Hürthle cell presence alters the distribution and outcome of categories in the Bethesda system for reporting thyroid cytopathology

Yazgan, Aylin; Balcı, Serdar; Dinçer, Nazmiye; Kıyak, Gülten; Tüzün, Dilek; Ersoy, Reyhan; Çakır, Bekir; Güler, Gülnur

doi:10.1111/cyt.12093

Cited by 22 publications

(45 citation statements)

References 9 publications

(10 reference statements)

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“…This difference obviously resulted in an increased risk of malignancy for their HCN cases. Sometimes, it can be difficult to distinguish HCN from PTC with squamoid or Hürthle cell-like cytoplasm [6]. It was not surprising that high PTC percentages among malignant cases in the HCN category were also reported in other studies [4,6,7] although PMCs were excluded.…”

Section: Discussionmentioning

confidence: 99%

“…Another study demonstrated an even higher follow-up malignancy rate for cases diagnosed as FN/SFN with Hürthle cell (6/11, 54.5%) compared to those without Hürthle cell change (7/32, 18.8%) by excluding PMC [6]. However, our results revealed FNA cases diagnosed as AUS-H and HCN carried a malignancy risk of 7 and 24%, respectively, which is within the range of malignancy suggested by the BSRTC for the AUS and FN diagnostic categories.…”

Section: Discussionmentioning

confidence: 99%

“…HCNs, also called oncocytic variants of follicular neoplasms (FNs), are relatively rare [4]. In two studies with follow-up histology, the risk of malignancy following an FNA diagnosis of HCN or FN/suspicious for FN (SFN) with Hürthle cell change ranged from 45 to 54.5%, respectively [5,6]. However, the risk of malignancy for FN/SFN in BSRTC is supposed to fall within the range of 15-30%.…”

Section: Introductionmentioning

confidence: 99%

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Hürthle Cell Neoplasms Diagnosed by Fine Needle Aspiration Are Not Associated with an Increased Risk of Malignancy

McKee¹,

Wu²,

Wang³

et al. 2014

Acta Cytologica

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Objectives: The aim of this study is to determine the risk of neoplasm and malignancy in thyroid fine needle aspiration (FNA) diagnosed as atypia of undetermined significance with Hürthle cell change (AUS-H) or Hürthle cell neoplasm (HCN). Study Design: A computerized search of our laboratory information system was performed to identify all thyroid FNA and correlating surgical pathology diagnoses including Hürthle cell or oncocyte in the diagnostic nomenclature. The risks of neoplasm and malignancy were calculated for AUS-H and HCN categories separately. Results: For the 29 AUS-H cases, the follow-up histology demonstrated 15 benign lesions, 4 follicular adenomas, 7 Hürthle cell adenomas, 1 papillary microcarcinoma (PMC), 1 follicular carcinoma and 1 Hürthle cell carcinoma. For the 93 HCN cases, the follow-up histology demonstrated 28 benign lesions, 9 follicular adenomas, 32 Hürthle cell adenomas, 2 PMCs, 2 papillary thyroid carcinomas, 6 follicular carcinomas and 14 Hürthle cell carcinomas. Conclusions: The risks of neoplasm and malignancy were 62 and 7% for the AUS-H category and 73 and 24% for the HCN category, respectively. The risk of malignancy for the AUS-H patients is within the 5- to 15-percent range suggested by the Bethesda System for Reporting Thyroid Cytology and within the 15- to 30-percent range suggested for follicular neoplasms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hürthle Cell Neoplasms Diagnosed by Fine Needle Aspiration Are Not Associated with an Increased Risk of Malignancy

McKee¹,

Wu²,

Wang³

et al. 2014

Acta Cytologica

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“…On the contrary, follicular carcinoma was the final histological diagnosis in only 21.1% of AUS/FLUS cases with architectural atypia [45]. The presence of oncocytes increases both the cytological diagnosis of AUS/FLUS and FNs as well as a final histological diagnosis of malignancy [46]. On the other hand, Wu et al [19] reported AUS/FLUS cases with a lower risk of malignancy (0 vs. 7%), but with a significantly higher risk of neoplasm (89 vs. 33%).…”

Section: Aus/flus Subclassification or Diminishment?mentioning

confidence: 99%

Thyroid Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance: An Indispensable Bethesda 2010 Diagnostic Category or Waste Garbage?

Kholová

Ludvíková²

2014

Acta Cytologica

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Objective: The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) was introduced in thyroid cytology in 2007 and is now generally accepted. BSRTC categories include a morphologic description and risk of malignancy as well as follow-up suggestions in each group. However, the category entitled ‘atypia of undetermined significance or follicular lesion of undetermined significance' (AUS/FLUS) is problematic. This category is heterogeneous and has been overused so far. Study Design: Twenty-six studies were included in a meta-analysis. In addition to AUS/FLUS percentage, we analysed repeated AUS/FLUS percentage, cytological and histological correlations, and risk of malignancy and neoplasm for AUS/FLUS. Furthermore, stratification, inter- and intra-observer variability, and the possibility of a switch to another category and its clinical consequences were reviewed. Results: Out of a total of 81,833 cases, AUS/FLUS accounted for 10.9%, with a 34% risk of malignancy. Persistent AUS/FLUS was found in 21.6% in repeated cytology. Cytohistological correlation was analysed from 16 studies (4,964 cases), revealing 10.4% as AUS/FLUS and a 21.5% risk of malignancy. Conclusions: An AUS/FLUS category seems to be currently reasonable with clearly defined cytomorphological criteria which do not correspond unequivocally with those of the other categories. An AUS/FLUS category is justified and possible means of its improvement with immunohistochemistry, molecular analysis and imaging are discussed.

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“…Some authors indicate that the frequency of cancer is higher in oxyphilic type of FLUS [47]. Others do not support such observations [13][14].…”

Section: Prace Oryginalnementioning

confidence: 94%

Analiza znaczenia klinicznego niejednoznacznych wyników biopsji tarczycy ze szczególnym uwzględnieniem kategorii ZPBN na podstawie 5 lat stosowania nowej klasyfikacji rozpoznań cytologicznych

Słowińska-Klencka

Wojtaszek-Nowicka

Sporny

et al. 2016

Endokrynologia Polska

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Introduction: The diagnostic category of follicular lesion of undetermined significance (FLUS) was intended to allow selection of cases with low risk of malignancy from all smears with indeterminate, suspicious cytology (ISC), which can potentially take advantage from repeat fine-needle aspiration (rFNA). Aim of the study was a comparison of the risk of malignancy related to FLUS nodules and other nodules with ISC: suspected follicular neoplasm (SFN) and suspected malignancy (SM), as well as analysis of the usefulness of assessing ultrasonographic malignancy risk features (UMRF) in nodules with ISC. Material and methods: We analysed UMRF, rFNA, and results of histopathological examination (H) in 441 FLUS, 135 SFN, and 72 SM nodules. Results: The frequency of exposing cancer in H in FLUS nodules was 5.9%, and when cytological follow up was also included it was 2.9%. rFNAs made the diagnosis more precise in 72.7% of FLUS, and in 5.2% it was diagnosis/suspicion of cancer. The incidence of cancer in SFN nodules was 8.2%, in SM nodules with suspicion of papillary cancer -61.1%, and in nodules with suspicion of other or unspecified malignancy -53.8% (p < 0.0001 FLUS vs. both groups). The presence of calcifications is the only independent UMRF for nodules with ISC (OR 4.7). Features of importance are also microcalcifications (OR 3.8), especially in the SM group, and taller-than-wide-shape (OR 2.2). FLUS and SFN nodules are characterised by particularly low value of assessing suspicious margins; analysis of hypoechogenicity is of low value in SFN nodules, like suspected vascularisation in SFN and SM nodules. Conclusions: The risk of cancer in FLUS and SFN nodules is lower than in SM nodules. rFNAs of FLUS nodules make the diagnosis more precise in more than 70% of cases and are effective in revealing cancers. UMRFs present variable diagnostic value depending on the subcategory of ISC. (Endokrynol Pol 2016; 67 (1): 23-34)

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Hürthle cell presence alters the distribution and outcome of categories in the Bethesda system for reporting thyroid cytopathology

Abstract: We found that the rates of AUS/FLUS and FN/SFN categories in the Bethesda system were higher when Hürthle cells were present. After surgery, neoplastic and malignant outcomes were significantly higher in the Hürthle cell group.

Cited by 22 publications

References 9 publications

Hürthle Cell Neoplasms Diagnosed by Fine Needle Aspiration Are Not Associated with an Increased Risk of Malignancy

Hürthle Cell Neoplasms Diagnosed by Fine Needle Aspiration Are Not Associated with an Increased Risk of Malignancy

Thyroid Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance: An Indispensable Bethesda 2010 Diagnostic Category or Waste Garbage?

Analiza znaczenia klinicznego niejednoznacznych wyników biopsji tarczycy ze szczególnym uwzględnieniem kategorii ZPBN na podstawie 5 lat stosowania nowej klasyfikacji rozpoznań cytologicznych

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