Eliminating the “Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance” Category From the Bethesda System for Reporting Thyroid Cytopathology

Singh, Remmi S.; Wang, Helen H.

doi:10.1309/ajcpix52mbokticp

Cited by 66 publications

(81 citation statements)

References 18 publications

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“…For example, in two of the studies cited in determining risks of malignancy for the Bethesda diagnostic categories, the data were from1980-1997 and 1995-2004 (23,24). In the study by Jung et al (27)(28)(29). Similarly, our rate of malignancy for the SUS category is also comparable to these groups (28,29).…”

Section: Strickland Et Alsupporting

confidence: 81%

The Impact of Noninvasive Follicular Variant of Papillary Thyroid Carcinoma on Rates of Malignancy for Fine-Needle Aspiration Diagnostic Categories

Strickland

Howitt

Marqusee

et al. 2015

Thyroid

229

299

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Background: Increased recognition of the indolent nature of noninvasive follicular variant of papillary thyroid carcinoma (NFVPTC) along with greater insight into the molecular alterations of these tumors has prompted endocrine pathologists to question whether these tumors warrant a diagnosis of carcinoma. However, a change in terminology would affect the rates of malignancy of fine-needle aspiration (FNA) diagnostic categories. Therefore, the aim of this study was to determine the percentage decrease in associated risk of malignancy for each FNA diagnostic category if NFVPTCs were no longer termed carcinomas. Methods: We evaluated a cohort of 655 FNAs with subsequent resection specimens over a 22-month time period. The diagnoses of the preceding FNAs were recorded according to the Bethesda System for Reporting Thyroid Cytopathology. For cases with more than one preceding FNA, the FNA diagnosis associated with the highest risk of malignancy was identified. Slides for all resection specimens with a diagnosis of FVPTC were reviewed to identify noninvasive tumors. By definition, all of these tumors were encapsulated, partially encapsulated, or well circumscribed and lacked any indication of infiltrative growth, capsular penetration, or lymphovascular invasion. Results: Our cohort of 655 FNAs with subsequent resection specimens included 53 (8.1%) nondiagnostic (ND), 167 (25.5%) benign, 97 (14.8%) atypia/follicular lesion of undetermined significance (AUS/FLUS), 88 (13.4%) suspicious for follicular neoplasm (SFN), 94 (14.4%) suspicious for malignancy (SUS), and 156 (23.8%) malignant cases (POS). Surgical resections demonstrated benign findings in 309 (47.2%) and malignant tumors in 346 (52.8%), including 85 NFVPTCs accounting for 24.6% of malignancies. Our rates of malignancy for ND, benign, AUS/FLUS, SFN, SUS, and POS were 18.9%, 13.2%, 39.2%, 45.5%, 87.2%, and 98.7%, respectively. If NFVPTC were no longer termed carcinoma, these rates would drop to 17.0% (10% decrease), 5.4% (59% decrease), 21.6% (45% decrease), 37.5% (18% decrease), 45.7% (48% decrease), and 93.6% (5% decrease), respectively. Conclusion: Our findings demonstrate that if terminology were changed and NFVPTCs were not considered carcinomas, the rates of malignancy for FNA diagnostic categories would be substantially decreased, with the most clinically significant decrease seen in the SUS category, which demonstrated a relative decrease of nearly 50%.

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Section: Strickland Et Alsupporting

confidence: 81%

The Impact of Noninvasive Follicular Variant of Papillary Thyroid Carcinoma on Rates of Malignancy for Fine-Needle Aspiration Diagnostic Categories

Strickland

Howitt

Marqusee

et al. 2015

Thyroid

229

299

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“…29,30 In our pediatric population, the overall rate of thyroid malignancy was 35%, and the vast majority of these malignancies were PTC (95%). This rate of malignancy is comparable to the range of malignancy (20%-50%) reported by other studies examining surgically resected pediatric and adult thyroid nodules, 2,5,22,30,31 and likely overestimates the true risk of malignancy because of selection bias. Prior studies reporting lower malignancy rates (6.6%-18%) in pediatric thyroid nodules included smaller sample sizes and younger patients (13.1-14.6 vs 16.5 years of age).…”

Section: Original Article 348supporting

confidence: 80%

Cytomorphological and molecular genetic findings in pediatric thyroid fine‐needle aspiration

Monaco

Pantanowitz

Khalbuss

et al. 2012

Cancer Cytopathology

145

167

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BACKGROUND:The Bethesda System for Reporting Thyroid Cytopathology is largely based on data from adult studies.Although thyroid nodules in children are rare, the rate of malignancy is high. The authors' aim was to analyze the cytomorphology and mutational profiles in pediatric thyroid fine-needle aspirations (FNAs). METHODS: Thyroid FNAs from patients 21 years old or younger were identified from the authors' pathology archive, categorized using the Bethesda System for Reporting Thyroid Cytopathology, and correlated with histological and molecular follow-up. RESULTS: A total of 179 samples from 142 patients were identified, including 96 cases (54%) with histological follow-up and 66 cases (37%) with molecular data. The diagnoses included 21 (12%) unsatisfactory, 82 (46%) negative, 43 (24%) atypia or follicular lesion of undetermined significance, 19 (11%) suspicious for follicular neoplasm, 6 (3%) suspicious for malignancy, and 8 (4%) positive for malignancy. The rate of malignancy in each category was 0%, 7%, 28%, 58%, 100%, and 100%, respectively. Of the 66 FNAs with molecular data, there were 11 (17%) positive for mutations. All mutation-positive FNAs were papillary thyroid carcinomas (PTCs) on resection. The overall sensitivity and specificity in this population were 80% and 100%, respectively. CONCLUSIONS: This study demonstrates that thyroid FNA in children is a sensitive and highly specific tool.There was a 17% positivity rate for a genetic mutation, which correlated with malignancy in all cases. In comparison to adults, there was a higher prevalence of RET/PTC mutations and lower prevalence of BRAF mutations, which may in part explain the less aggressive nature of PTCs reported in children. Cancer (Cancer Cytopathol) 2012;120:342-50. V C 2012 American Cancer Society.

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“…[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. 7 The recommended management is clinical correlation and a repeat FNAB in 3 to 6 months.…”

Section: Introductionmentioning

confidence: 99%

“…10 It has been recommended that if there is an indication for surgical intervention, it is not necessary to repeat the FNAB. 4 Although it has been suggested that the usage of AUS/FLUS should not exceed 7% of thyroid FNABs, 3,7,9,10 there is variation of this percentage from 3 to 29% across laboratories and from 2.5 to 28.6% among cytopathologists. 5 Ultrasound findings can facilitate reaching a diagnosis of nodules with AUS/FLUS, 11 although they may not differentiate benign from malignant nodules.…”

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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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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Eliminating the “Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance” Category From the Bethesda System for Reporting Thyroid Cytopathology

Cited by 66 publications

References 18 publications

The Impact of Noninvasive Follicular Variant of Papillary Thyroid Carcinoma on Rates of Malignancy for Fine-Needle Aspiration Diagnostic Categories

The Impact of Noninvasive Follicular Variant of Papillary Thyroid Carcinoma on Rates of Malignancy for Fine-Needle Aspiration Diagnostic Categories

Cytomorphological and molecular genetic findings in pediatric thyroid fine‐needle aspiration

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

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