Divide and rule: Cytodiagnosis of thyroid lesions using pattern analysis: A study of 233 cases

Muddegowda, Prakash H; Lingegowda, Jyothi B; Natesan, Rajesh; Kurpad, Ramkumar

doi:10.1002/dc.21486

Cited by 7 publications

(5 citation statements)

References 27 publications

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“…Layfield et al, Ohori et al, Muddegowda et al, and Shi et al have reported low reproducibility for AUS/FLUS, with marked interobserver and intraobserver variations. 15,16,30,31 The level of experience of the clinician/pathologist performing the thyroid FNA, the methods used for specimen preparation and staining, the number of FNA passes performed, and the availability of onsite rapid interpretation may all be contributing factors to this variation. The publication of reference images and text for TBSRTC, both in print and on the Internet (available at: www.papsociety.org), will inevitably promote greater uniformity.…”

Section: Aus/flus Usementioning

confidence: 99%

The atypical thyroid fine‐needle aspiration: Past, present, and future

Bongiovanni

Krane

Cibas

et al. 2011

Cancer Cytopathology

111

105

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Thyroid fine‐needle aspiration has developed into a key test in the evaluation of thyroid nodules. Although the interpretation of thyroid aspirates containing mild abnormalities is problematic, the introduction of the atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category in The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has helped to delineate such cases in a systematic and clinically meaningful manner. Herein the authors review the cytomorphologic features associated with the AUS/FLUS interpretation and summarize the results of studies conducted since the implementation of TBSRTC. Cancer (Cancer Cytopathol) 2012;. © 2011 American Cancer Society.

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Section: Aus/flus Usementioning

confidence: 99%

The atypical thyroid fine‐needle aspiration: Past, present, and future

Bongiovanni

Krane

Cibas

et al. 2011

Cancer Cytopathology

111

105

View full text Add to dashboard Cite

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“…Two schools of thought have emerged—one proposes to eliminate the FLUS category (or combine the FLUS and FN categories to form a five‐tiered system) and the other suggests a further subdivision of FLUS into categories with different risk assignments . Related issues involve determining whether nuclear atypia or architectural atypia (microfollicles) in an FNA is more reliably predictive of malignancy, quantifying the amount or extent of a “diagnostic” feature that should be required for inclusion in the suspicious for malignancy category, assessing the value of repeat FNA in nodules reported as FLUS and FN nodules, requiring consensus review before a thyroid FNA is diagnosed as FLUS, and assessing the potential role of molecular studies as an adjunct to cytodiagnosis . This study was designed to determine if cytomorphology could help further stratify lesions that are currently being reported as FLUS.…”

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confidence: 99%

Follicular lesion of undetermined significance in thyroid FNA revisited

Walts

Mirocha

Bose

2013

Diagnostic Cytopathology

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Controversy exists regarding the validity of follicular lesion of undetermined significance (FLUS), an indeterminate diagnostic category of The Bethesda System for Reporting Thyroid Cytopathology (BSRTC). According to BSRTC, FLUS carries a 5-15% risk of cancer. This study was designed to determine if cytomorphology could stratify FLUS into subgroups with different risks of malignancy. Reports of 127 consecutive FNAs reported as FLUS with subsequent tissue diagnoses were evaluated for the presence of various cytologic features and the results were correlated with histological diagnoses. FLUS cases with focal nuclear atypia (nuclear overlap/crowding, nuclear grooves/membrane irregularities, nuclear enlargement, and/or nuclear pseudoinclusions) were more frequently malignant on excision whereas those with architectural atypia (microfollicles) were more often benign on excision (P < 0.05). The presence of any one or more of these nuclear features increased the risk of carcinoma in subsequent thyroid resection. Papillary carcinomas predominated in excised FLUS cases with focal nuclear atypia whereas most FLUS with architectural atypia were adenomas or hyperplastic nodules on histological evaluation. BSRTC recommends that thyroid aspirates containing follicular cell nuclear and/or architectural atypia insufficient for a diagnosis of suspicious for follicular neoplasm, suspicious for malignancy or malignant be classified as FLUS. Our findings indicate that FLUS cases with focal nuclear atypia carry a risk for malignancy that is substantially higher than that assigned to FLUS and are best classified as suspicious. FLUS cases lacking these atypical nuclear features have a risk for malignancy that approximates the risk BSRTC has assigned to FLUS.

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“…Low reproducibility for AUS/FLUS has been reported, variability in criteria used for AUS/FLUS is responsible for significant interobserver and inter‐institutional variation in making diagnoses. In our study also poor interobserver agreement level ( K = 0.1301) was observed in the AUS/FLUS category; however, our sample size for AUS, 12, was small.…”

Section: Discussionmentioning

confidence: 99%

Implementation of the bethesda system for reporting thyroid cytopathology: Interobserver concordance and reclassification of previously inconclusive aspirates

Pathak

Srivastava

Singh

et al. 2014

Diagnostic Cytopathology

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Standardized diagnostic terminology was introduced by the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in an effort to bring uniformity to the reporting of thyroid cytopathology, provide more defined categories to enable clinical management, and minimize the number of inconclusive cases. Previous studies indicate that the BSRTC is a reliable and valid reporting system for thyroid cytology. This study was conducted to compare the concordance between observers with varying cytopathology experience when using the BSRTC, and to assess the impact on the number of inconclusive reports. A retrospective study was conducted in two parts. In the first part 415 thyroid aspirates were reviewed independently by three observers with different experience levels. The aspirates were reclassified according to BSRTC and agreement scores were calculated using kappa statistics. In the second part 39 inconclusive aspirates signed out previously, were recategorized according to BSRTC. Agreement level between the three observers using the BSRTC was strong (Fleiss' kappa score = 0.6561). Inconclusive cases could be categorized further with BSRTC; there was significant reduction in the number of inconclusive diagnoses (P < 0.001). Strong interobserver agreement with BSRTC indicates the ease with which the new system can be applied in regular reporting. Significant reduction in the number of inconclusive diagnoses results in better communication with the clinician and improved risk assessment for thyroid aspirates.

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Divide and rule: Cytodiagnosis of thyroid lesions using pattern analysis: A study of 233 cases

Cited by 7 publications

References 27 publications

The atypical thyroid fine‐needle aspiration: Past, present, and future

The atypical thyroid fine‐needle aspiration: Past, present, and future

Follicular lesion of undetermined significance in thyroid FNA revisited

Implementation of the bethesda system for reporting thyroid cytopathology: Interobserver concordance and reclassification of previously inconclusive aspirates

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