- Volume 15 Issue 23
DOI QR Code
Thyroid Nodules with Atypia or Follicular Lesions of Undetermined Significance (AUS/FLUS): Analysis of Variables Associated with Outcome
- Kayilioglu, Selami Ilgaz (Department of General Surgery, Ankara Numune Research and Training Hospital) ;
- Dinc, Tolga (Department of General Surgery, Ankara Numune Research and Training Hospital) ;
- Sozen, Isa (Department of General Surgery, Ankara Numune Research and Training Hospital) ;
- Senol, Kazim (Department of General Surgery, Ankara Numune Research and Training Hospital) ;
- Katar, Kagan (Department of General Surgery, Ankara Numune Research and Training Hospital) ;
- Karabeyoglu, Melih (Department of General Surgery, Ankara Numune Research and Training Hospital) ;
- Tez, Mesut (Department of General Surgery, Ankara Numune Research and Training Hospital) ;
- Coskun, Faruk (Department of General Surgery, Faculty of Medicine, Hitit University)
- Published : 2015.01.06
Background: The Bethesda System for Reporting Thyroid Cytopathology is one of the main classification systems for thyroid nodules. It expects that 7% of all fine needle aspiration biopsies will be reported as atypia or follicular lesions of undetermined significance, and 5-15% of these undetermined nodules are malignant. Our study is a retrospective analysis of variables that may be associated with outcome in patients with indeterminate thyroid nodules. Materials and Methods: Patients who underwent thyroidectomy in our institution between 2010 and 2014 were retrieved from the institutional records database. Patient demographics and medical histories were recorded. All ultrasonography reports were examined for nodule features and biochemical blood levels, hormone levels and complete blood counts were recorded. Results: A total of 103 patient cytopathology reports were regarded as belonging to the undetermined category. Some 35% of patients had malignant nodules. Median preoperative red cell distribution width (RDW) level was 13.6 inthe benign group, while it was 14.3 in patients with malignancy, demonstrating a significant correlation (p=0.003). Only calcification presence was significantly different between benign and malignant groups on ultrasonography (p=0.034). Conclusions: Ultrasonography is one of the primary tools for this matter. RDW levels may become another promising tool to predict malignancy.
Cytology;thyroid neoplasms;thyroid nodule red blood cell distribution width
- Beyazit Y, Kekilli M, Ibis M, et al (2012). Can red cell distribution width help to discriminate benign from malignant biliary obstruction? A retrospective single center analysis. Hepatogastroenterology, 59, 1469-73.
- Chen JC, Pace SC, Khiyami A, et al (2014). Should atypia of undetermined significance be subclassified to better estimate risk of thyroid cancer? Am J Surg, 207, 331-6; discussion 5-6. https://doi.org/10.1016/j.amjsurg.2013.09.022
- Cheng P, Chen ED, Zheng HM, et al (2013). Ultrasound score to select subcentimeter-sized thyroid nodules requiring ultrasound-guided fine needle aspiration biopsy in eastern China. Asian Pac J Cancer Prev, 14, 4689-92. https://doi.org/10.7314/APJCP.2013.14.8.4689
- Cibas ES, Ali SZ (2009). The Bethesda system for reporting thyroid cytopathology. Thyroid, 19, 1159-65. https://doi.org/10.1089/thy.2009.0274
- Cuhaci N, Arpaci D, Ucler R, et al (2014). 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, 25, 248-56. https://doi.org/10.1007/s12022-014-9298-7
- Dincer N, Balci S, Yazgan A, et al (2013). Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology. Cytopathology, 24, 385-90. https://doi.org/10.1111/cyt.12021
- Dorgalaleh A, Mahmoodi M, Varmaghani B, et al (2013). Effect of thyroid dysfunctions on blood cell count and red blood cell indice. Iran J Ped Hematol Oncol, 3, 73-7.
- Gharib H, Papini E, Paschke R, et al (2010). 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. J Endocrinol Invest, 33, 1-50. https://doi.org/10.1007/BF03346541
- Alexander EK, Kennedy GC, Baloch ZW, et al (2012). Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N Engl J Med, 367, 705-15. https://doi.org/10.1056/NEJMoa1203208
- Bashir H, Bhat MH, Farooq R, et al (2012). Comparison of hematological parameters in untreated and treated subclinical hypothyroidism and primary hypothyroidism patients. Med J Islam Repub Iran, 26, 172-8.
- Ho AS, Sarti EE, Jain KS, et al (2014). Malignancy rate in thyroid nodules classified as bethesda category III (AUS/ FLUS). Thyroid, 24, 832-9. https://doi.org/10.1089/thy.2013.0317
- Hong N, Oh J, Kang SM, et al (2012). Red blood cell distribution width predicts early mortality in patients with acute dyspnea. Clin Chim Acta, 413, 992-7. https://doi.org/10.1016/j.cca.2012.02.024
- Horne MJ, Chhieng DC, Theoharis C, et al (2012). Thyroid follicular lesion of undetermined significance: Evaluation of the risk of malignancy using the two-tier sub-classification. Diagn Cytopathol, 40, 410-5. https://doi.org/10.1002/dc.21790
- Hyeon J, Ahn S, Shin JH, et al (2014). The prediction of malignant risk in the category "atypia of undetermined significance/follicular lesion of undetermined significance" of the Bethesda System for Reporting Thyroid Cytopathology using subcategorization and BRAF mutation results. Cancer Cytopathol, 122, 368-76. https://doi.org/10.1002/cncy.21396
- Jeong SH, Hong HS, Lee EH, et al (2013). Outcome of thyroid nodules characterized as atypia of undetermined significance or follicular lesion of undetermined significance and correlation with Ultrasound features and BRAF (V600E) mutation analysis. Am J Roentgenol, 201, 854-60. https://doi.org/10.2214/AJR.12.9901
- Kocjan G, Chandra A, Cross PA, et al (2011). The interobserver reproducibility of thyroid fine-needle aspiration using the UK Royal College of Pathologists' classification system. Am J Clin Pathol, 135, 852-9. https://doi.org/10.1309/AJCPZ33MVMGZKEWU
- Lee KH, Shin JH, Oh YL, et al (2014). Atypia of undetermined significance in thyroid fine-needle aspiration cytology: prediction of malignancy by us and comparison of methods for further management. Ann Surg Oncol, 21, 2326-31. https://doi.org/10.1245/s10434-014-3568-y
- Park HJ, Moon JH, Yom CK, et al (2014). Thyroid "atypia of undetermined significance" with nuclear atypia has high rates of malignancy and BRAF mutation. Cancer Cytopathol, 122, 512-20. https://doi.org/10.1002/cncy.21411
- Rosario PW (2014). Thyroid nodules with atypia or follicular lesions of undetermined significance (Bethesda Category III): Importance of ultrasonography and cytological subcategory. Thyroid, 24, 1115-20. https://doi.org/10.1089/thy.2013.0650
- Rosario PW, Purisch S (2010). Ultrasonographic characteristics as a criterion for repeat cytology in benign thyroid nodules. Arq Bras Endocrinol Metabol, 54, 52-5. https://doi.org/10.1590/S0004-27302010000100009
- Rosario PW, Salles DS, Bessa B, et al (2010). Contribution of scintigraphy and ultrasonography to the prediction of malignancy in thyroid nodules with indeterminate cytology. Arq Bras Endocrinol Metabol, 54, 56-9. https://doi.org/10.1590/S0004-27302010000100010
- Ryu YJ, Jung YS, Yoon HC, et al (2014). Atypia of undetermined significance on thyroid fine needle aspiration: surgical outcome and risk factors for malignancy. Ann Surg Treat Res, 86, 109-14. https://doi.org/10.4174/astr.2014.86.3.109
- Yoon JH, Lee HS, Kim EK, et al (2014). A nomogram for predicting malignancy in thyroid nodules diagnosed as atypia of undetermined significance/follicular lesions of undetermined significance on fine needle aspiration. Surgery.
- Yu HM, Park KS, Lee JM (2014). The value of red blood cell distribution width in subclinical hypothyroidism. Arq Bras Endocrinol Metabol, 58, 30-6. https://doi.org/10.1590/0004-2730000002836
- Zorlu A, Bektasoglu G, Guven FM, et al (2012). Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol, 109, 128-34. https://doi.org/10.1016/j.amjcard.2011.08.015
- Diagnostic Utility of Molecular and Imaging Biomarkers in Cytological Indeterminate Thyroid Nodules vol.39, pp.2, 2018, https://doi.org/10.1210/er.2017-00133