Thyroid Bethesda Category AUS/FLUS in Our Microscopes: Three-Year-Experience and Cyto-Histological Correlation

Huhtamella, Roope; Kholová, Ivana

doi:10.3390/cancers11111670

Cited by 21 publications

(23 citation statements)

References 28 publications

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“…However, among these six categories of TBSRTC, further management is still complicated for the third category. 5 , 6 This category contains heterogeneous lesions assigned to two subgroups: atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS). 3–6 The prevalence of malignancy within this category ranges from 5% to 37%.…”

Section: Introductionmentioning

confidence: 99%

The Correlation of Age with Prognosis of Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Thyroid Nodules

Kaliszewski

Diakowska

Rzeszutko

et al. 2021

CMAR

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Purpose Although some prognostic variables and risk factors for thyroid cancer (TC) are age-related, the association between age and the risk of TC in patients with thyroid nodules (TNs) assigned to atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS) is poorly estimated. The aim of this study was to assess the histopathology of AUS/FLUS and the risk of TC according to the age of the patients at the time of AUS/FLUS diagnosis. Patients and Methods Among 5021 individuals treated for TNs at one institution from 2008 to 2018, 161 (3.2%) patients with 161 TNs assigned to the AUS/FLUS category (1 nodule per patient) were selected and stratified by age at initial diagnosis: <55 years, 55–75 years and >75 years. Logistic regression analysis was used to estimate the association of age with the risk of TC diagnosis. Results Ninety-one (56.52%) patients <55 years old, 58 (36.02%) patients 55–75 years old, and 12 (7.45%) individuals >75 years old were identified. There were 130 (80.7%) females and 31 (19.3%) males with a mean age of 50.6 ± 16.12 years. Among the evaluated TNs, 142 (88.2%) were ultimately diagnosed as benign, and 19 (11.8%) were diagnosed as malignant. Younger age in patients was significantly related to malignancy outcome (p=0.024 for age <55 years). Patients aged 55–75 years had a significantly lower risk of TC than the other age categories (p=0.040). The risks of high vascularity and fast tumor growth were significantly higher in the youngest category than in the other categories (age <55 years old: p=0.045 and p=0.002, respectively). Conclusion Although patients with TNs classified as AUS/FLUS by ultrasound-guided fine needle aspiration biopsy (UG-FNAB) are not typically qualified for surgery, it is worth noting that younger patients with an AUS/FLUS diagnosis might be at a higher risk of TC.

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Section: Introductionmentioning

confidence: 99%

The Correlation of Age with Prognosis of Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Thyroid Nodules

Kaliszewski

Diakowska

Rzeszutko

et al. 2021

CMAR

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“…This finding is slightly higher yet very similar to that reported by Eisa et al [33] with a malignancy rate of 74% in samples with nuclear/cytological atypia. Another study conducted by Huhtamella found that the rate of malignancy was almost the same for both nodules with architectural and cytological atypia, 12 and 12.4% respectively [34]. Among the malignant variants, papillary carcinoma was the most common diagnosis with a prevalence of 80.5% followed by NHL (1.5%) and medullary carcinoma (1.5%).…”

Section: Discussionmentioning

confidence: 99%

Cytological Sub-Classification of Atypia of Undetermined Significance May Predict Malignancy Risk in Thyroid Nodules

2021

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Background: Atypia/follicular lesion of undetermined significance (AUS/FLUS) carries a malignancy risk reaching up to 50%. Based on the reported malignancy rate in a given population, the clinical practice towards such a category varies. We hereby identify clinical parameters for risk stratification to aid in decision-making for either surgical referral or a clinical follow-up. Our aim is to identify clinical parameters that guided both clinicians and patients at our institutions to reach a clinical decision including atypia types. Methods: A retrospective review of patients with Bethesda III category thyroid nodules from tertiary centres in the Emirate of Abu Dhabi during January 2011 through December 2015 was carried out. Malignancy risk in Bethesda category III nodules and repeat FNA utility were calculated. Parameters that guided both clinicians and patients for appropriate referral to surgery were studied. Results: Two hundred and two cases were included in the study. Of these, 101 cases underwent surgery initially following the first FNA and 10 cases following FNA repeat. Histology confirmed malignancy in (41%) of cases that went initially to surgery and in (40%) of cases that underwent a repeat FNA. Repeat FNA resulted in 17 (44.74%) cases being re-classified into benign category, 10 (26.3%) being AUS/FLUS category, 6 (15.7%) being both suspicious and malignant, and 5 (13.16%) being unsatisfactory. Repeating FNA resulted in a definitive diagnostic utility in 50% of the cases. Eighty percent of malignant cases demonstrated nuclear atypia. Conclusion: The relatively high malignancy rate in our institutions, the suspicious radiographic features, the atypia groups, and the repeat FNA predictive value stratified Bethesda III category nodules for proper malignancy prediction and appropriate management.

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“…The two indeterminate categories of III & IV are reported in the BSRTC definition report in about 15–30% and 25–40% of nodules respectively [ 16 , 17 ]. They pose clinical challenges for endocrine physicians [ 19 – 21 ]. While the majority will have benign nodules, the malignancy risk is not trivial and typically triggers for additional investigations or treatment [ 20 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided fine needle aspiration cytology and ultrasound examination of thyroid nodules in the UAE: A comparison

et al. 2021

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Background Thyroid nodules are a common clinical finding and most are benign, however, 5–15% can be malignant. There is limited regional data describing the accuracy of ultrasound-guided fine needle aspiration (FNA) cytological examination compared to ultrasound examination of thyroid in patients who have undergone thyroid surgery. Methods A retrospective analysis of ultrasonographic (US) reports, FNA cytology reports and histopathology reports of 161 thyroid nodules presented at the endocrine center at Tawam hospital in Al Ain city, the United Arab Emirates during the period 2011–2019 was performed. US reports and images with FNA cytopathology reports and slides were reviewed by an independent radiologist and pathologist. Results In total, 40 nodules were reported as benign by US examination, while very low suspicious, low suspicious, intermediate suspicious and highly suspicious categories were reported in 21, 41, 14 and 45 nodules respectively. In addition, 68 nodules were reported as benign (Bethesda category II), while atypical follicular cells of unknown significance (Bethesda category III), follicular neoplasm (Bethesda category IV), suspicious for malignancy (Bethesda category V), and malignant (Bethesda category VI) categories were reported in 33, 9, 24 and 27 nodules respectively. The risk of malignancy for US benign nodules was 5%, while the risks of malignancy in very low suspicious, low suspicious, intermediate suspicious and highly suspicious nodules were 52%, 36%, 100% and 87%, respectively. The risk of malignancy for Bethesda category II was 3%, while the risks of malignancy in category III, IV, V and VI were 58%, 67%, 96% and 100%, respectively. Conclusion Thyroid FNA cytological examination and ultrasonography are key tools in predicting malignancy in thyroid nodules. Thyroid nodules with the diagnosis of Bethesda category III & IV run a high risk of malignancy thus more vigilance is required.

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Thyroid Bethesda Category AUS/FLUS in Our Microscopes: Three-Year-Experience and Cyto-Histological Correlation

Cited by 21 publications

References 28 publications

The Correlation of Age with Prognosis of Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Thyroid Nodules

The Correlation of Age with Prognosis of Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Thyroid Nodules

Cytological Sub-Classification of Atypia of Undetermined Significance May Predict Malignancy Risk in Thyroid Nodules

Ultrasound-guided fine needle aspiration cytology and ultrasound examination of thyroid nodules in the UAE: A comparison

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