Shrestha Rupendra T, Hennessey James V
Division of Endocrinology, Diabetes and Metabolism, University of Minnesota, Minneapolis, Minnesota.
Harvard Medical School, Boston, Massachusetts.
Diagn Cytopathol. 2016 Jun;44(6):492-8. doi: 10.1002/dc.23472. Epub 2016 Mar 30.
The atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) category in the Bethesda System of reporting thyroid fine-needle aspiration (FNA) includes various cytological findings considered to have a low risk of malignancy. It is still unclear if any particular subset of the cytological findings within this category carries a higher risk for malignancy requiring a more aggressive treatment plan.
We reviewed 221 AUS/FLUS FNAs performed between January of 2006 and May of 2012. Histopathological data from surgery was available in 101 nodules and characteristics of these nodules were analyzed. We reviewed the initial cytology report and subclassified the nodules into one of four groups: architectural atypia (AA, includes abnormal follicular arrangement but no cellular abnormalities), cellular atypia (CA, atypical cellular findings) with or without AA, Hurthle cells Predominant and Others that included otherwise unspecified AUS categories. The surgical pathology confirmed malignancy rate for each group was calculated.
Papillary thyroid carcinoma was the most common malignancy identified (26 of 29 or 90%). We found that in the AA only category, 2/21 (10%) nodules were malignant, whereas when CA with or without AA was present, 23/66 (35%) were malignant, significantly higher than the former group (P values of 0.025).
CA seen on initial AUS/FLUS had a higher malignancy rate compared to AA group. Further research is required to consider subclassification of this category to assign appropriate risk of malignancy for AUS nodules. Diagn. Cytopathol. 2016;44:492-498. © 2016 Wiley Periodicals, Inc.
甲状腺细针穿刺活检（FNA）报告的贝塞斯达系统中意义未明的非典型病变或意义未明的滤泡性病变（AUS/FLUS）类别包括各种被认为恶性风险较低的细胞学发现。目前尚不清楚该类别中任何特定的细胞学发现子集是否具有更高的恶性风险，需要更积极的治疗方案。
我们回顾了2006年1月至2012年5月期间进行的221例AUS/FLUS FNA。101个结节有手术的组织病理学数据，并对这些结节的特征进行了分析。我们回顾了最初的细胞学报告，并将结节分为四组之一：结构异型性（AA，包括异常滤泡排列但无细胞异常）、有或无AA的细胞异型性（CA，非典型细胞发现）、嗜酸性细胞为主型和其他类别（包括其他未明确指定的AUS类别）。计算每组手术病理确诊的恶性率。
甲状腺乳头状癌是最常见的确诊恶性肿瘤（29例中的26例，占90%）。我们发现，仅AA类别的结节中，2/21（10%）为恶性，而存在有或无AA的CA时，23/66（35%）为恶性，显著高于前一组（P值为0.025）。
与AA组相比，最初AUS/FLUS中出现的CA恶性率更高。需要进一步研究考虑对该类别进行亚分类，以确定AUS结节的适当恶性风险。诊断细胞病理学。2016；44：492 - 498。©2016威利期刊公司。
