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

Abstract

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)

The predictive value of sonographic images of follicular lesions – a comparison with nodules unequivocal in FNA – single centre prospective study

“…Such a design has both advantages (certainty of the correct diagnosis of benign and malignant lesions) and disadvantages (a bias introduced by the additional selection of nodules). But in our material the difference in the risk of malignancy in FLUS nodules, as determined by histopathological examination and cytological follow-up, is not big (<3%) [25]. Our previous study also showed that there were no differences in the ultrasound image of FLUS nodules in the patients treated surgically and conservatively.…”

“…Our previous study also showed that there were no differences in the ultrasound image of FLUS nodules in the patients treated surgically and conservatively. Patients treated surgically were younger and had larger nodules [25]. A disadvantage of our study is the relatively low number of cancers in the FL group, but it reflects the frequency of cancers in this cytological category in our population.…”

“…Unfortunately, they are considered only in a minority of studies despite data indicating that PTC and FTC differ from each other in ultrasound imaging [22]. In our centre, where cytological diagnostics is performed in the population which had been exposed to iodine deficiency until only 20 years ago [23], the risk of malignancy in FLUS nodules, as determined with the results of histopathological examination, does not exceed 6% [24, 25]. This risk is concordant with the assumptions made when the FLUS category was created and is significantly lower than that in SFN nodules, which show a 10-20% malignancy risk [25, 26].…”

Porównanie skuteczności elastografii w diagnostyce zmian pęcherzykowych tarczycy i ognisk z jednoznacznym wynikiem BAC

“…In the case of category IV the risk of malignancy in a nodule is usually over 15% and a surgical treatment is recommended [1]. But in areas of iodine deficiency or in post-endemic areas that risk may be lower (due to non-neoplastic hyperplastic follicular nodules outnumbering follicular neoplasms), and then the decision on the surgical treatment becomes less obvious [3,4]. The risk of malignancy of category III is more diverse and it ranges from 5% to as much as 50% [5][6][7][8][9] among various centres.…”