Research Article
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Year 2023, Volume: 9 Issue: 4, 708 - 716, 04.07.2023
https://doi.org/10.18621/eurj.1203523

Abstract

References

  • 1. Cakir B, Aydin C, Korukluoğlu B, Ozdemir D, Sisman IC, Tüzün D, et al. Diagnostic value of elastosonographically determined strain index in the differential diagnosis of benign and malignant thyroid nodules. Endocrine 2011;39:89-98.
  • 2. Rago T, Vitti P. Potential value of elastosonography in the diagnosis of malignancy in thyroid nodules. Q J Nucl Med Mol Imaging 2009;53:455-64.
  • 3. Welker MD, Orlov MS. Thyroid cancer treatment. Ohio State University College of Medicine and Public Health. Ohio Am Fam Physician 2003;67:559-74.
  • 4. Chang SH, Joo M, Kim H. Fine needle aspiration biopsy of thyroid nodules in children and adolescents. J Korean Med Sci 2006;21:469-73.
  • 5. Nikiforov YE, Ohori NP, Hodak SP, Carty SE, LeBeau SO, Ferris RL, et al. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules: a prospective analysis of 1056 FNA samples. J Clin Endocrinol Metab 2011;96:3390-7.
  • 6. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer 2007;111:306-15.
  • 7. Crippa S, Mazzucchelli L, Cibas ES, Ali SZ. The Bethesda System for reporting thyroid fine needle aspiration specimens. Am J Clin Pathol 2010;134:343-4.
  • 8. Cibas ES, Ali SZ. The Bethesda System For Reporting Thyroid Cytopathology. Am J Clin Pathol 2009;132:658-65.
  • 9. Bernstein JM, Shah M, MacMillan C, Freeman JL. Institution-specific risk of papillary thyroid carcinoma in atypia/follicular lesion of undetermined significance. Head Neck 2016;38:1210-5.
  • 10. Kholova I, Ludvikova M. Thyroid atypia of undetermined significance or follicular lesion of undetermined significance: an indispensable Bethesda 2010 diagnostic category or waste garbage? Acta Cytol 2014;58:319-29.
  • 11. Ryu YJ, Jung YS, Yoon HC. Atypia of undetermined significance on thyroid fine needle aspiration: surgical outcome and risk factors for malignancy. Ann Surg Treat Res 2014;86:109-14.
  • 12. Heller M, Zanocco K, Zydowicz S. Cost-effectiveness analysis of repeat fine-needle aspiration for thyroid biopsies read as atypia of undetermined significance. Surgery 2012;152:423-30.
  • 13. VanderLaan PA, Marqusee E, Krane JF. Clinical Outcome for atypia of undetermined significance in thyroid fine-needle aspirations: should repeated fna be the prefrred initial approach? Am J Clin Pathol 2011;135:770-5.
  • 14. Bongiovanni M, Krane JF, Cibas ES, Faquin WC. The atypical thyroid fine-needle aspiration: past, present, and future. Cancer Cytopathol 2012;120:73-86.
  • 15. Singh RS, Wang HH. Eliminating the "Atypia of undetermined significance/follicular lesion of undetermined significance" category from the Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol 2011;136:896-902.
  • 16. Carr R, Ustun B, Chhieng D. Radiologic and clinical predictors of malignancy in the follicular lesion of undetermined significance of the thyroid. Endocr Pathol 2013;24:62-8.
  • 17. Walts AE, Mirocha J, Bose S. Follicular lesion of undetermined significance in thyroid FNA revisited. Diagn Cytopathol 2014;42:18-22.
  • 18. Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis. Acta Cytol 2012;56:333-9.
  • 19. Sahin M, Gursoy A, Tutuncu NB, Guvener DN. Prevalence and prediction of malignancy in cytologically indeterminate thyroid nodules. Clin Endocrinol 2006;65:514-8.
  • 20. Renshaw AA. Should "atypical follicular cells" in thyroid fine needle aspirates be subclassified? Cancer Cytopathol 2010;118:186-9.
  • 21. Luu MH, Fischer AH, Stockl TJ, Pisharodi L, Owens CL. Atypical follicular cells with equivocal features of papillary thyroid carcinoma is not a low-risk cytologic diagnosis. Acta Cytol 2011;55:526-30.
  • 22. Olson MT, Clark DP, Erozan YS, Ali SZ. Spectrum of risk of malignancy in subcategories of 'atypia of undetermined significance'. Acta Cytol 2011;55:518-25.
  • 23. Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 1997;126:226-31.
  • 24. Cuhaci N, Arpaci D, Ucler R. Malignancy rate of thyroid nodules defined as follicular lesion of undetermined significance and atypia of undetermined significance in thyroid cytopathology and its relation with ultrasonographic features. Endocr Pathol 2014;25:248-56.
  • 25. Ozluk Y, Pehlivan E, Gulluoglu MG, Poyanlı A, Salmaslioglu A, Colak N, et al. The use of the Bethesda Terminology in thyroid fine-needle aspiration results in a lower rate of surgery for nonmalignant nodules: A report from a reference center in Turkey. Int J Surg Pathol 2011;19:761-71.
  • 26. Tee YY, Lowe AJ, Brand CA, Judson RT. Fine-needle aspiration may miss a third of all malignancy in palpable thyroid nodules: a comprehensive literature review. Ann Surg Nov 2007;246:714-20.
  • 27. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016;26:1-133.
  • 28. Jang EK, Kim WG, Kim EY. Usefulness of NRAS codon 61 mutation analysis and core needle biopsy for the diagnosis of thyroid nodules previously diagnosed as atypia of undetermined significance. Endocrine 2016;52:305-12.

Should encountering atypia of undetermined significance / follicular lesion of undetermined significance after thyroid biopsy lead to the operation?

Year 2023, Volume: 9 Issue: 4, 708 - 716, 04.07.2023
https://doi.org/10.18621/eurj.1203523

Abstract

Objectives: Nodular goiter is the most common disease of the thyroid gland. Thyroid nodules are malignant in 3-5% cases. To determine the incidence of malignancy in patients defined as atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) as a result of fine needle aspiration biopsy (FNAB) and evaluate the clinical, biochemical and sonographic features as possible predictors of malignancy.

Methods: Patients who had undergone at least one FNAB and diagnosed as AUS/FLUS from January 2011 to December 2015 were included in the study. Age, gender, benign disease, thyroid stimulating hormone (TSH) level, size, localization, number, time of FNAB, ultrasonography (USG) characteristics, follow-up data on repeated FNAB results and, if surgical excision was performed, final pathological results were analyzed.

Results: A total of 5181 thyroid nodules were biopsied in 4089 patients, and the biopsy specimen taken from 611 nodules was diagnosed histopathologically as AUS/FLUS (11.79%). After FNAB, 167 of 611 patients diagnosed with AUS/FLUS were operated. While 65.9% (n = 110) of 167 patients who underwent surgery were made a benign diagnosis; malign diagnosis was made to 34.1% (n = 57).

Conclusions: The rate of malignancy in surgically confirmed nodules was 34.1% in this study, which is higher than the Bethesda classification. Due to the high malignancy rate which determined in cytologically diagnosed AUS/FLUS, we think that the repeat decision of the FNAB should be reconsidered and the surgical plan after the first FNAB should be considered more seriously.

References

  • 1. Cakir B, Aydin C, Korukluoğlu B, Ozdemir D, Sisman IC, Tüzün D, et al. Diagnostic value of elastosonographically determined strain index in the differential diagnosis of benign and malignant thyroid nodules. Endocrine 2011;39:89-98.
  • 2. Rago T, Vitti P. Potential value of elastosonography in the diagnosis of malignancy in thyroid nodules. Q J Nucl Med Mol Imaging 2009;53:455-64.
  • 3. Welker MD, Orlov MS. Thyroid cancer treatment. Ohio State University College of Medicine and Public Health. Ohio Am Fam Physician 2003;67:559-74.
  • 4. Chang SH, Joo M, Kim H. Fine needle aspiration biopsy of thyroid nodules in children and adolescents. J Korean Med Sci 2006;21:469-73.
  • 5. Nikiforov YE, Ohori NP, Hodak SP, Carty SE, LeBeau SO, Ferris RL, et al. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules: a prospective analysis of 1056 FNA samples. J Clin Endocrinol Metab 2011;96:3390-7.
  • 6. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer 2007;111:306-15.
  • 7. Crippa S, Mazzucchelli L, Cibas ES, Ali SZ. The Bethesda System for reporting thyroid fine needle aspiration specimens. Am J Clin Pathol 2010;134:343-4.
  • 8. Cibas ES, Ali SZ. The Bethesda System For Reporting Thyroid Cytopathology. Am J Clin Pathol 2009;132:658-65.
  • 9. Bernstein JM, Shah M, MacMillan C, Freeman JL. Institution-specific risk of papillary thyroid carcinoma in atypia/follicular lesion of undetermined significance. Head Neck 2016;38:1210-5.
  • 10. Kholova I, Ludvikova M. Thyroid atypia of undetermined significance or follicular lesion of undetermined significance: an indispensable Bethesda 2010 diagnostic category or waste garbage? Acta Cytol 2014;58:319-29.
  • 11. Ryu YJ, Jung YS, Yoon HC. Atypia of undetermined significance on thyroid fine needle aspiration: surgical outcome and risk factors for malignancy. Ann Surg Treat Res 2014;86:109-14.
  • 12. Heller M, Zanocco K, Zydowicz S. Cost-effectiveness analysis of repeat fine-needle aspiration for thyroid biopsies read as atypia of undetermined significance. Surgery 2012;152:423-30.
  • 13. VanderLaan PA, Marqusee E, Krane JF. Clinical Outcome for atypia of undetermined significance in thyroid fine-needle aspirations: should repeated fna be the prefrred initial approach? Am J Clin Pathol 2011;135:770-5.
  • 14. Bongiovanni M, Krane JF, Cibas ES, Faquin WC. The atypical thyroid fine-needle aspiration: past, present, and future. Cancer Cytopathol 2012;120:73-86.
  • 15. Singh RS, Wang HH. Eliminating the "Atypia of undetermined significance/follicular lesion of undetermined significance" category from the Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol 2011;136:896-902.
  • 16. Carr R, Ustun B, Chhieng D. Radiologic and clinical predictors of malignancy in the follicular lesion of undetermined significance of the thyroid. Endocr Pathol 2013;24:62-8.
  • 17. Walts AE, Mirocha J, Bose S. Follicular lesion of undetermined significance in thyroid FNA revisited. Diagn Cytopathol 2014;42:18-22.
  • 18. Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis. Acta Cytol 2012;56:333-9.
  • 19. Sahin M, Gursoy A, Tutuncu NB, Guvener DN. Prevalence and prediction of malignancy in cytologically indeterminate thyroid nodules. Clin Endocrinol 2006;65:514-8.
  • 20. Renshaw AA. Should "atypical follicular cells" in thyroid fine needle aspirates be subclassified? Cancer Cytopathol 2010;118:186-9.
  • 21. Luu MH, Fischer AH, Stockl TJ, Pisharodi L, Owens CL. Atypical follicular cells with equivocal features of papillary thyroid carcinoma is not a low-risk cytologic diagnosis. Acta Cytol 2011;55:526-30.
  • 22. Olson MT, Clark DP, Erozan YS, Ali SZ. Spectrum of risk of malignancy in subcategories of 'atypia of undetermined significance'. Acta Cytol 2011;55:518-25.
  • 23. Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 1997;126:226-31.
  • 24. Cuhaci N, Arpaci D, Ucler R. Malignancy rate of thyroid nodules defined as follicular lesion of undetermined significance and atypia of undetermined significance in thyroid cytopathology and its relation with ultrasonographic features. Endocr Pathol 2014;25:248-56.
  • 25. Ozluk Y, Pehlivan E, Gulluoglu MG, Poyanlı A, Salmaslioglu A, Colak N, et al. The use of the Bethesda Terminology in thyroid fine-needle aspiration results in a lower rate of surgery for nonmalignant nodules: A report from a reference center in Turkey. Int J Surg Pathol 2011;19:761-71.
  • 26. Tee YY, Lowe AJ, Brand CA, Judson RT. Fine-needle aspiration may miss a third of all malignancy in palpable thyroid nodules: a comprehensive literature review. Ann Surg Nov 2007;246:714-20.
  • 27. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016;26:1-133.
  • 28. Jang EK, Kim WG, Kim EY. Usefulness of NRAS codon 61 mutation analysis and core needle biopsy for the diagnosis of thyroid nodules previously diagnosed as atypia of undetermined significance. Endocrine 2016;52:305-12.
There are 28 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Original Articles
Authors

Bilgin Çelebi 0000-0002-2127-0005

Halil Afşin Taşdelen 0000-0003-0198-1827

Eray Kurnaz 0000-0002-9043-558X

Early Pub Date June 1, 2023
Publication Date July 4, 2023
Submission Date November 13, 2022
Acceptance Date January 18, 2023
Published in Issue Year 2023 Volume: 9 Issue: 4

Cite

AMA Çelebi B, Taşdelen HA, Kurnaz E. Should encountering atypia of undetermined significance / follicular lesion of undetermined significance after thyroid biopsy lead to the operation?. Eur Res J. July 2023;9(4):708-716. doi:10.18621/eurj.1203523

e-ISSN: 2149-3189 


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