Both Ultrasound Features and Nuclear Atypia are Associated with Malignancy in Thyroid Nodules with Atypia of 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.

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Outcomes Study of Suspicious Afirma Genomic Sequencing Classifier Result in Thyroid Nodules with Atypia of Undetermined Significance (Bethesda System Diagnostic Category III)

Journal of the American Society of Cytopathology ◽

10.1016/j.jasc.2021.07.091 ◽

2021 ◽

Vol 10 (5) ◽

pp. S54

Author(s):

Ujalla Sheikh ◽

Ammar Karo ◽

Maria Gonzalez ◽

Robert Cabay ◽

Odile David

Keyword(s):

Thyroid Nodules ◽

Diagnostic Category ◽

Genomic Sequencing ◽

Bethesda System ◽

Outcomes Study ◽

Undetermined Significance

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Ultrasound predictive criteria for short term benign thyroid nodular volume reduction after ultrasound guided radiofrequency ablation

QJM ◽

10.1093/qjmed/hcab106.030 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Khaled Fikry Tawfik Shehab ◽

Ahmed Mohamed Hussein ◽

Rasha Tolba Khattab

Keyword(s):

Thyroid Nodules ◽

Reduction Ratio ◽

Volume Reduction ◽

Body Sensation ◽

Significant Difference ◽

Noticeable Improvement ◽

Us Findings ◽

Benign Thyroid Nodules ◽

Benign Thyroid ◽

Ultrasound Features

Abstract Purpose This study evaluates the outcome of patients complaining of compressive& cosmetic problems due to benign thyroid nodules after recieving RF ablation with correlation between some ultrasound features of the nodules and their shrinkage and volume reduction. Methods and material fifteen patients with benign thyroid nodules causing compressive symptoms (foreign body sensation,neck discomfort or pain) and cosmetic problems. Results A total of 15 patients were included with the age rangmg from 22-82 years old the mean was 52.73 years old (SD + 14.37).Among them 12 patients (800 0)were females and 3 patients(20%) were males. There was statistically significant difference between volume of nodules before the procedure with mean volume was 21.13±5.13 and I month after with mean volume I I .96±3.08 and 3 months after the procedure with mean volume 7.70±2.82 with noticeable improvement in nodules with peri and intranodular vascularity showing mean reduction ratio 69.88% after 3 months vs 59.93% and 64 12% of weak peripheral vascularity and intense intra-nodular vasculanty respectively as well as US structure with spongiform nodules showing mean reduction ratio 68.48% at 3 months vs 59.87% and 62.14% for solid &mixed nodules respectively.Mean symptoms and cosmetic score were significantly reduced. Conclusion: This study validated the efficacy and safety of RFA for treatment of benign thyroid nodules and showed correlation between shrinkage and some common US findings.

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Punção Aspirativa de Nódulos da Tiroide: Vale a Pena Repetir?

Acta Médica Portuguesa ◽

10.20344/amp.8215 ◽

2017 ◽

Vol 30 (6) ◽

pp. 472

Author(s):

Vera Fernandes ◽

Tânia Pereira ◽

Catarina Eloy

Keyword(s):

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Significant Proportion ◽

Cost Effective ◽

Needle Aspiration ◽

Fine Needle ◽

High Concordance ◽

Benign Nodules ◽

Cytology Result ◽

Undetermined Significance

Introduction: The fine-needle aspiration has a significant role in assessing the malignancy risk of thyroid nodules. There is uncertainty regarding the value of repeat fine-needle aspiration in benign nodules. This study aims to evaluate the concordance of results in consecutive fine-needle aspiration and to study the relevance of repetition in benign results.Material and Methods: Retrospective study of the 4800 thyroid nodules fine-needle aspiration held in Instituto de Patologia e Imunologia Molecular da Universidade do Porto between January 1, 2014 and May 2, 2016. Of the initial sample, we selected the repeated fine-needle aspiration on the same nodule.Results: The first fine-needle aspiration result of the 309 nodules underwent revaluation was non-diagnostic in 103 (33.3%), benign in 120 (38.8%) and atypia/follicular lesion of undetermined significance in 86 (27.8%). The agreement between the first and second fine-needle aspiration was significantly higher in cases with an initial benign result (benign: 85.8%, non-diagnostic: 27.2% and atypia/ follicular lesion of undetermined significance: 17.4%, p < 0.005). The fine-needle aspiration repeating motifs in initially benign nodules (n = 78) were repetition suggestion in 58, nodule growth in 17 and suspicious ultrasonographic features in 3.Discussion: The fine-needle aspiration repetition in nodules with initial non-diagnostic and atypia/follicular lesion of undetermined significance result changed the initial diagnosis in a significant proportion of patients, modifying their therapeutic approach. The high concordance of results in initially benign nodules makes fine-needle aspiration repetition not cost-effective in most cases.Conclusion: The fine-needle aspiration should be repeated when the initial cytology result is non-diagnostic or atypia/follicular lesion of undetermined significance.

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