The evolution of “atypia” in thyroid <scp>fine‐needle</scp> aspiration specimens

Kim, Teresa H.; Krane, Jeffrey F.

doi:10.1002/dc.24859

Cited by 10 publications

(8 citation statements)

References 42 publications

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“…[18][19][20] The reported ranges of ROM associated with each TBSRTC diagnostic category have been consistent except in the so-called indeterminate diagnoses, especially AUS/FLUS. 18,21 At the time of the first edition of TBSRTC (2010), the estimated ROM of the cases diagnosed as AUS/FLUS ranged from 5% to 15%, and by the time of the second edition (2017), had increased to 10%-30%. 4,15 As defined in TBSRTC, AUS/FLUS includes a heterogeneous group of thyroid lesions that are difficult to classify into a more definitive category.…”

Section: Discussionmentioning

confidence: 99%

“…TBSRTC played an important role in standardizing diagnostic terminology, facilitating communication among cytopathologists and clinicians, and improving the clinical management of patients with thyroid nodules 18–20 . The reported ranges of ROM associated with each TBSRTC diagnostic category have been consistent except in the so‐called indeterminate diagnoses, especially AUS/FLUS 18,21 . At the time of the first edition of TBSRTC (2010), the estimated ROM of the cases diagnosed as AUS/FLUS ranged from 5% to 15%, and by the time of the second edition (2017), had increased to 10%–30% 4,15 .…”

Section: Discussionmentioning

confidence: 99%

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Two‐tier subclassification of the Bethesda category III (atypia of undetermined significance/follicular lesion of undetermined significance) in thyroid cytology

Alden,

Lambrou,

Yang

2023

Diagnostic Cytopathology

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BackgroundThe Bethesda category III, AUS/FLUS, comprises a heterogeneous group of thyroid lesions with variable risk of malignancy (ROM). This study evaluates ROM in two subgroups of this category based on nuclear atypia and architectural atypia.MethodsCases in Bethesda category III were reported based on nuclear atypia (AUS) and architectural atypia (FLUS). ROM was calculated by comparing the cytologic diagnosis to the follow‐up histologic diagnosis.ResultsAmong the 610 Bethesda category III cases in this study, 306 (50.2%) and 304 (49.8%) cases were reported as AUS and FLUS, respectively. One hundred and eighty six of 306 AUS (60.8%) and 193 of 304 FLUS (63.5%) cases underwent surgical intervention. ROM of the cases in Bethesda category III was 12.8% if all cases were counted and 20.6% if only surgical cases were counted. When analyzing separately, ROM of AUS cases was 17.0% and 28.0% with all cases and surgical cases only, respectively. For FLUS cases, ROM was 8.6% and 13.5% with all cases and surgical cases only, respectively.ConclusionIn Bethesda category III, ROM in the cases with nuclear atypia was significantly higher than the cases with architectural atypia. Sub‐classifying the Bethesda Category III cases with nuclear atypia and architectural atypia, respectively may better stratify the ROM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Two‐tier subclassification of the Bethesda category III (atypia of undetermined significance/follicular lesion of undetermined significance) in thyroid cytology

Alden,

Lambrou,

Yang

2023

Diagnostic Cytopathology

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“…The Advances in Health Sciences Research, volume 46 risk of malignancy related to the nuclear atypia rather than architectural atypia. Previous study showed that the presence of 2 nuclear features will increase the risk of malignancy up to 30-33% and will reach up to 100% when 4 nuclear features appeared [6,7] The AUS category comprises a heterogeneous group of findings, and the risk of malignancy associated with the nature of the observed atypia [8]. Most guidelines have recommended close follow-up for the AUS and repeating USG-guided FNA [7].…”

Section: Discussionmentioning

confidence: 99%

Management of Atypia of Undetermined Significant Thyroid Nodule

Mayangsari¹,

Moulanda²

2021

Advances in Health Sciences Research

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Thyroid nodules are one of frequent clinical problem with prevalence of 5% palpable nodules. Results of atypia of undetermined significance (AUS) can be found with risk of 5-15% malignancy rates. Management of AUS is still challenging and complex including observation until surgical approach. We present two cases of nodule thyroid. The 1st case of 44-year-old female with nodule of left thyroid lobe for 1 year. Ultrasonography (USG) examination showed TIRADS 4 at left lobe yet the Fine needle aspiration (FNA) resulted as AUS. The 2 nd case was 44-year-old male with nodule at left thyroid lobe for 3 years. USG showed TIRADS 5 of left lobe and TIRADS 4 of right lobe meanwhile FNA resulted as AUS. Left hemithyroidectomy was performed for the 1 st patient and histopathology examinations showed as struma adenomatous with focus of thyroid papillary carcinoma with follicular variant. Completion thyroidectomy then performed 2 months after the first procedure. Observation was chosen for the 2 nd case. Patient has been asymptomatic with close thyroid function and USG follow up. Hemithyroidectomy was performed 6 months afterwards since the mass getting bigger, and histopathology showed papillary carcinoma thus proceed with total thyroidectomy. Management of AUS is still debatable. It can present as heterogeneous lesions with different sub classifications according to cytomorphologic and molecular findings. Considerations of clinical risk stratification, USG findings and FNAB should be combined altogether for the best management and treatment outcome.

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“…For this entity to remain a valid and valuable category, AUS should not be over-used. 15 Cases with scant follicular groups trapped in fibrin clots with crowded architecture or focal nuclear pallor should be called non-diagnostic instead of AUS. A cellular aspirate with predominant benign findings and only focal microfollicles should be called benign, not AUS.…”

Section: Differential Diagnosis and Potential Pitfallsmentioning

confidence: 99%

Bethesda System for Reporting Thyroid Cytopathology–An Updated Review

Han¹,

Fan²

2023

J Clin Transl Pathol

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The Bethesda System for Reporting Thyroid Cytopathology is the first reporting system established in non-gynecologic cytopathology after the Bethesda System for Reporting Cervical Cytopathology. It adopts the same concept of providing a uniform reporting system for all pathologists and clinicians to follow in thyroid cytology. The reporting system is composed of six diagnostic categories. There are defined diagnostic criteria, estimated risk of malignancy, and management recommendations for each category. The reporting system has undergone two revisions upon the emergence of a new entity, updated terminology in histology, and development and refinement of molecular testing. The third edition is soon to be published in 2023. This review will provide an updated summary of the reporting system. Potential diagnostic pitfalls and molecular testing are also discussed.

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The evolution of “atypia” in thyroid fine‐needle aspiration specimens

Cited by 10 publications

References 42 publications

Two‐tier subclassification of the Bethesda category III (atypia of undetermined significance/follicular lesion of undetermined significance) in thyroid cytology

Two‐tier subclassification of the Bethesda category III (atypia of undetermined significance/follicular lesion of undetermined significance) in thyroid cytology

Management of Atypia of Undetermined Significant Thyroid Nodule

Bethesda System for Reporting Thyroid Cytopathology–An Updated Review

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