Gazi University Medical Faculty, Department of Pathology, Ankara, Turkey.
Cancer Cytopathol. 2014 Aug;122(8):604-10. doi: 10.1002/cncy.21434. Epub 2014 May 28.
The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) provides uniform diagnostic terminology for communication between pathologists and clinicians. Each diagnostic category is associated with a specific risk of malignancy and a recommendation for its management. The indeterminate diagnostic categories of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) present a major challenge for both pathologists and clinicians. We report our institution's 3 years' experience with the AUS/FLUS category and follow-up of these patients.
A retrospective analysis was conducted for all thyroid fine-needle aspirations (FNAs) between July 2010 and July 2013. During this period, 9242 nodules from 4916 patients were reported according to the BSRTC guidelines. We adopted the AUS terminology in our practice to refer to both AUS, and FLUS.
Of the 4916 patients, 347 (7%) were diagnosed as AUS. The malignancy risk for patients who underwent surgical resection after initial diagnosis of AUS was 22.8%, whereas that for patients who underwent a second FNA and surgical resection was 36%. When we included patients with second FNA and without surgery, the malignancy risk was 15.7%.
The malignancy risk for AUS reported in the present study is consistent with those reported previously and is higher than those anticipated according to the Bethesda System. This supports that a multimodal approach (clinical, radiologic, and cytopathologic) is necessary for the management of thyroid nodules diagnosed as AUS. Therefore, we suggest that the recommendation for repeat FNA following an initial diagnosis of AUS should be based on a multimodal approach for each particular patient.
甲状腺细胞病理学报告的 Bethesda 系统（BSRTC）为病理学家和临床医生之间的交流提供了统一的诊断术语。每个诊断类别都与特定的恶性肿瘤风险相关，并推荐了相应的管理建议。不典型意义不明确/滤泡性病变不明确（AUS/FLUS）的不确定诊断类别对病理学家和临床医生都是一个主要的挑战。我们报告了我们机构在 AUS/FLUS 类别和这些患者的随访方面的 3 年经验。
对 2010 年 7 月至 2013 年 7 月间所有甲状腺细针抽吸（FNA）进行回顾性分析。在此期间，根据 BSRTC 指南，报告了来自 4916 例患者的 9242 个结节。我们在实践中采用 AUS 术语来指代 AUS 和 FLUS。
在 4916 例患者中，有 347 例（7%）被诊断为 AUS。初始诊断为 AUS 后行手术切除的患者恶性肿瘤风险为 22.8%，而进行第二次 FNA 和手术切除的患者恶性肿瘤风险为 36%。当我们包括第二次 FNA 而无手术的患者时，恶性肿瘤风险为 15.7%。
本研究报道的 AUS 恶性肿瘤风险与以往报道的风险一致，高于根据 Bethesda 系统预期的风险。这支持了对诊断为 AUS 的甲状腺结节采用多模态方法（临床、影像学和细胞学）进行管理的必要性。因此，我们建议，在初始诊断为 AUS 后，应根据每位患者的具体情况，基于多模态方法来决定是否需要重复 FNA。
