The impact of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features on the rate of malignancy for atypia of undetermined significance subcategories

Hang, Jen‐Fan; Westra, William H.; Zhou, Alice; Cooper, David S.; Ali, Syed Z.

doi:10.1002/cncy.21981

Cited by 12 publications

(2 citation statements)

References 37 publications

(112 reference statements)

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“…In 2016, the new terminology of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was been proposed to replace the noninvasive encapsulated follicular variant of papillary thyroid carcinoma (PTC) [17] and this has been further adopted by the 2017 World Health Organization Classification of Tumors of Endocrine Organs [18]. The change in tumor classification inevitably influences the preoperative thyroid FNA diagnosis [19] and the utilization of molecular testing [20]. However, an international multi-institutional study from India, Japan, South Korea, Taiwan, and Thailand revealed a less significant impact of NIFTP reclassification on the practice of thyroid cytopathology [21].…”

Section: Impact Of Noninvasive Follicular Thyroid Neoplasm With Papilmentioning

confidence: 99%

Thyroid fine-needle aspiration cytology in Taiwan: a nationwide survey and literature update

Chen

Hang²,

Liu

et al. 2020

J Pathol Transl Med

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Fine-needle aspiration (FNA) is minimally invasive and widely used for assessing thyroid nodules [1]. It is also a decisive procedure for evaluating thyroid nodules that require surgery or conservative management [2,3]. Although the Bethesda System is the most widely accepted diagnostic system for thyroid cytology, there are significant deviations in practices in different countries [4,5]. Our previous review summarized the history and the evolution of the thyroid FNA practice in Taiwan [6]. The aims of this article are to provide an overview of the current thyroid FNA practice in Taiwan, particularly data from our nationwide survey, describe the changes due to the new World Health Organization (WHO) classification, and the advances of novel technologies. CURRENT THYROID CYTOPATHOLOGY IN TAIWAN In Taiwan, the majority of thyroid FNA cases are now performed with ultrasound guidance, since ultrasound-guided FNA provides better sampling of smaller or multiple nodules compared to palpation-guided FNA. High-resolution neck ultrasonography provides a simple, real-time, and noninvasive method to assess thyroid nodules. The accuracy of neck ultrasonography

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Section: Impact Of Noninvasive Follicular Thyroid Neoplasm With Papilmentioning

confidence: 99%

Thyroid fine-needle aspiration cytology in Taiwan: a nationwide survey and literature update

Chen

Hang²,

Liu

et al. 2020

J Pathol Transl Med

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“…There was also considerable variability in AUS/FLUS utilization at different centers, with reporting rates that range from 3.1%‐59.4% (Table 2). The largest studies included into the systematic analysis consisting of the largest number of case series (totally 5132 cases with histopathological correlations) are reported by Evranos 23 Topaloğlu et al, 24 Hyeon et al, 25 Kim et al, 14 Mosca et al, 1 Jan et al, 26 Faquin et al, 27 Ho et al, 28 , Türkyılmaz et al, 2 Mathur et al, 12 Hang et al 29 Li et al, 30 Renshaw, 31 Kiernan et al, 32 and VanderLaan et al 33 and are listed in the same order within Table 2 including their reported data.…”

Section: Resultsmentioning

confidence: 99%

High risk of malignancy in cases with atypia of undetermined significance on fine needle aspiration of thyroid nodules even after exclusion of NIFTP

Özkara

Bayrak

Turan

2020

Diagnostic Cytopathology

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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 within last 13 years. All patients undergoing surgery for AUS/FLUS were included into the study. Histopathology results were correlated; the impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) diagnosis on RoM is evaluated. Results: Of the 280 patients (16%) undergoing surgery, neoplasia were detected in 177 (RoN:63.2%) and malignancy in 119 (RoM:42.5%) of these neoplasia. Follicular variant of papillary thyroid carcinoma (FVPTC) was the commonest malignancy (55.5%). Additional 58 (20.7%) nodules were neoplastic, of which 26 (9.3%) were encapsulated follicular tumors with unknown malignancy potential (FT-UMP) and 32 (11.4%) were follicular adenomas. The remaining 103 patients (36.8%) had nonneoplastic nodules. After reevaluation of the encapsulated FVPTC cases, 20 of them were NIFTP and RoM dropped to 35.4% with a relative decrease of 16.7% and an absolute decrease of 7.1%. Conclusion: In our series, 42.5% of nodules with AUS/FLUS were malignant; 63.2% of them were neoplastic. The RoM and RoN for AUS/FLUS nodules are still much higher than the revised expected RoM of international guidelines even after NIFTP cases excluded. Therefore, current recommendations should be reevaluated periodically in view of detailed clinicopathologic studies.

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Outcome of atypia of undetermined significance/follicular lesion of undetermined significance in thyroid fine‐needle aspirations: A six‐year institutional experience

Angelova

Clement

2021

Diagnostic Cytopathology

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BackgroundAtypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is one of six diagnostic categories of The Bethesda System for Reporting Thyroid Cytopathology (BSRTC). The goal of our study is to assess the outcome of cases classified as AUS/FLUS at our institution.MethodsAUS/FLUS cases were identified by computer searching of the thyroid fine‐needle aspiration (FNA) cases performed between 2010 and 2016. Outcomes were categorized as: follow‐up surgery, repeat FNA or no follow‐up available. Demographics, ultrasound findings and FNA diagnostic criteria were reviewed for AUS/FLUS cases with follow‐up surgical pathology diagnosis.ResultsOur AUS/FLUS thyroid FNA rate was 6% (117 out of 1984 FNAs). Only 15% of the AUS/FLUS cases had repeat FNA, while 41% underwent surgery. The risk of malignancy (ROM) for cases with follow‐up surgery was 17%. When considering all AUS/FLUS cases, the ROM was 7%. Statistically, benign neoplasms were more likely to be single lesions on ultrasound comparing to malignant neoplasms, and to exhibit architectural atypia as opposed to non‐neoplastic lesions on FNA. The malignancy rates among patients that directly went to surgical resection (17%) and patients having repeat FNA after the first AUS/FLUS diagnosis followed by surgery (29%) was not significantly different. However, repeat FNA was able to reclassify the majority of cases into more definitive categories.ConclusionThe outcome of the thyroid FNAs diagnosed as AUS/FLUS in our institution meets the benchmark statistics for AUS/FLUS rate and ROM. This study constitutes a valuable quality assurance measure and serves as a baseline for subsequent quality improvement.

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The impact of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features on the rate of malignancy for atypia of undetermined significance subcategories

Abstract: A subset of resected AUS nodules can be reclassified as NIFTP, and that significantly decreases the ROM, especially for AUS-N and AUS-F. Nonetheless, AUS-N still harbors a substantially higher ROM than AUS-F. Cancer Cytopathol 2018;126:309-16. © 2018 American Cancer Society.

Cited by 12 publications

References 37 publications

Thyroid fine-needle aspiration cytology in Taiwan: a nationwide survey and literature update

Thyroid fine-needle aspiration cytology in Taiwan: a nationwide survey and literature update

High risk of malignancy in cases with atypia of undetermined significance on fine needle aspiration of thyroid nodules even after exclusion of NIFTP

Outcome of atypia of undetermined significance/follicular lesion of undetermined significance in thyroid fine‐needle aspirations: A six‐year institutional experience

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