2020
DOI: 10.1002/dc.24533
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High risk of malignancy in cases with atypia of undetermined significance on fine needle aspiration of thyroid nodules even after exclusion of NIFTP

Abstract: Background: Fine needle aspiration cytopathology (FNAC) is the most reliable tool for evaluating thyroid nodules. However, diagnosing Bethesda category III, atypia/ follicular lesion of undetermined significance (AUS/FLUS), is a major limitation. The aim of this study was to evaluate the risk of malignancy (RoM) in AUS/FLUS nodules. A systematic review was also carried out analyzing the largest series. Methods: Totally 1750 cases (9%) diagnosed with AUS/FLUS were evaluated retrospectively out of 19 392 cases w… Show more

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Cited by 5 publications
(3 citation statements)
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“…ROM of AUS/FLUS diagnosis according to TBSRTC (2017) is estimated to be 10–30% if noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is considered malignant, and 6–18% if excluding NIFTP from the malignant group [ 3 , 4 ]. However, some authors suggest higher malignancy risk, reaching up to 50% [ 10 ], and even after excluding NIFTP [ 11 ]. Based on the various ROM rates, the clinical practice towards AUS/FLUS category varies.…”
Section: Discussionmentioning
confidence: 99%
“…ROM of AUS/FLUS diagnosis according to TBSRTC (2017) is estimated to be 10–30% if noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is considered malignant, and 6–18% if excluding NIFTP from the malignant group [ 3 , 4 ]. However, some authors suggest higher malignancy risk, reaching up to 50% [ 10 ], and even after excluding NIFTP [ 11 ]. Based on the various ROM rates, the clinical practice towards AUS/FLUS category varies.…”
Section: Discussionmentioning
confidence: 99%
“…The most clinically challenging lesions in terms of indeterminate FNAC associate to the Bethesda category III/AUS, a group that may represent a wide spectrum of atypical cellular features, spanning from architectural to cellular variations. What unites these atypical findings is their shared occurrence in both benign and malignant entities, and even though these features may not alone suffice to warrant a Bethesda VI category diagnosis, they raise legitimate concerns regarding the potential nonbenign nature of the lesion in question [5,6]. The significant consequence of overcalling thyroid FNAC specimens as "atypical" can lead to unwarranted surgical interventions, which not only pose risks to patients but also burden the healthcare monies.…”
Section: Introductionmentioning
confidence: 99%
“…A proportion (~20%) of these will be indeterminate and require further investigation including those that are classified as atypia of undetermined significant/follicular lesion of undetermined significance (AUS/FLUS) and are graded as Bethesda III 1 . For these nodules, the risk of malignancy is usually quoted at 5%–15% but some studies report risk as high as 25% 2 . Recommendations are usually to repeat FNAB in 3 months or perform a hemithyroidectomy for confirmatory diagnosis.…”
Section: Introductionmentioning
confidence: 99%