Department of Pathology, Baptist Hospital of Miami, Miami, Florida 33176, USA.
Cancer Cytopathol. 2011 Oct 25;119(5):322-7. doi: 10.1002/cncy.20154. Epub 2011 Mar 25.
Atypical cells of undetermined significance (AUS) in thyroid fine-needle aspirates (FNAs) may have poor interobserver agreement. Some authors have suggested that "atrophic" microfollicles should be diagnosed as benign. This laboratory sought to determine whether criteria for this diagnosis could be improved by subcategorizing cases into specific patterns, including the atrophic pattern, and determining their risk of malignancy.
A series of 7089 FNAs were reviewed and correlated with subsequent resection specimens. Cases of AUS were reviewed and subclassified.
Cases could be subcategorized into the following categories: 1) atypical, papillary carcinoma cannot be ruled out, 2) atypical, Hürthle cell neoplasm can not be ruled out, 3) cellular atrophic pattern, 4) scant atrophic pattern, and 5) cytologic atypia alone. Cytologic atypia alone (50%) and both atrophic patterns (21% and 34%) had a significant risk of malignancy.
The majority of AUS cases in thyroid FNA can be subcategorized into 5 different patterns, all with associated significant risk of malignancy. "Atrophic" microfollicles are a significant risk factor for malignancy and should not be diagnosed as benign on the basis of lack of cytologic atypia.
甲状腺细针抽吸物（FNA）中的不典型意义不明细胞（AUS）可能存在观察者间的一致性较差的问题。一些作者建议将“萎缩性”微滤泡诊断为良性。本实验室旨在通过将病例分为特定模式（包括萎缩模式）并确定其恶性风险，来改善该诊断标准。
回顾了一系列 7089 例 FNA，并与随后的切除标本进行了相关性分析。回顾了 AUS 病例并进行了分类。
病例可分为以下几类：1）不典型，不能排除乳头状癌；2）不典型，Hürthle 细胞肿瘤不能排除；3）细胞萎缩模式；4）稀少萎缩模式；5）单纯细胞学异型性。单纯细胞学异型性（50%）和两种萎缩模式（21%和 34%）均具有显著的恶性风险。
甲状腺 FNA 中的大多数 AUS 病例可分为 5 种不同的模式，所有模式均与显著的恶性风险相关。“萎缩性”微滤泡是恶性肿瘤的一个重要危险因素，不应仅凭缺乏细胞学异型性就将其诊断为良性。
