Should atypia of undetermined significance be subclassified to better estimate risk of thyroid cancer?

Chen, Joy C.; Pace, S; Khiyami, Amer; McHenry, Christopher R.

doi:10.1016/j.amjsurg.2013.09.022

Cited by 31 publications

(32 citation statements)

References 10 publications

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“…This will justify the continued surveillance in patients who otherwise do not have an indication for surgical intervention. Similar conclusions were made by Broome et al 4 and Chen et al 6 The latter authors advised to repeat FNAB after 3 to 6 months, and if the repeated biopsy is nondiagnostic or again interpreted as AUS/FLUS, then surgery is indicated. On the contrary, some authors observed that no difference in malignancy rate between one and repeated FNABs.…”

Section: Discussionmentioning

confidence: 54%

“…The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) has six categories, one of which is AUS or FLUS, which is a heterogeneous group that is difficult to classify as benign, follicular neoplasm, suspicious for malignancy, or malignant. [1][2][3][4][5][6] In AUS/FLUS, the risk of malignancy in resected nodules is 5 to 15%, but a variation from 6 to 48% is in record. [6][7][8][9] It has been reported that with repeated FNAB in AUS/ FLUS cases, about 56 to 68% will have a more definitive result and 15.6 to 48.6% will be interpreted as AUS/FLUS.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Outcome of Thyroid Nodules with Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Fine Needle Aspiration Biopsy

Alqahtani¹,

Al-Sobhi²,

Alsalloum³

et al. 2017

World Journal of Endocrine Surgery

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Aim: To correlate selected clinical and ultrasonographic (US) characteristics with the final histopathological diagnosis in patients with atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS), and whether this information can be used in planning the surgical approach. Materials and methods:It is a retrospective study including the operated cases of AUS/FLUS from 2011 to 2014 treated at one center.Results: This cohort included 87 women and 28 men. To test for independence between categorical variables, the chi-square test was used. There was no significant correlation between age or US variables and final pathological diagnosis. However, final diagnosis of malignancy was higher in men compared with women (64.3 and 41.4% respectively; p = 0.035). Furthermore, a significant association between the diagnosis of repeated fine needle aspiration biopsy (FNAB) and the final pathological diagnosis was noted (benign vs malignant, p = 0.005). Conclusion:The FNAB has a significant role in the assessment of thyroid nodules. Our results showed no correlation between age, US variables, and the risk of malignancy. Male gender is associated with higher risk of malignancy.Clinical significance: Determining the risk of malignancy and prediction of surgical outcome may help triaging cases for repeat FNA or proceeding to surgery.

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Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Surgical Outcome of Thyroid Nodules with Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Fine Needle Aspiration Biopsy

Alqahtani¹,

Al-Sobhi²,

Alsalloum³

et al. 2017

World Journal of Endocrine Surgery

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“…Malignancy rates that were reported by first group studies, including all undetermined patients for follow-up, are found between 15.7% and 44.1% (Horne Dincer et al, 2013;Chen et al, 2014;Ho et al, 2014;Hyeon et al, 2014;Rosario, 2014). In contrast, these rates are reported between 22.8% and 54% in the second group of studies that have only selected the patients who underwent surgery (Alexander et al, 2012;Jeong et al, 2013;Chen et al, 2014;Cuhaci et al, 2014;Ho et al, 2014;Park et al, 2014;Ryu et al, 2014). In our study, as a consequence of our patient selection, there is a predictable selection bias, caused by including the patients who only underwent thyroidectomy.…”

Section: Discussionmentioning

confidence: 94%

Thyroid Nodules with Atypia or Follicular Lesions of Undetermined Significance (AUS/FLUS): Analysis of Variables Associated with Outcome

Kayilioglu¹,

Dinç²,

Sozen³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: The Bethesda System for Reporting Thyroid Cytopathology is one of the main classification systems for thyroid nodules. It expects that 7% of all fine needle aspiration biopsies will be reported as atypia or follicular lesions of undetermined significance, and 5-15% of these undetermined nodules are malignant. Our study is a retrospective analysis of variables that may be associated with outcome in patients with indeterminate thyroid nodules. Materials and Methods: Patients who underwent thyroidectomy in our institution between 2010 and 2014 were retrieved from the institutional records database. Patient demographics and medical histories were recorded. All ultrasonography reports were examined for nodule features and biochemical blood levels, hormone levels and complete blood counts were recorded. Results: A total of 103 patient cytopathology reports were regarded as belonging to the undetermined category. Some 35% of patients had malignant nodules. Median preoperative red cell distribution width (RDW) level was 13.6 inthe benign group, while it was 14.3 in patients with malignancy, demonstrating a significant correlation (p=0.003). Only calcification presence was significantly different between benign and malignant groups on ultrasonography (p=0.034). Conclusions: Ultrasonography is one of the primary tools for this matter. RDW levels may become another promising tool to predict malignancy.

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“…This could be accomplished using a concise note, Common patterns that would be candidates for subclassifiers include: architectural atypia, nuclear atypia, oncocytic features, and NOS. Several studies have demonstrated that subclassification within the AUS/FLUS category can be effective to better define the ROM, and that nuclear atypia is associated with a higher ROM than other AUS/FLUS patterns [23,24,25,26,27,28]. …”

Section: Specific Issues Pertaining To the Different Diagnostic Categmentioning

confidence: 99%

The Bethesda System for Reporting Thyroid Cytopathology: Proposed Modifications and Updates for the Second Edition from an International Panel

Pusztaszeri

Rossi

Auger³

et al. 2016

Acta Cytologica

113

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The Bethesda System for Reporting Thyroid Cytology (TBSRTC) was proposed in 2007 at the National Cancer Institute Thyroid Fine Needle Aspiration State of the Art and Science Conference held in Bethesda, Maryland. The aim was to address the inconsistent and sometimes confusing reporting terminologies used for thyroid FNA throughout the world. The TBSRTC consists of 6 diagnostic categories, each associated with an implied risk of malignancy that translates directly into a clinical management algorithm. Since the publication of the TBSRTC cytology Atlas in January 2010, considerable experience has been gained regarding its application in cytology practice, clinical impact, and limitations. In conjunction with the International Academy of Cytology (IAC), an international panel composed of sixteen cytopathologists and an endocrinologist with special interest in thyroid cytology, including several co-authors of the 2010 TBSRTC Atlas, was created to: (1) analyze the current worldwide impact of TBSRTC, (2) report on the current state of TBSRTC based upon a review of the published literature, and (3) provide possible recommendations for a future update of TBSRTC. Herein, we summarize the panel's deliberations and key recommendations that our panel hopes will be useful during the preparation of the second edition of TBSRTC.

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Should atypia of undetermined significance be subclassified to better estimate risk of thyroid cancer?

Cited by 31 publications

References 10 publications

Surgical Outcome of Thyroid Nodules with Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Fine Needle Aspiration Biopsy

Surgical Outcome of Thyroid Nodules with Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Fine Needle Aspiration Biopsy

Thyroid Nodules with Atypia or Follicular Lesions of Undetermined Significance (AUS/FLUS): Analysis of Variables Associated with Outcome

The Bethesda System for Reporting Thyroid Cytopathology: Proposed Modifications and Updates for the Second Edition from an International Panel

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