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

Abstract

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.

Clinical and ultrasonographic features in cancer risk stratification of indeterminate thyroid nodules

“…16 In the present study, the majority of patients were female )84%(, which is consistent with previous studies. 11,14 There were no significant correlations between age, gender, and pathology type )benign vs. malignant(, which is concordant with the results of a previous study. 17 Few studies have assessed the utility of the ACR TI-RADS classification for Bethesda categories III and IV.…”

“…The present study included both Bethesda category III and IV nodules; previously published studies from Saudi Arabia only included Bethesda category III nodules. 11,12 Cytologically indeterminate thyroid nodules are known for their heterogeneity and ambiguity. In this study, the AUS/FLUS rate was 6.4% )recommended range: <7%( and the FN/SFN rate was 3.6% )recommended range: 1-25%(.…”

“…18 However, no significant association was observed between US features and pathology type, which is in agreement with previous studies. 2,11,17 Rago et al 19 concluded that US elastography could play role in the detection of thyroid cancer, particularly in cases of indeterminate or non-diagnostic cytology.…”

Outcomes of repeat fineneedle aspiration biopsy for AUS/FLUS thyroid nodules

“…Twenty seven studies comprising 3932 AUS/FLUS nodules with RFNA were used to calculate the expected prevalence of cytological categories on RFNA following an initial AUS/ FLUS diagnosis (3,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37) (Table 2). Using a random-effects model, the expected redistribution of nodules among the Bethesda categories after RFNA was 4% (95% CI: 3%, 5%) as non-diagnostic (B-I); 48% (95% CI: 43%, 54%) as benign (B-II); 26% (95% CI: 20%, 32%) as AUS/FLUS (B-III); 4% (95% CI: 3%, 6%) as follicular neoplasm (B-IV); 5% (95% CI: 3%, 6%) as suspicious for malignancy (B-V); 2% (95% CI: 1%, 2%) as malignant (B-VI).…”

Thyroid Fine-needle Aspiration: Histologic Correlation of the Diagnostic Categories of the Bethesda System with Emphasis on &ldquo;Atypia of Undetermined Significance&rdquo;: A 5-year Single-institution Experience

“…No significant correlation was found between the ultrasound findings and the final diagnosis of nodules with AUS. 10 Layfield et al identified malignancy in 36 cases out of the total 127 cases of AUS that underwent surgical exploration (28.3%). 11 The malignancy risk found by Gucon et al is 15.7%.…”