Management and Malignancy Rate of Thyroid Nodules with a Cytologic Diagnosis of Atypia or Follicular Lesion of Undetermined Significance
Abstract
Objective. This study describes the clinical data of adult patients who underwent Fine Needle Aspiration Biopsy (FNAB) of thyroid nodule(s) with a cytologic diagnosis of Atypia or Follicular Lesion of Undetermined Significance (AUS or FLUS) at St. Luke’s Medical Center from January 2012 to October 2013.
Methodology. Adult patients who underwent FNAB of the thyroid nodule with a cytologic diagnosis of AUS or FLUS were studied retrospectively using the ultrasound result, initial consultation form and operative techniques of these patients. The cytologic and histopathologic diagnoses were retrieved through the electronic Healthcare-Results Management System.
Results and Conclusion. A third (34%) of the patients with a cytologic diagnosis of AUS or FLUS (8.9%) underwent surgery. Of the 68 patients who underwent surgery, 44 were benign and 24 were malignant with a malignancy rate of 35.3%. Preoperatively, there were no ultrasound characteristics or microscopic descriptions significantly associated with malignancy. The recommendation of the Bethesda System to do a repeat FNAB in these thyroid nodules should, therefore, be reconsidered.
Downloads
References
Gharib H, Papini E, Paschke R, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocrine Practice. 2011;16 (Suppl 1):1-43.
Carlos-Raboca J, Jimeno C, Kho S, et al. The Philippine Society of Endocrinology and Metabolism PhilTidDes Working Group, The Philippine Thyroid Disease Study (PhilTiDes 1): Prevalence of thyroid disorders among adults in the Philippines. Journal of the ASEAN Federation of Endocrine Societies. 2012;27(2):27-33.
Melmed S, Polonsky K, Larsen P, Kronenberg H. Williams Textbook of Endocrinology 12th ed. Elsevier Saunders, Philadelphia, PA.; 2011:445.
Cooper D, Doherty G, Haugen B, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19(11):1167-1214.
Cibas E, Ali S. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132:658-665.
Teixeira G, Chikota H, et al. Incidence of malignancy in thyroid nodules determined to be follicular lesions of undetermined significance on fine-needle aspiration. World J Surg. 2012;36:69-74.
Shi Y, Ding X, Klein M, et al. Thyroid fine-needle aspiration with atypia of undetermined significance: A necessary or optional category? Cancer Cytopathology. 2009;299-304.
Bonzaninm M, Amadori P, et al. Subclassification of the “Grey Zone” of thyroid cytology, a retrospective descriptive study with clinical cytological and histological corrrelation. Journal of Thyroid Research. 2011:1-8.
Rabaglia J, Kabbani W, et al. Effect of the Bethesda system for reporting thyroid cytopathology on thyroidectomy rates and malignancy risk in cytologically indeterminate lesions. Surgery. 2010;148:1267-73.
Chen J, Pace C, et al. Yield of repeat fine-needle aspiration biopsy and rate of malignancy in patients with atypia or follicular lesion of undetermined significance: The impact of the Bethesda system for reporting thyroid cytopathology. Surgery. 2012;152:1037-44.
Nagarkatii S, Faquin W, Lubitz C, et al. Management of thyroid nodules with atypical cytology on fine-needle aspiration biopsy. Ann Surg Oncol. 2013;20:60-65.
Theoharis C, Schofield K, et al. The Bethesda thyroid fine-needle aspiration classification system: Year 1 at an academic institution. Thyroid. 2009;1(11):1215-1223.
Yoon J, Kwak J, Kim E, et at. How to approach thyroid nodules with indeterminate cytology. Ann Surg Oncol. 2010;17:2147-2155.
VanderLaan P, Marqusee E, Krane J. Usefulness of diagnostic qualifiers for thyroid fine-needle aspirations with atypia of undetermined signifiance. Am J Clin Pathol. 2011;136:572-577.
Kim D, Lee E, et.al. Role of sonographic diagnosis in managing Bethesda class III nodules. Am J Neuroradiol. 2011;32:2136-2141.
Yang J, Schnadig V, Logrono R, Wasserman P. Fine-needle aspiration of thyroid nodules: A study of 4703 patients with histologic and clinical correlations. Cancer Cythopathol. 2007;111:306-315.
Yassa L, Cibas E, Benson C, et.al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer Cytopathol. 2007;111:508-516.
Published
How to Cite
Issue
Section
License
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to jafes@asia.com or jafes.editor@gmail.com.
A written agreement shall be emailed to the requester should permission be granted.