pap.0000000000000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fine needle aspiration is a well-known procedure for the diagnosis and management of thyroid lesions, representing the first diagnostic tool for the definition of their nature. In clinical practice, a thyroid nodule can be classified as solid, cystic, and partially cystic based on its internal components. Different thyroid imaging reporting systems and cytologic diagnostic systems have focused their attention on solid nodules, which are more frequently linked with a malignant outcome. In fact, numerous papers demonstrated that nodules with microcalcifications, a taller-than-wide shape, hypoechogeneity, and irregular margins, are more likely to be malignant on histology. Nevertheless, according to the literature, the risk of malignancy in a partially cystic thyroid nodule ranges between 3.3 and 17-5%, including, for instance, the possible diagnosis of a cystic papillary thyroid carcinoma and other malignant entities. Therefore, in the current review article, we are going to discuss the approach to thyroid cystic lesions on fine needle aspiration cytology.
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Affiliation(s)
| | | | | | | | | | - Carmen De Crea
- Division of Endocrine-Surgery-Fondazione Policlinico Universitario"Agostino Gemelli"-IRCCS, Rome Italy Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Marco Raffaelli
- Division of Endocrine-Surgery-Fondazione Policlinico Universitario"Agostino Gemelli"-IRCCS, Rome Italy Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
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3
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Amado A, Castro B, Torre AP, Graça S, Tavares A, Póvoa A, Soares C, Gonçalves G. Serum TSH as a predictor of malignancy in indeterminate thyroid nodules. Ann R Coll Surg Engl 2021; 104:380-384. [PMID: 34939834 DOI: 10.1308/rcsann.2021.0196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Thyroid nodules are lesions that are radiologically distinct from the thyroid parenchyma. Cervical ultrasound diagnoses 19-67% of nodules and is crucial in identifying those that lack cytological characterisation. Approximately 25% of biopsies reveal an indeterminate cytological result (Bethesda III), in which the risk of malignancy is variable (5-15%). The clinical importance of the diagnostic strategy used for thyroid nodules results from the need to exclude malignancy. The aim of this study was to evaluate the usefulness of serum thyroid-stimulating hormone (TSH) levels as a predictor of malignancy in cytologically indeterminate thyroid nodules. METHODS Our retrospective study included 40 patients with cytologically indeterminate thyroid nodules seen in our hospital between January 2013 and December 2017. Clinical parameters were reviewed, including age, gender, serum TSH levels, family history of thyroid carcinoma, radiation exposure and some sonographic features of the nodules. Statistical analysis was performed using SPSS. Statistical significance was defined as p<0.05. RESULTS Female gender was predominant (85%) and the mean (SD) age was 53.3 (15) years. Thyroid carcinoma was confirmed in 28% of patients. Median TSH levels were higher in patients with malignant (2.73µIU/ml) compared with benign (1.56µIU/ml) nodules (p<0.05). We demonstrated an increased risk of malignancy in patients with TSH levels of 2.68µIU/ml or above (p<0.05). CONCLUSION Higher serum TSH levels are associated with an increased risk of thyroid carcinoma in cytologically indeterminate nodules. TSH can become a fundamental diagnostic tool in stratifying the risk of malignancy and assist in diagnostic and therapeutic approaches to these nodules.
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Affiliation(s)
- A Amado
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - B Castro
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - A P Torre
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - S Graça
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - A Tavares
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - A Póvoa
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - C Soares
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - G Gonçalves
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
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4
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Hacim NA, Akbaş A, Ulgen Y, Aktokmakyan TV, Meric S, Tokocin M, Karabay O, Altinel Y. Impact of Ultrasonographic Features for Thyroid Malignancy in Patients With Bethesda Categories III, IV, and V: A Retrospective Observational Study in a Tertiary Center. Cureus 2021; 13:e16708. [PMID: 34466333 PMCID: PMC8397844 DOI: 10.7759/cureus.16708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Although fine-needle aspiration biopsy (FNAB) with cytologic interpretation using the Bethesda System for Reporting Thyroid Cytopathology has been widely used for thyroid nodules, its efficiency in Bethesda categories of III, IV, and V has been questioned due to variable risk of malignancy. We aimed to evaluate the impact of radiological parameters in Bethesda category III, IV, and V for thyroid malignancy. Methods: We performed a retrospective review of patients with Bethesda category III, IV, and V, and subsequent thyroidectomy. Demographic, ultrasonographic, and clinical variables were recorded. Independent variables for thyroid malignancy and the predictive power of imaging findings were analyzed. Results: There were 159 patients with a mean age of 48.1±13.4 years. Hypoechogenicity of the index nodule was the most common finding in 87 patients (54.7%). There were 74 (46.5%), 34 (21.4%), and 51 patients (32.1%) with Bethesda III, IV, and V categories, respectively. There were 91 patients (57.2%) with a diagnosis of thyroid malignancy. Overall malignant pathology was detected in 18 (24.3%), 25 (73.5%), and 48 patients (94.1%) in Bethesda III, IV, and V categories, respectively (p=0.001). The presence of solitary nodule, hypoechogenicity, and solid structure of index nodule and Bethesda category IV and V were significant variables for final malignant pathology (p<0.05 for all). Conclusion: Hypoechogenicity and solid structure in a solitary index nodule should be regarded as significant ultrasonographic findings for thyroid malignancy. Bethesda category IV and V were also significantly associated with malignancy.
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Affiliation(s)
- Nadir Adnan Hacim
- General Surgery, Bağcılar Training and Research Hospital, Istanbul, TUR
| | - Ahmet Akbaş
- Surgical Oncology, Bağcılar Training and Research Hospital, Istanbul, TUR
| | - Yigit Ulgen
- Pathology, Bağcılar Training and Research Hospital, Istanbul, TUR
| | | | - Serhat Meric
- General Surgery, Bağcılar Training and Research Hospital, Istanbul, TUR
| | - Merve Tokocin
- General Surgery, Bağcılar Training and Research Hospital, Istanbul, TUR
| | | | - Yuksel Altinel
- General Surgery, Bağcılar Training and Research Hospital, Istanbul, TUR
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5
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Suh YJ, Choi YJ. Strategy to reduce unnecessary surgeries in thyroid nodules with cytology of Bethesda category III (AUS/FLUS): a retrospective analysis of 667 patients diagnosed by surgery. Endocrine 2020; 69:578-586. [PMID: 32297204 DOI: 10.1007/s12020-020-02300-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/30/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Fine-needle aspiration (FNA) is widely used for the diagnosis of thyroid nodules detected by ultrasonography. However, the cytology of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) often leads to unnecessary thyroid surgery. This study aimed to identify a strategy to reduce unnecessary surgeries in patients with AUS/FLUS nodules. METHODS Medical records of 667 patients with the cytology of AUS/FLUS who underwent surgery from January 2007 to December 2017 were retrospectively reviewed. Clinicopathological data were analyzed to identify malignant factors in thyroid nodules with AUS/FLUS. Factors were compared between patients with thyroid cancer and those with benign thyroid nodules, using stepwise multivariate logistic regression and decision tree model. RESULTS Pathological thyroid cancer was identified in 193 (43.3%) patients. There was a significant difference in malignancy incidence with respect to family history, number of nodules, number of FNAs, ultrasonographic finding, lymphocytic thyroiditis, and BRAFV600E mutation. Multivariate analysis showed that ultrasonography (K-TIRADS 5) was the most influential independent predictor of malignancy in AUS/FLUS (odds ratio = 11.02, p < 0.001), followed by possessing BRAFV600E mutation (odds ratio = 4.54, p < 0.001). This strategy enabled 226 (89.3%) patients to avoid unnecessary surgeries based on the decision tree model. There was no node of repeated FNA in the decision tree model, which reduced the risk of malignancy (odds ratio = 0.35, p = 0.029). CONCLUSION K-TIRADS 5 and BRAFV600E mutation were predictive of malignancy in nodules of AUS/FLUS. These factors should be considered in strategies to reduce unnecessary surgeries for AUS/FLUS.
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Affiliation(s)
- Yong Joon Suh
- Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang, 14068, Republic of Korea.
| | - Yeon Ju Choi
- Research Cooperation Center, Hallym University, Chuncheon, 24252, Republic of Korea
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6
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Abstract
Fine-needle aspiration (FNA) is among the first diagnostic tools used in the evaluation of thyroid nodules. It has the ability to triage patients with benign and malignant lesions, thus defining the optimum clinical and/or surgical management. The Bethesda System for Reporting Thyroid Cytopathology has found worldwide acceptance. Thyroid FNA offers high positive predictive value (97%-99%), with sensitivities and specificities of 65% to 99% and 72% to 100%, respectively. Nonetheless, many potential diagnostic pitfalls exist that can lead to false-positive and/or false-negative results. This article discusses several of the potential pitfalls in the cytologic evaluation of thyroid lesions.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, A. Gemelli Square, 1, Rome 20123, Italy
| | - Adebowale J Adeniran
- Department of Pathology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - William C Faquin
- Department of Pathology, WRN 219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Li F, Pan D, Wu Y, Peng J, Li Q, Gui X, Ma W, Yang H, He Y, Chen J. Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule. Diagn Cytopathol 2019; 47:881-889. [PMID: 31211509 PMCID: PMC6772092 DOI: 10.1002/dc.24248] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/19/2019] [Accepted: 05/23/2019] [Indexed: 12/15/2022]
Abstract
Background This study was designed to explore whether ultrasound of thyroid nodules facilitates the interpretation of the malignant risk of Bethesda III/IV thyroid nodules to inform further therapies. Methods We reviewed patient records in which the results of ultrasound‐guided fine‐needle aspiration (US‐FNA) were classified by the Bethesda III/IV in our institution between January 2016 and June 2018. Studies were retrieved from PubMed, Cochrane Central Register of Controlled Trials, ISI Web of Science, Science Direct, Wiley Online Library, EMBASE, China National Knowledge Infrastructure, WanFang, and Chinese VIP. The odds ratio (OR) was used to measure associations between risk factors and thyroid nodule malignancy. Results Fifty‐nine cases of Bethesda III/IV with corresponding surgeries were included, and the malignancy risk was 54.2%. Meta‐analysis revealed irregular borders, solitary nodules, hypoechogenicity, microcalcifications, and being taller than wide, all of which increased the malignancy risk of thyroid nodules. Combined ORs for these factors were 4.08 (95% CI: 2.34‐7.14, P < .001), 2.18 (95% CI: 1.39‐3.42, P = .001), 2.02 (95% CI: 1.35‐3.01, P = .001), 3.21 (95% CI: 2.26‐4.56, P < .001), and 4.35 (95% CI: 3.07‐6.15, P < .001), respectively. Conclusion As the risk of malignancy for papillary thyroid carcinoma (PTC) is high, when any one of the five ultrasound features of malignancy were confirmed, repeated FNA is recommended to confirm PTC‐type malignancy, even though nodules were Bethesda III/IV classification. However, repeated FNA should be avoided when none of these ultrasound features are identified because repeated FNA does not contribute to identifying non‐PTC type malignancies, such as follicular thyroid carcinoma and poorly differentiated thyroid carcinoma.
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Affiliation(s)
- Fu Li
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Denghua Pan
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yuquan Wu
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Jinbo Peng
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Qing Li
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Xiaolong Gui
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Wei Ma
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Hong Yang
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yun He
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Junqiang Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
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de Koster EJ, de Geus-Oei LF, Dekkers OM, van Engen-van Grunsven I, Hamming J, Corssmit EPM, Morreau H, Schepers A, Smit J, Oyen WJG, Vriens D. Diagnostic Utility of Molecular and Imaging Biomarkers in Cytological Indeterminate Thyroid Nodules. Endocr Rev 2018; 39:154-191. [PMID: 29300866 DOI: 10.1210/er.2017-00133] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022]
Abstract
Indeterminate thyroid cytology (Bethesda III and IV) corresponds to follicular-patterned benign and malignant lesions, which are particularly difficult to differentiate on cytology alone. As ~25% of these nodules harbor malignancy, diagnostic hemithyroidectomy is still custom. However, advanced preoperative diagnostics are rapidly evolving.This review provides an overview of additional molecular and imaging diagnostics for indeterminate thyroid nodules in a preoperative clinical setting, including considerations regarding cost-effectiveness, availability, and feasibility of combining techniques. Addressed diagnostics include gene mutation analysis, microRNA, immunocytochemistry, ultrasonography, elastosonography, computed tomography, sestamibi scintigraphy, [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), and diffusion-weighted magnetic resonance imaging.The best rule-out tests for malignancy were the Afirma® gene expression classifier and FDG-PET. The most accurate rule-in test was sole BRAF mutation analysis. No diagnostic had both near-perfect sensitivity and specificity, and estimated cost-effectiveness. Molecular techniques are rapidly advancing. However, given the currently available techniques, a multimodality stepwise approach likely offers the most accurate diagnosis, sequentially applying one sensitive rule-out test and one specific rule-in test. Geographical variations in cytology (e.g., Hürthle cell neoplasms) and tumor genetics strongly influence local test performance and clinical utility. Multidisciplinary collaboration and implementation studies can aid the local decision for one or more eligible diagnostics.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Smit
- Department of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Division of Radiotherapy and Imaging, Institute of Cancer Research, and Department of Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Turkyilmaz S, Ulusahin M, Celebi B, Cekic AB, Mungan S, Kucuktulu U, Tasdelen A, Guner A, Cinel A. Thyroid nodules classified as atypia or follicular lesions of undetermined significance deserve further research: Analysis of 305 surgically confirmed nodules. Cytopathology 2017; 28:391-399. [PMID: 28714532 DOI: 10.1111/cyt.12438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of the present study was to determine the malignancy risk for nodules categorised as atypia or follicular lesions of undetermined significance atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) and to investigate the predictors of malignancy. METHODS All nodules diagnosed as AUS/FLUS on fine needle aspiration (FNAs) performed between January 2011 and December 2015 were retrospectively reviewed. Clinical data, ultrasonographic features, follow-up data and the final pathological results were recorded. After further exclusion, only nodules that underwent surgical excision were included in the final analysis. The malignancy rate and the range of malignancy rates were calculated. Clinical and ultrasound features were examined to determine the predictors of malignancy. RESULTS During the study period, FNA was performed on 9938 nodules, and 1019 (10.2%) nodules were diagnosed as AUS/FLUS. After further exclusion, 976 nodules were evaluated. After the initial diagnosis of AUS/FLUS, 139 (14.2%) patients underwent surgery, 518 (53.1%) had repeated FNAs. A total of 305 (31%) had undergone surgical excision at different time points. For surgically confirmed nodules, the malignancy rate after the initial FNA was 34.5% (the lower and upper thresholds for the malignancy rate were 19.3% and 66.3%, respectively), and 37.9% after the repeated FNA. No ultrasound feature was determined as a predictor, whereas age (>55 years) was a predictor for malignancy. CONCLUSIONS The overall malignancy rate for nodules diagnosed as AUS/FLUS and the malignancy rate for nodules that underwent repeated FNA after AUS/FLUS were higher than the expected malignancy rates of the National Cancer Institute. It is, therefore, suggested that the current recommendations should be reconsidered.
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Affiliation(s)
- S Turkyilmaz
- Department of General Surgery, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| | - M Ulusahin
- Department of General Surgery, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| | - B Celebi
- Department of General Surgery, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - A B Cekic
- Department of General Surgery, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| | - S Mungan
- Department of Pathology, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| | - U Kucuktulu
- Department of General Surgery, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - A Tasdelen
- Department of General Surgery, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - A Guner
- Department of General Surgery, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| | - A Cinel
- Department of General Surgery, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
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10
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Gao LY, Wang Y, Jiang YX, Yang X, Liu RY, Xi XH, Zhu SL, Zhao RN, Lai XJ, Zhang XY, Zhang B. Ultrasound is helpful to differentiate Bethesda class III thyroid nodules: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e6564. [PMID: 28422844 PMCID: PMC5406060 DOI: 10.1097/md.0000000000006564] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Fine-needle aspiration (FNA) is the most dependable tool to triage thyroid nodules for medical or surgical management. However, Bethesda class III cytology, namely "follicular lesion of undetermined significance" (FLUS) or "atypia of undetermined significance" (AUS), is a major limitation of the US-FNA in assessing thyroid nodules. As the most important imaging method, ultrasound (US) has a high efficacy in diagnosing thyroid nodules. This meta-analysis aimed to assess the role of US in evaluating Bethesda class III thyroid nodules. METHODS With keywords "Undetermined Significance," "Bethesda Category III," "Bethesda system," "Cytological Subcategory," "AUS/FLUS," "Atypia of Undetermined Significance," and "Ultrasound/US," papers in PubMed, Cochrane Library, Medline, Web of Science, Embase, and Google Scholar from inception to December 2016 were searched. A meta-analysis of these trials was then performed for evaluating the diagnostic value of thyroid ultrasound in Bethesda Category III thyroid nodules. RESULTS Fourteen studies including 2405 nodules were analyzed. According to the criteria for US diagnosis of thyroid nodules in each article, with any one of suspicious features as indictors of malignancy, US had a pooled sensitivity of 0.75 (95% CI 0.72-0.78) and a pooled specificity of 0.48 (95% CI 0.45-0.50) in evaluating Bethesda Class III Nodules. The pooled diagnostic odds ratio was 10.92 (95% CI 6.04-19.74). The overall area under the curve was 0.84 and the Q* index was 0.77. With any 2 or 3 of US suspicious features as indictors of malignancy, the sensitivity and specificity were 0.77 (95% CI 0.71-0.83) and 0.54 (95% CI 0.51-0.58), 0.66 (95% CI 0.59-0.73) and 0.71 (95% CI 0.68-0.74), respectively. CONCLUSIONS US was helpful for differentiating benign and malignant Bethesda class III thyroid nodules, with the more suspicious features, the more likely to be malignant.
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Affiliation(s)
- Lu-Ying Gao
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
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11
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Gan TRX, Nga ME, Lum JHY, Wong WM, Tan WB, Parameswaran R, Ngiam KY. Thyroid cytology-nuclear versus architectural atypia within the “Atypia of undetermined significance/follicular lesion of undetermined significance” Bethesda category have significantly different rates of malignancy. Cancer Cytopathol 2017; 125:245-256. [DOI: 10.1002/cncy.21823] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 12/18/2016] [Accepted: 12/21/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Tiffany Rui Xuan Gan
- Yong Loo Lin School of Medicine, Department of Surgery; National University of Singapore; Singapore
| | - Min En Nga
- Department of Pathology; National University Hospital; Singapore
| | | | - Wendy Meihua Wong
- Division of Thyroid and Endocrine Surgery, Department of Surgery; National University Hospital; Singapore
| | - Wee Boon Tan
- Division of Thyroid and Endocrine Surgery, Department of Surgery; National University Hospital; Singapore
| | - Rajeev Parameswaran
- Division of Thyroid and Endocrine Surgery, Department of Surgery; National University Hospital; Singapore
| | - Kee Yuan Ngiam
- Division of Thyroid and Endocrine Surgery, Department of Surgery; National University Hospital; Singapore
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12
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Conzo G, Avenia N, Ansaldo GL, Calò P, De Palma M, Dobrinja C, Docimo G, Gambardella C, Grasso M, Lombardi CP, Pelizzo MR, Pezzolla A, Pezzullo L, Piccoli M, Rosato L, Siciliano G, Spiezia S, Tartaglia E, Tartaglia F, Testini M, Troncone G, Signoriello G. Surgical treatment of thyroid follicular neoplasms: results of a retrospective analysis of a large clinical series. Endocrine 2017; 55:530-538. [PMID: 27075721 DOI: 10.1007/s12020-016-0953-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/05/2016] [Indexed: 02/06/2023]
Abstract
The most appropriate surgical management of "follicular neoplasm/suspicious for follicular neoplasm" lesions (FN), considering their low definitive malignancy rate and the limited predictive power of preoperative clinic-diagnostic factors, is still controversial. On behalf of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB), we collected and analyzed the experience of 26 endocrine centers by computerized questionnaire. 1379 patients, surgically treated after a FN diagnosis from January 2012 and December 2103, were evaluated. Histological features, surgical complications, and medium-term outcomes were reported. Total thyroidectomy (TT) was performed in 1055/1379 patients (76.5 %), while hemithyroidectomy (HT) was carried out in 324/1379 cases (23.5 %). Malignancy rate was higher in TT than in HT groups (36.4 vs. 26.2 %), whereas the rates of transient and definitive hypoparathyroidism following TT were higher than after HT. Consensual thyroiditis (16.8 vs. 9.9 %) and patient age (50.9 vs. 47.9 %) also differed between groups. A cytological FN diagnosis was associated to a not negligible malignancy rate (469/1379 patients; 34 %), that was higher in TT than in HT groups. However, a lower morbidity rate was observed in HT, which should be considered the standard of care in solitary lesions in absence of specific risk factors. Malignancy could not be preoperatively assessed and clinical decision-making is still controversial. Further efforts should be spent to more accurately preoperatively classify FN thyroid nodules.
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Affiliation(s)
- Giovanni Conzo
- Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Gen.G.Orsini 42, 80132, Naples, Italy.
| | - Nicola Avenia
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
- Unit of Endocrine Surgery, S. Maria University Hospital, Terni, Italy
| | - Gian Luca Ansaldo
- Dipartimento di Discipline Chirurgiche, Morfologiche e Metodologie Integrate, Cattedra di Chirurgia Generale, Università degli Studi di Genova, Genoa, Italy
| | - Piergiorgio Calò
- Chirurgia Generale A, Policlinico Universitario di Monserrato, AOU di Cagliari, Monserrato, Italy
| | - Maurizio De Palma
- General Surgery and Endocrine Surgical Unit, AORN A. Cardarelli, Naples, Italy
| | - Chiara Dobrinja
- UCO Chirurgia Generale, Cattinara Teaching Hospital, Strada di Fiume, 34100, Trieste, Italy
| | - Giovanni Docimo
- Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Gen.G.Orsini 42, 80132, Naples, Italy
| | - Claudio Gambardella
- Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Gen.G.Orsini 42, 80132, Naples, Italy
| | - Marica Grasso
- General Surgery and Endocrine Surgical Unit, AORN A. Cardarelli, Naples, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine and Metabolic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Rosa Pelizzo
- Clinica Chirurgica 2, University School of Padova, Padova University, Padua, Italy
| | - Angela Pezzolla
- Department of Emergency and Oral Transplantation-DETO, Bari University Hospital Policlinico, Bari, Italy
| | - Luciano Pezzullo
- Thyroid and Parathyroid Surgery Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Micaela Piccoli
- Chirurgia Generale d'Urgenza e Nuove Tecnologie - NOCSAE di Modena, Modena, Italy
| | | | - Giuseppe Siciliano
- Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Gen.G.Orsini 42, 80132, Naples, Italy
| | - Stefano Spiezia
- Ultrasound Guided and Neck Pathologies Surgery Operative Unit, Department of Surgery, S. Maria del Popolo degli Incurabili ASLNA1 Hospital, Naples, Italy
| | - Ernesto Tartaglia
- Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Gen.G.Orsini 42, 80132, Naples, Italy
| | | | - Mario Testini
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Bari, Italy
| | - Giancarlo Troncone
- Department of Biomorphologic and Functional Sciences, "Federico II" University of Naples, Naples, Italy
| | - Giuseppe Signoriello
- Department of Mental Health and Preventive Medicine, Second University of Naples, Caserta, Italy
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Topaloglu O, Baser H, Cuhaci FN, Sungu N, Yalcin A, Ersoy R, Cakir B. Malignancy is associated with microcalcification and higher AP/T ratio in ultrasonography, but not with Hashimoto's thyroiditis in histopathology in patients with thyroid nodules evaluated as Bethesda Category III (AUS/FLUS) in cytology. Endocrine 2016; 54:156-168. [PMID: 27172917 DOI: 10.1007/s12020-016-0982-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/03/2016] [Indexed: 01/08/2023]
Abstract
The predictors of malignancy are important for the decision of appropriate management in nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS). Our aim was to determine the ultrasonographical, clinical, and biochemical predictors of malignancy in these patients. A total of 427 patients with cytologically Bethesda Category III (AUS/FLUS) thyroid nodules were included in this retrospective study. We divided the nodules into two subgroups according to the histopathology as benign and malignant, and compared the preoperative ultrasonographical, clinical, and biochemical findings. In overall, 427 patients with 449 AUS/FLUS nodules who had undergone surgery, the rate of malignancy was 23.4 % (105/449). When evaluated separately, the rate of malignancy was 25.8 % in nodules with AUS (82/318) and 17.6 % in nodules with FLUS (23/131) (p = 0.061). The vast majority of malignant specimens in histopathology consisted of papillary thyroid carcinoma (PTC) (n = 91, 86.7 %). Preoperative ultrasonographic features of 105 malignant nodules in histopathology were compared with the 344 benign nodules in histopathology. Anteroposterior/Transverse (AP/T) ratio was significantly higher in malignant group compared to benign group (p = 0.013). In multiple logistic analysis, we found that higher AP/T ratio and microcalcification were independently associated with malignancy (p < 0.05). The malignancy-associated cut-off value of AP/T ratio at maximum sensitivity and specificity was ≥0.81. We did not find any correlation between malignancy and Hashimoto's thyroiditis in histopathology in multivariate analysis (p > 0.05). In Bethesda Category III nodules with higher AP/T ratio and microcalcification, surgery might be considered as a first therapeutic option instead of repeat fine-needle aspiration biopsy or observation.
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Affiliation(s)
- Oya Topaloglu
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey.
| | - Husniye Baser
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Fatma Neslihan Cuhaci
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Nuran Sungu
- Department of Pathology, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Abdussamed Yalcin
- Department of General Surgery, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
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14
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Bobanga ID, McHenry CR. Evaluation and management of thyroid nodules with atypia/follicular lesion of undetermined significance on fine-needle aspiration. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.15.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Since the introduction of the Bethesda System for Reporting Thyroid Cytopathology in 2008, the management of thyroid nodules has become more standardized, with clearly defined algorithms based on risk of malignancy for each of the six cytologic categories. However, the management of a thyroid nodule with a fine-needle aspiration biopsy classified as Bethesda III, or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), remains controversial due to the cytologic heterogeneity and the variability in the reported rates of malignancy. In this review, the history and rationale for the new Bethesda III category is examined, the reported incidence and risk of malignancy from published studies is reviewed and recommendations for management of patients with a thyroid nodule and AUS/FLUS are provided. Recent advances in molecular analysis and their role in the evaluation of patients with AUS/FLUS are also discussed.
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Affiliation(s)
- Iuliana D Bobanga
- Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Christopher R McHenry
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109, USA
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15
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Yoo MR, Gweon HM, Park AY, Cho KE, Kim JA, Youk JH, Son EJ. Repeat Diagnoses of Bethesda Category III Thyroid Nodules: What To Do Next? PLoS One 2015; 10:e0130138. [PMID: 26115096 PMCID: PMC4482684 DOI: 10.1371/journal.pone.0130138] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 05/15/2015] [Indexed: 01/21/2023] Open
Abstract
Objectives To assess the malignancy rates of thyroid nodules repeatedly classified as Bethesda category III on fine needle aspiration (FNA), and to suggest management guidelines for these lesions. Methods This is a retrospective study that included 395 thyroid nodules categorized as Bethesda III undergone either surgery or ultrasound (US) follow-up. There were 67 nodules classified a second time as Bethesda category III on repeat FNA. We compared malignancy rates, clinicopathologic and ultrasonographic characteristics between direct surgery and repeat FNA groups and between the initial and repeat Bethesda category III groups, each. And in the repeat Bethesda III group, clinicopathologic and US variables were compared between benign and malignant nodules. Results Incidence of concurrent cancer, underlying thyroiditis and positive BRAF mutation were significantly higher in 142 nodules with direct surgery than 243 nodules with repeat FNA (p < 0.05). Of the 395 nodules with Bethesda category III cytology on initial FNA, the malignancy rate was 59.5%. In 67 nodules with repeat Bethesda III classification, however, the malignancy rate was 73.1% (p < 0.05). However, none of the variables were significantly different between the initial Bethesda category III group and the repeat Bethesda category III group (p > 0.05). In the repeat Bethesda category III group, solid consistency, irregular/microlobulated margins, nonparallel shape, and number of suspicious findings or “suspicious malignant” US assessments were associated with a high malignancy rate (p < 0.05). On multivariate logistic regression analysis, the factor associated with malignancy in the repeat Bethesda category III group was irregular/microlobulated margin (odds ratio = 15.576; 95% CI, 2.097–115.6804, p = 0.007) with a sensitivity, specificity, positive and negative predictive values, and accuracy of 81.6%, 83.3%, 93.0%, 62.5% and 82.1%, respectively. Conclusion Thyroid nodules with repeated Bethesda category III classification and irregular/microlobulated margins on US are at increased risk of malignancy, and operative management should be considered as opposed to repeat FNA.
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Affiliation(s)
- Mi Ri Yoo
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Hye Mi Gweon
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Ah Young Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Kyung Eun Cho
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Jeong-Ah Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Ji Hyun Youk
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Eun Ju Son
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
- * E-mail:
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16
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Kamaya A, Lewis GH, Liu Y, Akatsu H, Kong C, Desser TS. Atypia of undetermined significance and follicular lesions of undetermined significance: sonographic assessment for prediction of the final diagnosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:767-774. [PMID: 25911708 DOI: 10.7863/ultra.34.5.767] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To determine whether radiologic assessment of thyroid nodules can potentially help guide clinical management after a cytologic diagnosis of atypia of undetermined significance or a follicular lesion of undetermined significance. METHODS We identified 41 patients with 41 thyroid nodules initially diagnosed as atypia or follicular lesions of undetermined significance on fine-needle aspiration that were subsequently definitively diagnosed by either surgical resection or repeated fine-needle aspiration. All sonograms of nodules were reviewed by 2 blinded board-certifiedradiologists. Lesions were assessed in 3 ways: (1) Mayo pattern classification as benign, indeterminate, or worrisome for malignancy (Ultrasound Q 2005; 21:157-165); (2) thyroid imaging reporting and data system scores (scale of 1-5) based on 2 different previously published scoring criteria (Park et al [Thyroid 2009; 19:1257-1264] and Kwak et al [Radiology 2011; 260:892-899]); and (3) binary classification as benign or malignant. RESULTS Of the 41 nodules, 25 had benign histologic findings, and 16 were malignant. Mayo pattern classification was 100% accurate for the benign score. Lesions with a Mayo score of indeterminate were malignant in 21% of cases (6 of 28) and benign in 79% (22 of 28). Lesions with a Mayo score of malignant were malignant in 91% of cases (10 of 11) and benign in 9% (1 of 11). Thyroid imaging reporting and data system scores had area under the receiver operating characteristic curve values of 0.827 for Park scores and 0.822 for Kwak scores. Radiologist binary classification of thyroid nodules showed 88% overall accuracy. CONCLUSIONS Radiologist assessment of thyroid nodules in cases of atypia of undetermined significance or follicular lesions of undetermined significance is highly predictive of the final diagnosis and can help guide management of thyroid nodules of these pathologic types.
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Affiliation(s)
- Aya Kamaya
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.).
| | - Gloria Huang Lewis
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
| | - Yi Liu
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
| | - Haruko Akatsu
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
| | - Christina Kong
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
| | - Terry S Desser
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
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17
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Wong LQ, LiVolsi VA, Baloch ZW. Diagnosis of atypia/follicular lesion of undetermined significance: An institutional experience. Cytojournal 2014; 11:23. [PMID: 25210530 PMCID: PMC4158655 DOI: 10.4103/1742-6413.139725] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/08/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The overall malignancy rate for the thyroid fine-needle aspiration (FNA) diagnosed as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) ranges from 5% to 30%. In this study, we present our institutional experience with thyroid nodules diagnosed as AUS/FLUS and further stratified into subcategories. In addition, we also assessed the significance of various clinicopathologic factors that may influence AUS/FLUS diagnoses and their outcomes. DESIGN A search of our laboratory information system was performed to identify all in-house thyroid FNA cases diagnosed as AUS/FLUS from 2008 to 2012. The data were collected and characterized by patient demographic information, cytopathology diagnosis with sub-classifiers and follow-up. RESULTS The case cohort included 457 cases diagnosed as AUS/FLUS. These were further sub-classified into one of six subcategories depending on the cytomorphologic findings and suspicion for or against a neoplastic process. Of the 457 cases, repeat FNA and/or surgical follow-up was available in 363 cases. There were 182 (39.8%) cases with cytologic follow-up only; 18 (9.9%) remained as AUS/FLUS, while 158 (86.8%) were re-classified with the majority being benign (142 cases). Histologic follow-up was available in 181 (39.6%) cases. There were 60 malignant cases confirmed by surgical excision, with an overall malignancy rate of 33.1%. The malignancy rate was 38.8% for cases with a repeat FNA versus 25.6% for cases that went directly to surgery without a repeat FNA. Papillary thyroid carcinoma accounted for 93.3% (56 cases) of the malignant cases. CONCLUSION Based on our study, even though the malignancy rate of AUS/FLUS cases is similar to those reported for cases diagnosed as follicular neoplasm/suspicious for follicular neoplasm, we are of the belief that these comparable malignancy rates are a product of better clinical management and selection of patients diagnosed as AUS/FLUS for surgery after a repeat FNA.
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Affiliation(s)
- Lawrence Q Wong
- Address: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Virginia A LiVolsi
- Address: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Zubair W Baloch
- Address: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
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18
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Rosario PW. Thyroid nodules with atypia or follicular lesions of undetermined significance (Bethesda Category III): importance of ultrasonography and cytological subcategory. Thyroid 2014; 24:1115-20. [PMID: 24684285 DOI: 10.1089/thy.2013.0650] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND One possible result of fine-needle aspiration (FNA) in patients with thyroid nodules is "follicular lesion of undetermined significance" (FLUS) or "atypia of undetermined significance" (AUS). The risk of malignancy is relevant information to define appropriate management, and knowledge of predictors of malignancy in these nodules is therefore important. The objective of this prospective study was to evaluate clinical, laboratory, ultrasonographic, and cytological predictors of malignancy in patients with thyroid nodules and FLUS/AUS cytology. METHODS The sample consisted of 150 patients with thyroid nodules and an indication for FNA whose cytology was classified as FLUS/AUS according to the Bethesda classification criteria. RESULTS In the second FNA, cytology was nondiagnostic in 2 (1.3%) nodules and benign in 54 (36%), FLUS/AUS cytology persisted in 73 (48.6%), and cytology was suspicious for follicular neoplasm in 11 (7.3%) and for malignancy in 10 (6.6%). The rate of malignancy was 22.6%. Clinical and laboratory data or nodule size were not predictors of malignancy. The rate of malignancy was lower in nodules initially classified as FLUS (10.8% versus 41.3% with AUS). Ultrasonography (US) was also useful for predicting malignancy, with sensitivity, specificity, and positive and negative predictive values of 79.4%, 90.5%, 71%, and 93.75%, respectively. Different malignancy rates were obtained when the two parameters, cytological subcategory and US, were combined: (i) 3.9% for nodules nonsuspicious on US and FLUS, (ii) 11.4% for nonsuspicious nodules with AUS, (iii) 46.6% for suspicious nodules with FLUS, and (iv) 87% for suspicious nodules with AUS. CONCLUSIONS The combination of cytological subcategory (FLUS or AUS) and US provides different risks of malignancy for nodules initially classified as Bethesda category III.
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19
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Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. A nomogram for predicting malignancy in thyroid nodules diagnosed as atypia of undetermined significance/follicular lesions of undetermined significance on fine needle aspiration. Surgery 2014; 155:1006-13. [DOI: 10.1016/j.surg.2013.12.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/30/2013] [Indexed: 01/21/2023]
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20
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Poller DN, Glaysher S. BRAFV600 co-testing is technically feasible in conventional thyroid fine needle aspiration (FNA) cytology smears and can reduce the need for completion thyroidectomy. Cytopathology 2013; 25:155-9. [DOI: 10.1111/cyt.12109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2013] [Indexed: 12/18/2022]
Affiliation(s)
- D. N. Poller
- Department of Pathology; Queen Alexandra Hospital; Cosham Portsmouth UK
| | - S. Glaysher
- Department of Pathology; Queen Alexandra Hospital; Cosham Portsmouth UK
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