Purpose
To establish the malignancy rate of initially Bethesda III (atypia of undetermined significance or follicular lesions of undetermined significance) thyroid nodules and whether they differ according to histological subcategories.
To investigate the value of ultrasonographic (US) features that predict malignancy,
and BRAF600E analysis,
and to suggest management of AUS/FLUS nodules.
Methods and Materials
From January 2010 to June 2012,
6118 focal thyroid nodules underwent US-guided FNA.
A total of 411 of 6118 (6.7%) focal thyroid nodules were diagnosed as AUS/FLUS,
and 246 were excluded because of a lack of further evaluation,
such as surgery,
rFNA,
or follow-up US (n=240) or because further FNA showed AUS/FLUS again without additional histological confirmation (n=6).
A total of 162 patients (146 women and 16 men) with 165 thyroid nodules were analyzed in the present study.
The mean age of patients was 49...
Results
The malignancy rate of initially AUS/FLUS nodules was 55.2% (91/165).
The malignancy rates were 0% in groups 1(0/2),
2(0/3),
4(0/3),
7 (0/3) and 8(0/1),
76.5% (13/17) in group 3,
83.1% (59/71) in group 5,
and 29.2% (19/65) in group 9.
The malignancy rate of nodules with suspicious US features was 79.3% (73/92) and the malignancy rate with intermediate US features was 24.7% (18/73).
Among suspicious US features,
nodules with a taller-than-wide shape showed a significantly higher odds ratio compared to those with an oval shape...
Conclusion
In our study,
the malignancy rate of AUS/FLUS thyroid nodules was higher than that reported previously.
Nodules with suspicious US features showed a significantly higher malignancy rate than indeterminate nodules.
In addition,
the malignancy rate was different among histological subcategories of AUS/FLUS thyroid nodules.
Thus,
management of these nodules should be tailored according to histological subcategory.
For management of AUS/FLUS nodules,
we suggest the following:
Bethesda III nodules should be histologically subcategorized and in group 3 and 5,
the malignancy rate is high and we...
References
1.
Cibas ES,
Ali SZ.
The Bethesda System for reporting thyroid cytopathology.
Am J Clin Pathol 2009; 132:658–665
2.
Yoon JH,
Kwak JY,
Kim EK et al.
How to approach thyroid nodules with indeterminate cytology.
Ann Surg Oncol 2010; 17:2144–2155
3.
Cooper DS,
Doherty GM,
Haugen BR et al.
American Thyroid Association (ATA) Guideline Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer.
Thyroid 2009; 19:1167–1214
4.
Moon WJ,
Choi N,
Choi JW,
Kim SK,
Hwang TS.
BRAF Mutation analysis and sonography as adjuncts to fine-needle...
Personal Information
Sun Hye Jeong,
Depeartment of Radiology,
Asan medical center in Korea.
E-mail:
[email protected]
