Differences in Risk of Malignancy and Management Recommendations in Subcategories of Thyroid Nodules with Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance: The Role of Ultrasound-Guided Core-Needle Biopsy

Choi, Young Jun; Baek, Jung Hwan; Ha, Eun Ju; Lim, Hyun; Lee, Jeong Hyun; Kim, Tae Yong; Song, Dong Eun; Shong, Young Kee; Hong, Suck Joon

doi:10.1089/thy.2012.0635

Cited by 92 publications

(153 citation statements)

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“…A particularly controversial problem is the degree of nuclear atypia (polymorphism) that allows the categorisation of aspirate as FLUS and not SM. Some authors even distinguish the separate category for smears with abnormalities in cellular nuclei, such as the presence of occasional nuclear grooves, an abnormal chromatin pattern, or nuclear overlapping and crowding [7][8][9][10][11]22].…”

Section: Prace Oryginalnementioning

confidence: 99%

“…These findings concern the presence of a papillary thyroid carcinoma. Choi et al (2014) named that subgroup -"AUS -atypia with undetermined significance"; Ho et al applied the term "AUS/FLUS -cannot rule out PTC" [11,23]. Rosario defined AUS as cytology demonstrating nuclear atypia, but not diagnostic of suspicious for malignancy or malignant tumour [12].…”

Section: Prace Oryginalnementioning

confidence: 99%

“…Another assumption was that FLUS diagnosis would not be a direct indication for surgical treatment, in contrast to other ISC categories (SFN and SM). However, numerous reports indicate that FLUS may be related to higher than assumed risk of malignancy [7][8][9][10][11][12][13][14]. It is also unclear whether implementation of the new FLUS category does not significantly affect the malignancy risk related to other ISC categories (SFN and SM).…”

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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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Section: Prace Oryginalnementioning

confidence: 99%

Section: Prace Oryginalnementioning

confidence: 99%

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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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“…In the meta-analysis by Bongiovanni et al (2012), the overall value of malignancy was reported to be 16% according to diagnostic criteria III and 26% according to diagnostic criteria IV, but cytological-histological correlation was available for only about 70% of nodules. In studies in which cytological-histological correlation has been available in BSRTC category III lesions, the risk of malignancy has been seen to fluctuate widely, from 19% to 77% (Dincer et al, 2013;Choi et al, 2014;Cuhaci et al, 2014;Ho et al, 2014;Hyeon et al, 2014;Rosario, 2014;Yoon et al, 2014;Deniwar et al, 2015;Kapila et al, 2015;Yoo et al, 2015). Also, there was a significant increase in the malignancy rate from sub-category FLUS to sub-category AUS in some (Choi et al, 2014), but not all (Cuhaci et al, 2014), investigations.…”

Section: Introductionmentioning

confidence: 99%

“…In studies in which cytological-histological correlation has been available in BSRTC category III lesions, the risk of malignancy has been seen to fluctuate widely, from 19% to 77% (Dincer et al, 2013;Choi et al, 2014;Cuhaci et al, 2014;Ho et al, 2014;Hyeon et al, 2014;Rosario, 2014;Yoon et al, 2014;Deniwar et al, 2015;Kapila et al, 2015;Yoo et al, 2015). Also, there was a significant increase in the malignancy rate from sub-category FLUS to sub-category AUS in some (Choi et al, 2014), but not all (Cuhaci et al, 2014), investigations. By contrast, in BSRTC category IV, the risk of malignancy (27%-34%) reported in the most recent literature Nikiforov et al, 2014;Deniwar et al, 2015;Kapila et al, 2015) seems to be closer to that previously observed (Cibas and Ali, 2009).…”

Section: Introductionmentioning

confidence: 99%

Retrospective cytological evaluation of indeterminate thyroid nodules according to the British Thyroid Association 2014 classification and comparison of clinical evaluation and outcomes

Giusti¹,

Massa²,

Balestra³

et al. 2017

J. Zhejiang Univ. Sci. B

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Abstract:The cytology of 130 indeterminate nodules (Thy 3) was retrospectively reviewed according to the British Thyroid Association 2014 classification. Nodules were divided into Thy 3a (atypical features) and Thy 3f (follicular lesion) categories. Histology was available as a reference for 97 nodules. Pre-surgical evaluations comprised biochemical tests, color-Doppler ultrasonography (US), semi-quantitative elastography-US (USE), contrast-enhanced US (CEUS), and mutation analysis from cytological slides. Thyroid malignancy was the final diagnosis for 19% of surgicallytreated nodules. No statistically significant difference in the risk of malignancy was found between Thy 3a (26%) and Thy 3f (14%) nodules. Histology of the Thy 3a and Thy 3f nodules showed a higher incidence of Hurtle cell adenomas in Thy 3f (29%) than in Thy 3a (3%) nodules (P=0.01). The only pre-surgical difference concerned the BRAF V600E mutation, which was positive in some Thy 3a but not in any Thy 3f nodules (P=0.04). Receiver-operating characteristic (ROC) analysis was used to obtain cut-off values from US (score), USE (ELX 2/1 strain index), and CEUS (time-topeak index and peak index) data. The cut-off values were similar for Thy 3a and Thy 3f nodules. Data showed that malignancy can be suspected if the US score is >2, ELX 1/2 strain index >1, time-to-peak index >1, and peak index <1. In a sub-group of 24 revised nodules (12 Thy 3a and 12 Thy 3f) with histology as a reference, the diagnostic power of cumulative pre-surgical analysis by means of US, USE, and CEUS showed high positive and negative predictive values (83% and 100%, respectively) for the presence of malignancy in Thy 3a and Thy 3f nodules. In conclusion, in our series of revised Thy 3 nodules, malignancy was low and displayed no significant differences between Thy 3a and Thy 3f categories. The use of cut-offs based on histology as a reference could reduce surgery. Our data support the conviction that, in mutation-negative Thy 3a and Thy 3f nodules, observation should be the first choice when not all instrumental results are suspect.

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Thyroid

2017

Cytopathology of the Head and Neck

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Differences in Risk of Malignancy and Management Recommendations in Subcategories of Thyroid Nodules with Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance: The Role of Ultrasound-Guided Core-Needle Biopsy

Abstract: US-guided CNB demonstrated that Group AUS showed a higher risk of malignancy, of becoming surgical candidates, of having malignant US findings, and of having malignant CNB readings than Group FLUS. Further management guidelines for Group AUS should differ from Group FLUS.

Cited by 92 publications

References 28 publications

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

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

Retrospective cytological evaluation of indeterminate thyroid nodules according to the British Thyroid Association 2014 classification and comparison of clinical evaluation and outcomes

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