Rosario Pedro Weslley
Santa Casa de Belo Horizonte , Minas Gerais, Brazil .
Thyroid. 2014 Jul;24(7):1115-20. doi: 10.1089/thy.2013.0650. Epub 2014 May 9.
One possible result of fine-needle aspiration (FNA) in patients with thyroid nodules is "follicular lesion of undetermined significance" (FLUS) or "atypia of undetermined significance" (AUS). The risk of malignancy is relevant information to define appropriate management, and knowledge of predictors of malignancy in these nodules is therefore important. The objective of this prospective study was to evaluate clinical, laboratory, ultrasonographic, and cytological predictors of malignancy in patients with thyroid nodules and FLUS/AUS cytology.
The sample consisted of 150 patients with thyroid nodules and an indication for FNA whose cytology was classified as FLUS/AUS according to the Bethesda classification criteria.
In the second FNA, cytology was nondiagnostic in 2 (1.3%) nodules and benign in 54 (36%), FLUS/AUS cytology persisted in 73 (48.6%), and cytology was suspicious for follicular neoplasm in 11 (7.3%) and for malignancy in 10 (6.6%). The rate of malignancy was 22.6%. Clinical and laboratory data or nodule size were not predictors of malignancy. The rate of malignancy was lower in nodules initially classified as FLUS (10.8% versus 41.3% with AUS). Ultrasonography (US) was also useful for predicting malignancy, with sensitivity, specificity, and positive and negative predictive values of 79.4%, 90.5%, 71%, and 93.75%, respectively. Different malignancy rates were obtained when the two parameters, cytological subcategory and US, were combined: (i) 3.9% for nodules nonsuspicious on US and FLUS, (ii) 11.4% for nonsuspicious nodules with AUS, (iii) 46.6% for suspicious nodules with FLUS, and (iv) 87% for suspicious nodules with AUS.
The combination of cytological subcategory (FLUS or AUS) and US provides different risks of malignancy for nodules initially classified as Bethesda category III.
甲状腺结节患者细针穿刺（FNA）的一个可能结果是“意义未明的滤泡性病变”（FLUS）或“意义未明的非典型性”（AUS）。恶性风险是确定适当治疗方案的相关信息，因此了解这些结节的恶性预测因素很重要。这项前瞻性研究的目的是评估甲状腺结节且细胞学检查为FLUS/AUS的患者的临床、实验室、超声和细胞学恶性预测因素。
样本包括150例有甲状腺结节且有FNA指征的患者，其细胞学检查根据贝塞斯达分类标准被分类为FLUS/AUS。
在第二次FNA中，2个结节（1.3%）细胞学检查无诊断意义，54个结节（36%）为良性，73个结节（48.6%）仍为FLUS/AUS细胞学表现，11个结节（7.3%）细胞学检查怀疑为滤泡性肿瘤，10个结节（6.6%）怀疑为恶性。恶性率为22.6%。临床和实验室数据或结节大小不是恶性的预测因素。最初分类为FLUS的结节恶性率较低（10.8%，而AUS为41.3%）。超声检查（US）对预测恶性也有帮助，其敏感性、特异性、阳性和阴性预测值分别为79.4%、90.5%、71%和93.75%。当细胞学亚类和US这两个参数结合时，获得了不同的恶性率：（i）US检查无异常且为FLUS的结节为3.9%，（ii）无异常结节且为AUS的为11.4%，（iii）US检查可疑且为FLUS的结节为46.6%，（iv）US检查可疑且为AUS的结节为87%。
细胞学亚类（FLUS或AUS）和US的结合为最初分类为贝塞斯达III类的结节提供了不同的恶性风险。
