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Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology.
Cytopathology. 2013 Dec; 24(6):385-90.C

Abstract

OBJECTIVE

To report our experience of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) rate and outcome.

METHODS

Among 7658 patients with 19 569 nodules, 524 (2.7%) nodules were diagnosed as AUS/FLUS on fine needle aspiration (FNA). After exclusion of patients with simultaneous nodules that were suspicious for follicular neoplasm or malignancy or that were malignant, 368 (4.8%) patients were diagnosed as AUS/FLUS. The outcome of 146 patients who had undergone surgery or repeated fine needle aspirate at the time of preparation of this study was evaluated. The original FNAs were matched to repeated FNAs and thyroidectomy or diagnostic lobectomy specimens.

RESULTS

Seventy-two (19.6%) of the 368 patients had directly undergone surgery, either a lobectomy or a thyroidectomy: of these, 27 (37.5%) had neoplastic nodules (21 were malignant). Seventy-four (20.1%) of the 368 patients had repeat FNA. On second FNA, 47 of 74 (63.5%) were benign, three were suspicious for follicular neoplasm, one was malignant and 23 (31.1%) were non-diagnostic. Four patients had a third FNA: two were AUS/FLUS, one was malignant and one non-diagnostic. One patient had a fourth FNA, which was diagnosed as AUS/FLUS. Sixteen (21.6%) of 74 patients with repeat FNA had surgery: three of these had neoplastic nodules (two were malignant). Overall, 88 of the 368 (23.9%) patients had a thyroidectomy of which 30 (34.1%) were neoplastic and 23 (26.1%) malignant. The neoplastic rate for patients who were once diagnosed with AUS/FLUS was 8.2% and the malignancy rate 6.3%. The malignancy rate for patients on follow-up at the time we prepared the study was 15.7% (23/146); 222 remained on follow-up without surgery or repeat FNA or were managed elsewhere.

CONCLUSIONS

Although in this category repeat FNA is expected rather than excision, we suggest evaluation of all AUS/FLUS patients in multidisciplinary meetings to decide management and recommend follow-up of all patients with this diagnosis.

Authors+Show Affiliations

Departments of PathologyEndocrinology and Metabolism, Yildirim Beyazit University, Ankara Ataturk Research and Education Hospital, Ankara, Turkey.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

23078633

Citation

Dincer, N, et al. "Follow-up of Atypia and Follicular Lesions of Undetermined Significance in Thyroid Fine Needle Aspiration Cytology." Cytopathology : Official Journal of the British Society for Clinical Cytology, vol. 24, no. 6, 2013, pp. 385-90.
Dincer N, Balci S, Yazgan A, et al. Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology. Cytopathology. 2013;24(6):385-90.
Dincer, N., Balci, S., Yazgan, A., Guney, G., Ersoy, R., Cakir, B., & Guler, G. (2013). Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology. Cytopathology : Official Journal of the British Society for Clinical Cytology, 24(6), 385-90. https://doi.org/10.1111/cyt.12021
Dincer N, et al. Follow-up of Atypia and Follicular Lesions of Undetermined Significance in Thyroid Fine Needle Aspiration Cytology. Cytopathology. 2013;24(6):385-90. PubMed PMID: 23078633.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology. AU - Dincer,N, AU - Balci,S, AU - Yazgan,A, AU - Guney,G, AU - Ersoy,R, AU - Cakir,B, AU - Guler,G, Y1 - 2012/10/18/ PY - 2012/10/20/entrez PY - 2012/10/20/pubmed PY - 2014/8/5/medline KW - AUS/FLUS KW - Bethesda classification KW - fine needle aspiration cytology KW - follow-up KW - thyroid SP - 385 EP - 90 JF - Cytopathology : official journal of the British Society for Clinical Cytology JO - Cytopathology VL - 24 IS - 6 N2 - OBJECTIVE: To report our experience of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) rate and outcome. METHODS: Among 7658 patients with 19 569 nodules, 524 (2.7%) nodules were diagnosed as AUS/FLUS on fine needle aspiration (FNA). After exclusion of patients with simultaneous nodules that were suspicious for follicular neoplasm or malignancy or that were malignant, 368 (4.8%) patients were diagnosed as AUS/FLUS. The outcome of 146 patients who had undergone surgery or repeated fine needle aspirate at the time of preparation of this study was evaluated. The original FNAs were matched to repeated FNAs and thyroidectomy or diagnostic lobectomy specimens. RESULTS: Seventy-two (19.6%) of the 368 patients had directly undergone surgery, either a lobectomy or a thyroidectomy: of these, 27 (37.5%) had neoplastic nodules (21 were malignant). Seventy-four (20.1%) of the 368 patients had repeat FNA. On second FNA, 47 of 74 (63.5%) were benign, three were suspicious for follicular neoplasm, one was malignant and 23 (31.1%) were non-diagnostic. Four patients had a third FNA: two were AUS/FLUS, one was malignant and one non-diagnostic. One patient had a fourth FNA, which was diagnosed as AUS/FLUS. Sixteen (21.6%) of 74 patients with repeat FNA had surgery: three of these had neoplastic nodules (two were malignant). Overall, 88 of the 368 (23.9%) patients had a thyroidectomy of which 30 (34.1%) were neoplastic and 23 (26.1%) malignant. The neoplastic rate for patients who were once diagnosed with AUS/FLUS was 8.2% and the malignancy rate 6.3%. The malignancy rate for patients on follow-up at the time we prepared the study was 15.7% (23/146); 222 remained on follow-up without surgery or repeat FNA or were managed elsewhere. CONCLUSIONS: Although in this category repeat FNA is expected rather than excision, we suggest evaluation of all AUS/FLUS patients in multidisciplinary meetings to decide management and recommend follow-up of all patients with this diagnosis. SN - 1365-2303 UR - https://www.unboundmedicine.com/medline/citation/23078633/Follow_up_of_atypia_and_follicular_lesions_of_undetermined_significance_in_thyroid_fine_needle_aspiration_cytology_ L2 - https://doi.org/10.1111/cyt.12021 DB - PRIME DP - Unbound Medicine ER -