Keywords:
Pathology, Outcomes, Biopsy, Ultrasound, Ultrasound physics, Thyroid / Parathyroids
Authors:
S. H. Jeong1, H. Hyun Sook2, E.-H. Lee2; 1Asan Medical Center/KR, 2Soonchunhyang University Hospital/KR
DOI:
10.1594/ecr2013/C-0842
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 recommend surgery rather than repeat FNA in these groups.
In group9,
the malignancy rate is 29.2% and relatively low compare with group 3 or 5.
Thus,
management of these nodules will depend on the physician or institution’s preference,
including follow-up US,
repeat US-FNA,
US-CNB,
and thyroid surgery.
US features and additional molecular study may be useful in predicting malignancy in AUS/FLUS thyroid nodules and could be helpful in planning management.
- In cases of group 1,
2,
4,
6,
7and 8,
there was no malignancy in this study but the total number of these groups is small (n=12) so more study needed.
- The malignancy rate of nodules resulting in FLUS again at rFNA was 88.9%.
Thus,
for nodules that result in FLUS again at rFNA,
we recommend surgery rather than a third FNA or F/U.
- The frequencies of malignant thyroid nodules in BRAF600E-positive and BRAF600E-negative nodules were 97.5% (39/40) and 39.7% (25/63),
respectively (P < 0.05).
Thus,
BRAF600E analysis should be considered for thyroid nodules with malignant US findings.
Several studies also proved the roles of BRAF600Emutation status and sonographic findings as adjuncts to FNA cytological diagnosis (3,4).