Yield of repeat fine-needle aspiration biopsy and rate of malignancy in patients with atypia or follicular lesion of undetermined significance: The impact of the Bethesda System for Reporting Thyroid Cytopathology

The aim of the study was to identify a possible relation between various ultrasonographic (US) appearances of Hashimoto′s thyroiditis (HT) and the risk of obtaining an alarming cytology of coexisting nodules. The study included 557 patients with HT, who had been referred for fine needle aspiration biopsy (FNA). We divided US patterns of HT (UP-HT) into eight groups: (a) Hypoechoic (compared to submandibular glands), homogeneous/fine echotexture; (b) hypoechoic, heterogeneous/coarse echotexture; (c) marked hypoechoic (darker than strap muscles), heterogeneous/coarse echotexture; (d) heterogeneous echotexture with hyperechoic, fibrous septa; (e) multiple, discrete marked hypoechoic areas (sized as 1 to 6 mm); (f) normoechoic pseudo-nodular areas; (g) echostructure similar to connective tissue; (h) thyroid parenchyma with no signs of HT. Indications for a surgical treatment resulting from the FNA outcome (categories IV–VI of Bethesda System for Reporting Thyroid Cytopathology) were identified only in patients with variants b, c, and e of UP-HT, but merely the “multiple, discrete marked hypoechoic areas” variant significantly increased the odds of obtaining such cytology (OR:5.7). The presence of the “normoechoic pseudo-nodular areas” variant significantly increased the odds for the benign cytology (OR:1.7). There are significant differences in the frequency of obtaining an alarming cytology in relation to the UP-HT variant.

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Core-Needle Biopsy Is More Useful Than Repeat Fine-Needle Aspiration in Thyroid Nodules Read as Nondiagnostic or Atypia of Undetermined Significance by the Bethesda System for Reporting Thyroid Cytopathology

Thyroid ◽

10.1089/thy.2011.0185 ◽

2012 ◽

Vol 22 (5) ◽

pp. 468-475 ◽

Cited By ~ 162

Author(s):

Dong Gyu Na ◽

Ji-hoon Kim ◽

Jin Yong Sung ◽

Jung Hwan Baek ◽

Kyeong Cheon Jung ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Needle Biopsy ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Core Needle ◽

Fine Needle ◽

Bethesda System ◽

Thyroid Cytopathology ◽

The Bethesda System ◽

Undetermined Significance

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BRAF V600E mutation and the Bethesda System for Reporting Thyroid Cytopathology of fine-needle aspiration biopsy for distinguishing benign from malignant thyroid nodules

Medicine ◽

10.1097/md.0000000000027167 ◽

2021 ◽

Vol 100 (37) ◽

pp. e27167

Author(s):

Danli Sheng ◽

Xiaoli Yu ◽

Hui Li ◽

Murui Zhang ◽

Jianzhong Chen

Keyword(s):

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Braf V600e Mutation ◽

Braf V600e ◽

Fine Needle ◽

Bethesda System ◽

Thyroid Cytopathology ◽

The Bethesda System

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Factors Predicting Thyroid Malignancy in Fine Needle Aspiration Biopsy Specimens Classified as Atypia of Uncertain Significance/Follicular Lesion of Uncertain Significance

The American Surgeon ◽

10.1177/000313481808400740 ◽

2018 ◽

Vol 84 (7) ◽

pp. 1207-1213 ◽

Cited By ~ 2

Author(s):

Ciara Brown ◽

William Mangano ◽

Stephanie Thompson ◽

Bryan Richmond

Keyword(s):

Fine Needle Aspiration ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Fine Needle ◽

Nuclear Atypia ◽

Uncertain Significance ◽

Bethesda System ◽

Needle Aspiration Biopsy ◽

Thyroid Cytopathology

The atypia of uncertain significance/follicular lesion of uncertain significance (AUS/FLUS) category of the Bethesda system for reporting thyroid cytopathology for fine needle aspiration biopsy (FNAB) has a predicted incidence of malignancy from 5 to 15 per cent. The literature has reported that suspicious ultrasound (SUS) characteristics can assist in predicting malignancy in thyroid biopsies. Some research suggests further subdivision of AUS/FLUS into nuclear atypia predominant or follicular predominant. We hypothesized that the rate of malignancy would be higher in AUS/FLUS biopsies with SUS characteristics and in the AUS/FLUS subset classified as nuclear atypia predominant. We performed a four-year retrospective analysis of patients who underwent FNAB classified as AUS/FLUS and who subsequently underwent thyroidectomy from October 2008–October 2012. A total of 3839 thyroid FNAB were performed over the four-year period, of which 342 received AUS/FLUS classification. Of these, we identified 119 patients who underwent thyroidectomy, of which 27 (23%) malignancies were identified. Reported cytology (nuclear atypia vs follicular predominant) did not differ between patients with and without carcinomas (P = 0.33). Suspicious ultrasound appearance failed to be significantly associated with an underlying carcinoma (P = 0.14); although, nearly 70 per cent of malignancies displayed SUS compared with 50 per cent within the benign group. Ultrasound seems to have no additional value in predicting malignancy in the AUS/FLUS categorization. Further subcategorization did not aid in risk stratification of this indeterminate category. This may suggest an expanded role for ancillary technologies such as molecular markers in this challenging Bethesda system for reporting thyroid cytopathology class. Further study of these findings is warranted.

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