Malignancy risk and reproducibility associated with atypia of undetermined significance on thyroid cytology

Surgery ◽  
2014 ◽  
Vol 156 (6) ◽  
pp. 1471-1476 ◽  
Author(s):  
Aarti Mathur ◽  
Alireza Najafian ◽  
Eric B. Schneider ◽  
Martha A. Zeiger ◽  
Matthew T. Olson
Keyword(s):  
Malignancy Risk ◽  
Thyroid Cytology ◽  
Undetermined Significance

scholarly journals The Bethesda system for reporting thyroid cytology: a prospective study in a tertiary care institute along with review of literature

2020 ◽  
Vol 8 (10) ◽  
pp. 3670
Author(s):  
Avni Bhatnagar ◽  
Kavita Mardi ◽  
Shivani Sood ◽  
Vijay Kaushal ◽  
Kanishk Gupta
Keyword(s):  
Tertiary Care ◽  
Follicular Neoplasm ◽  
Histopathological Diagnosis ◽  
Predictive Values ◽  
Malignancy Risk ◽  
Thyroid Cytology ◽  
Management Protocol ◽  
Bethesda System ◽  
The Bethesda System ◽  
Undetermined Significance

Background: The Bethesda system for reporting thyroid cytology (TSBRTC) was devised by the National Cancer Institute (NCI) to obtain uniformity, reproducibility and a defined management protocol while dealing with thyroid lesions. This study was undertaken with the aim to see the benefits of adopting TBSRTC in the diagnosis of thyroid FNAC, and identify the malignancy risk of each category.Methods: This cross-sectional study was conducted in Indira Gandhi Medical College, Shimla, Himachal Pradesh from June 2016 to July 2017 on 181 thyroid FNACs which were reported according to the Bethesda system for reporting thyroid cytopathology (TBSRTC) under six categories: (I) non-diagnostic/unsatisfactory (II) benign (III) atypia of undetermined significance/follicular lesion of undetermined significance (IV) follicular neoplasm/suspicious for follicular neoplasm (specify if Hurthle cell (oncocytic) type (V) suspicious for malignancy (VI) malignant. Histopathological diagnosis was available for 65 cases where thyroidectomy was performed. Malignancy risk was calculated for each category. Sensitivity, specificity, positive and negative predictive values for TBSRCT were also calculated. All the data was analyzed in SPSS software version 22.0 (IBM, USA).Results: Benign lesions constituted the major bulk. After the use of TBSRTC, there was increased ability to look for follicular neoplasms, improvement in making definitive diagnosis of the cases, an improvement in diagnostic accuracy, and we were in line with the implied risk outlined by TBSRTC in most of the cases.Conclusions: Application of TBSRTC results in uniformity in reporting among pathologists and better interdisciplinary communication and patient management.

scholarly journals Thyroid and Molecular Testing. Advances in Thyroid Molecular Cytopathology

2021 ◽  
Vol 2 (2) ◽  
pp. 77-92
Author(s):  
Esther Diana Rossi ◽  
Philippe Vielh
Keyword(s):  
Thyroid Nodules ◽  
Adult Population ◽  
Needle Aspiration ◽  
Common Finding ◽  
Molecular Testing ◽  
Additional Tool ◽  
Thyroid Cytology ◽  
Hürthle Cell ◽  
Cell Neoplasm ◽  
Undetermined Significance

Thyroid nodules are a common finding in the adult population including the fact that more than 50% of individuals, over the age of 60, have thyroid nodules. The majority have been mostly detected with ultrasonography and 10% by palpation. The majority of these nodules are benign, whereas 5–15% of them are malignant. The pre-operative diagnosis of cancer is a critical challenge in order to ensure that each patient can be treated with the best tailored management with a reduction of unnecessary surgery for benign lesions. Fine needle aspiration cytology (FNAC) represents the first and most important diagnostic tool for the evaluation of thyroid lesions. According to the literature, FNAC is able to render a conclusive diagnosis in up to 70–80% of all cases. For the remaining 20–30% of nodules, cytological diagnoses fall into the category of indeterminate lesions mostly due to the lack of specific morphological features. According to the Bethesda system for reporting thyroid cytopathology (TBSRTC), indeterminate lesions can be sub-stratified into three different subcategories including “atypia of undetermined significance/follicular lesion of undetermined significance-AUS/FLUS”; “follicular or Hürthle cell neoplasm/suspicious for follicular or Hürthle cell neoplasm-FN/SFN”; and “suspicious for malignancy-SFM”. Many of these indeterminate lesions undergo repetition or diagnostic lobectomy. Nonetheless, the majority of these cases will have a benign diagnosis due to the fact that the rate of cancer ranges between 6 and 30%. It stands to reason that the application of ancillary technique, mostly molecular testing, emerged as a critical additional tool for those thyroid indeterminate lesions. Since the early 1990s, material collected from cytological samples yields sufficient and adequate cells for the detection of point mutation or gene fusions. Nonetheless, the further availability of new sequencing technologies such as next-generation sequencing (NGS) has led to more comprehensive molecular applications adopted now in clinical use. The current review investigates the multiple advances in the field of molecular testing applied in thyroid cytology.

scholarly journals What is the malignancy risk for atypia of undetermined significance? Three years' experience at a university hospital in Turkey

2014 ◽  
Vol 122 (8) ◽  
pp. 604-610 ◽  
Author(s):  
Pinar Uyar Gocun ◽  
Esra Karakus ◽  
Pinar Bulutay ◽  
Mujde Akturk ◽  
Murat Akin ◽  
...  
Keyword(s):  
University Hospital ◽  
Malignancy Risk ◽  
Undetermined Significance

scholarly journals Malignancy Rate of Bethesda Class III Thyroid Nodules Based on the Presence of Chronic Lymphocytic Thyroiditis in Surgical Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Yoon Young Cho ◽  
Yun Jae Chung ◽  
Hee Sung Kim
Keyword(s):  
Thyroid Nodules ◽  
Chronic Lymphocytic Thyroiditis ◽  
Class Iii ◽  
Lymphocytic Thyroiditis ◽  
Malignancy Rate ◽  
Malignancy Risk ◽  
Follicular Lesions ◽  
Premalignant Condition ◽  
Thyroid Malignancies ◽  
Undetermined Significance

BackgroundHashimoto’s thyroiditis (HT), also known as chronic lymphocytic thyroiditis (CLT), may interfere with the accurate cytological diagnosis of thyroid nodules. Recently, HT has been considered a premalignant condition for thyroid cancer development. The diagnosis of atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) thyroid nodules is challenging and evidence for the malignancy risk of AUS/FLUS thyroid nodules coexisting with CLT is scarce. Therefore, we assessed the malignancy risk of AUS/FLUS thyroid nodules according to the presence of background CLT.MethodsThis study included 357 surgically resected thyroid nodules with AUS/FLUS cytology. Cases with concomitant malignant nodules were excluded. CLT was defined based on the pathologic report after thyroid surgery.ResultsAmong 357 tumors, 130 tumors (36%) were confirmed to have coexisting CLT, and 170 tumors (48%) were determined to be malignant after thyroidectomy. Malignancy rates were similar in both groups (48% in each) regardless of background CLT (62/130 with CLT vs. 108/227 without CLT). In the group with CLT, thyroiditis was more frequent in the final pathology (12% with CLT vs. 1% without CLT, P = 0.003). In multivariate analysis, positive BRAFV600E mutation, highly suspicious sonographic features (K-TIRADS 5), and smaller thyroid nodules were significant factors for thyroid malignancies.ConclusionThe malignancy rate of thyroid nodules with AUS/FLUS cytology was comparable irrespective of the presence of underlying CLT.

Cytomorphologic, Imaging, Molecular Findings, and Outcome in Thyroid Follicular Lesion of Undetermined Significance/Atypical Cell of Undetermined Significance (AUS/FLUS): A Mini-Review

2018 ◽  
Vol 63 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Bita Geramizadeh ◽  
Somayeh Bos-hagh ◽  
Zahra Maleki
Keyword(s):  
Needle Aspiration ◽  
American Thyroid Association ◽  
Atypical Cell ◽  
Thyroid Cytology ◽  
Bethesda System ◽  
Needle Aspiration Cytology ◽  
The Bethesda System ◽  
Ancillary Studies ◽  
Undetermined Significance

Objectives: Since the introduction of the entity of “Atypical cell of undetermined significance /follicular lesion of undetermined significance” (AUS/FLUS) by The Bethesda System for Reporting Thyroid Cytology (TBSRTC) in 2007, there have been many published studies about the cytomorphologic criteria, subclassification, outcome, and management of patients with the diagnosis of AUS/FLUS. There have been many studies in different aspects of this indeterminate category, i.e., cytologic and molecular findings, ultrasonographic findings, and in some instances even core-needle biopsy to address a better and safer way of the management of patients with this fine-needle aspiration cytology diagnosis. The second edition of TBSRTC and the 2015 American Thyroid Association guidelines provide an update on the follow-up and management of AUS/FLUS. A multidisciplinary team consisting of pathologists, endocrinologists, surgeons, and radiologists should be involved in the diagnosis and management of AUS/FLUS, and all of them should be aware of the heterogeneity of this lesion for the prediction of the treatment and outcome. Study Design: In this review, we consider different research platforms (2008–2017) to find the best and key reports for the above-mentioned challenging aspects of AUS/FLUS. Conclusion: AUS/FLUS is now a well-defined group of thyroid lesions, which can be most accurately diagnosed and managed with cytomorphology, molecular, and ancillary studies.

scholarly journals Malignancy Risk and Related Factors of Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance in Thyroid Fine Needle Aspiration

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
So-hyeon Hong ◽  
Hyejin Lee ◽  
Min-Sun Cho ◽  
Jee Eun Lee ◽  
Yeon-Ah Sung ◽  
...  
Keyword(s):  
Clinical Features ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Related Factors ◽  
Fine Needle ◽  
Malignancy Risk ◽  
Thyroid Fine Needle Aspiration ◽  
Risk Of Malignancy ◽  
Undetermined Significance

Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in thyroid fine needle aspiration (FNA) is a challenging category. The malignancy risk is different by multiple factors and subsequent management strategy is inconclusive. Therefore, we analyzed the malignancy risk of AUS/FLUS according to radiological and clinical features. A total of 687 nodules that had been initially diagnosed as AUS/FLUS were retrospectively reviewed from 6365 thyroid FNAs between 2011 and 2014. The ultrasonographic (US) features were categorized using the Korean Thyroid Imaging Reporting and Data System. Radiological and clinical features were compared according to the second FNA results or histologically confirmed results from surgery. Repeat FNA was performed on 248 (36%) nodules, and 49 (7%) nodules underwent immediate surgery. Among the 248 nodules subjected to repeated FNA, 49 (20%) nodules were diagnosed again as AUS/FLUS, 123 (50%) were found to be benign, and 47 (19%) were diagnosed as follicular neoplasm, suspicious for malignancy or malignant. Among histologically confirmed nodules, the US features were more unfavorable in malignant nodules, and hypo- or anechogenicity was associated with a higher risk of malignancy after adjusting for age, size, and other US features (P<0.01). In conclusion, we observed that malignant nodules tended to show unfavorable US features, especially hypo- or anechogenicity. Age, sex, and thyroid function were not significantly associated with malignancy risk. We also found out that malignancy risk was not different between the group which underwent immediate operation following the AUS/FLUS diagnosis and the group which underwent repeated FNA after the initial diagnosis.

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