Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category III (AUS/FLUS)

Kuru, Bekir; Atmaca, Ayşegül; Tarim, Ismail Alper; Kefeli, Mehmet; Topgül, Koray; Yoruker, Savas; Elmalı, Muzaffer; Danacı, Murat

doi:10.1016/j.ejso.2015.09.026

Cited by 43 publications

(41 citation statements)

References 22 publications

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“…In the present study, we observed irregular borders, hypoechogenicity, microcalcifications, being taller than wide, and components of the nodules all increased the risk for malignancy in thyroid nodules. This finding is in accordance with a study by Kure et al Brito et al demonstrated that being taller than wide had the highest diagnostic OR for judging the malignancy of thyroid nodules compared to other graphic ultrasound features. In our study, a relationship between the dimension of being taller than wide and risk of cancer was observed.…”

Section: Resultssupporting

confidence: 92%

Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Pan

et al. 2019

Diagnostic Cytopathology

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Background This study was designed to explore whether ultrasound of thyroid nodules facilitates the interpretation of the malignant risk of Bethesda III/IV thyroid nodules to inform further therapies. Methods We reviewed patient records in which the results of ultrasound‐guided fine‐needle aspiration (US‐FNA) were classified by the Bethesda III/IV in our institution between January 2016 and June 2018. Studies were retrieved from PubMed, Cochrane Central Register of Controlled Trials, ISI Web of Science, Science Direct, Wiley Online Library, EMBASE, China National Knowledge Infrastructure, WanFang, and Chinese VIP. The odds ratio (OR) was used to measure associations between risk factors and thyroid nodule malignancy. Results Fifty‐nine cases of Bethesda III/IV with corresponding surgeries were included, and the malignancy risk was 54.2%. Meta‐analysis revealed irregular borders, solitary nodules, hypoechogenicity, microcalcifications, and being taller than wide, all of which increased the malignancy risk of thyroid nodules. Combined ORs for these factors were 4.08 (95% CI: 2.34‐7.14, P < .001), 2.18 (95% CI: 1.39‐3.42, P = .001), 2.02 (95% CI: 1.35‐3.01, P = .001), 3.21 (95% CI: 2.26‐4.56, P < .001), and 4.35 (95% CI: 3.07‐6.15, P < .001), respectively. Conclusion As the risk of malignancy for papillary thyroid carcinoma (PTC) is high, when any one of the five ultrasound features of malignancy were confirmed, repeated FNA is recommended to confirm PTC‐type malignancy, even though nodules were Bethesda III/IV classification. However, repeated FNA should be avoided when none of these ultrasound features are identified because repeated FNA does not contribute to identifying non‐PTC type malignancies, such as follicular thyroid carcinoma and poorly differentiated thyroid carcinoma.

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Section: Resultssupporting

confidence: 92%

Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Pan

et al. 2019

Diagnostic Cytopathology

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“…In our study, higher rates of malignancy in histopathology may be explained by triage of the patients for surgery as it was reported by some authors previously (11). In our center, nearly all of the thyroid nodules diagnosed as AUS/FLUS are discussed in multidisciplinary conferences and if there is no unsettling radiological feature in US imaging of the nodule, the management goes on by repeating FNA as it is recommended by BRSTC (2).…”

Section: Discussionsupporting

confidence: 64%

Malignancy Rates in Bethesda Category AUS/FLUS: Single Center Experience

Can¹,

Ayturk²,

Tastekin³

et al. 2016

Acta Oncol Tur.

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ÖZETAmaç: Tiroid nodüllerinin prevelansı yüksek olmasına rağmen, bu nodüller için malignite oranları düşüktür. Bu nedenle, cerrahi yaklaşım gerektiren malign nodülleri, benign nodüllerden ayırmak çok önemlidir. Ultrasonografi, ultrasonografi eşliğinde ince iğne aspirasyonu ve ayrıca Tiroid Sitopatolojisi için Bethesda Raporlama Sistemi tiroid nodüllerinin değerlendirilmesinde fayda sağlamaktadır. Ancak, bu sistem 'Önemi Belirsiz Atipi/ Önemi Belirsiz Foliküler Lezyon (ÖBA/ÖBFL)' olarak adlandırılan problemli bir kategori içermektedir. Bu kategori için son zamanlarda bildirilen malignite yüzdeleri %5 ile %96,7 arasında değişmektedir. Bu çalışmada merkezimizde incelenen ilk ince iğne aspirasyon tanısı ÖBA/ÖBFL olan tiroid nodüllerindeki malignite oranlarının sunulması amaçlanmaktadır. Yöntem: Yedi yıl süresince, Trakya Üniversitesi Tıp Fakültesi Patoloji Anabilimdalı'nda (Edirne, Türkiye) incelenen hastaların tanıları (ince iğne aspirasyon ve tiroidektomi) geriye dönük olarak değerlendirildi. Bulgular: İnce iğne aspirasyon sitolojisinde ÖBA/ÖBFL tanısı alan 153 hastadan 68'inde (%44,4) histopatolojik tanı papiller tiroid karsinomu, 1'inde (%7) foliküler karsinom ve 1'inde (%7) de medüller karsinom idi. Tartışma ve Sonuç: Tiroid Sitopatolojisi için Bethesda Raporlama Sistemi bazı tanı kategorilerinde standardizasyon sağlamışsa da, ÖBA/ÖBFL kategorisi hala subjektif sitolojik kriterleri barındırmakta ve farklı çalışmalarda oldukça değişken histolojik malignite oranları bildirilmektedir. Bu nedenle, immünositokimya ve özellikle moleküler testler gibi yardımcı yöntemlerin kullanılması tiroid nodüllerinin preoperatif tanısında faydalı olabilir. Anahtar Kelimeler: Tiroid Karsinomu, Sitoloji, Önemi Belirsiz Atipi/ Önemi Belirsiz Foliküler Lezyon ABSTRACT Introduction: Although the prevelance of thyroid nodules is high, the rate of malignancy in these nodules is low. Thus, the distinction between the malignant nodules requiring surgical approach and the benign ones is very important. Ultrasound, ultrasound guided fine needle aspiration and also The Bethesda Reporting System for Thyroid Cytopathology are useful tools for interpretation of thyroid nodules. However, this system includes a problematic category titled as 'Atypia of Undetermined Significance/ Follicular Lesion of Undetermined Significance (AUS/FLUS)'. The reported percentages of malignancy in these nodules range between 5-96,7%, recently. We aimed to present the rate of malignancy in thyroid nodules with initial fine needle aspiration diagnosis as AUS/FLUS. Methods: The final diagnosis (fine needle aspiration and thyroidectomy) of patients who presented at the Department of Pathology of the Trakya University Medical Faculty (Edirne, Turkey) were reviewed for seven years. Results: Histological diagnosis was papillary thyroid carcinoma in 68 (44,4%), follicular carcinoma in 1 (0.7%) and medullary carcinoma in 1 (0.7%) of the 153 patients with prior fine needle aspiration diagnosis as AUS/FLUS. Discussion and Conclusion: Although, The Bethesda Reporting System for...

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“…However, the BSRTC estimates that only 10%‐40% of nodules in the FN/SFN category turn out to be malignant on histopathology . Therefore, to increase the diagnostic accuracy of FN/SFN category, and to avoid unnecessary surgery, clinical correlation with ultrasound factors could be used as the recommended management regime as used for the Bethesda category III (AUS/FLUS) . Our predictive risk index categories make it possible to estimate the sensitivity, NPV, and false‐negative rate and also increased the PPV.…”

Section: Discussionmentioning

confidence: 99%

“…When there was 1 risk factor she/he was allocated to risk category 1. Patients who had 2, 3, 4, and 5 risk factors were allocated to risk categories 2, 3, 4, and 5, respectively …”

Section: Methodsmentioning

confidence: 99%

Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category IV (FN/SFN)

Kuru

Kefeli

2018

Diagnostic Cytopathology

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Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category III (AUS/FLUS)

Cited by 43 publications

References 22 publications

Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Malignancy Rates in Bethesda Category AUS/FLUS: Single Center Experience

Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category IV (FN/SFN)

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