Hong So-Hyeon, Lee Hyejin, Cho Min-Sun, Lee Jee Eun, Sung Yeon-Ah, Hong Young Sun
Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
Int J Endocrinol. 2018 Jul 30;2018:4521984. doi: 10.1155/2018/4521984. eCollection 2018.
Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in thyroid fine needle aspiration (FNA) is a challenging category. The malignancy risk is different by multiple factors and subsequent management strategy is inconclusive. Therefore, we analyzed the malignancy risk of AUS/FLUS according to radiological and clinical features. A total of 687 nodules that had been initially diagnosed as AUS/FLUS were retrospectively reviewed from 6365 thyroid FNAs between 2011 and 2014. The ultrasonographic (US) features were categorized using the Korean Thyroid Imaging Reporting and Data System. Radiological and clinical features were compared according to the second FNA results or histologically confirmed results from surgery. Repeat FNA was performed on 248 (36%) nodules, and 49 (7%) nodules underwent immediate surgery. Among the 248 nodules subjected to repeated FNA, 49 (20%) nodules were diagnosed again as AUS/FLUS, 123 (50%) were found to be benign, and 47 (19%) were diagnosed as follicular neoplasm, suspicious for malignancy or malignant. Among histologically confirmed nodules, the US features were more unfavorable in malignant nodules, and hypo- or anechogenicity was associated with a higher risk of malignancy after adjusting for age, size, and other US features ( < 0.01). In conclusion, we observed that malignant nodules tended to show unfavorable US features, especially hypo- or anechogenicity. Age, sex, and thyroid function were not significantly associated with malignancy risk. We also found out that malignancy risk was not different between the group which underwent immediate operation following the AUS/FLUS diagnosis and the group which underwent repeated FNA after the initial diagnosis.
甲状腺细针穿刺活检（FNA）中意义未明的非典型性/意义未明的滤泡性病变（AUS/FLUS）是一个具有挑战性的类别。其恶性风险受多种因素影响，后续的管理策略尚无定论。因此，我们根据放射学和临床特征分析了AUS/FLUS的恶性风险。回顾性分析了2011年至2014年间6365例甲状腺FNA中最初诊断为AUS/FLUS的687个结节。超声（US）特征采用韩国甲状腺影像报告和数据系统进行分类。根据第二次FNA结果或手术组织学确诊结果比较放射学和临床特征。对248个（36%）结节进行了重复FNA，49个（7%）结节接受了即刻手术。在接受重复FNA的248个结节中，49个（20%）结节再次被诊断为AUS/FLUS，123个（50%）为良性，47个（19%）被诊断为滤泡性肿瘤，怀疑为恶性或恶性。在组织学确诊的结节中，恶性结节的US特征更不理想，在调整年龄、大小和其他US特征后，低回声或无回声与更高的恶性风险相关（<0.01）。总之，我们观察到恶性结节倾向于表现出不理想的US特征，尤其是低回声或无回声。年龄、性别和甲状腺功能与恶性风险无显著相关性。我们还发现，AUS/FLUS诊断后即刻手术组与初始诊断后接受重复FNA组之间的恶性风险无差异。
