Kaymaz Esin, Gun Banu Dogan, Tasdoven Ilhan, Kokturk Furuzan
Department of Pathology, Faculty of Medicine, Zonguldak Bulent Ecevit Universtiy, Kozlu, Zonguldak, Turkey.
Department of General Surgery, Faculty of Medicine, Zonguldak Bulent Ecevit Universtiy, Kozlu, Zonguldak, Turkey.
J Cytol. 2020 Oct-Dec;37(4):204-209. doi: 10.4103/JOC.JOC_5_20. Epub 2020 Nov 6.
It has been known that the "atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS)" category is the most problematic category in Bethesda system due to its highly heterogeneous morphological features. Recently, it has been reported that aspirates including nuclear atypia in the AUS/FLUS category have a higher risk of malignancy.
This study aimed to assess each nuclear property in aspirates with cytological atypia and also to determine the relationship with the risk of malignancy.
We reviewed 980 AUS/FLUS fine-needle aspirations (FNAs) performed between '2012 and 2019' at a single institution. We classified these aspirates into four groups: AUS-N (nuclear atypia), AUS-A (architectural atypia), AUS-H (Hurthle cell change), and AUS-O (other). Nuclear features were detailed sub-classified; size and shape (enlargement, elongation, and overlapping), membrane irregularities (irregular contours, grooves, pseudoinclusion), and chromatin characteristics (pale chromatin). The estimated risk of malignancy (ROM) was calculated for each subgroup.
Of 980 AUS/FLUS cases, follow-up histological outcome data were available for 209 cases. Among these cases, the estimated ROM was 27.8%. The ROM were 26.4%, 15.4%, and 22.5% for AUS-N, A, and H, respectively. The most common nuclear findings associated with ROM were nuclear groove (67.9%); irregular contours (76.9%) suspected pseudoinclusion (100%) and overlapping (56%) ( < 0,001). But nuclear findings such as nuclear enlargement, mild pleomorphism, or pale chromatin have a similar ROM as architectural atypia.
Although it is known that the presence of cytological atypia in an AUS/FLUS nodule increases the estimated risk of malignancy, all nuclear properties are not equally effective in predicting malignancy risk. Emphasizing nuclear atypia details in reports of AUS case may be a more sensitive way to identify nodules with a high risk of malignancy.
众所周知，“意义不明确的非典型性（AUS）/意义不明确的滤泡性病变（FLUS）”类别是贝塞斯达系统中最具问题的类别，因为其形态特征高度异质。最近，有报道称，AUS/FLUS类别中包括核非典型性的抽吸物具有更高的恶性风险。
本研究旨在评估具有细胞学非典型性的抽吸物中的每种核特性，并确定其与恶性风险的关系。
我们回顾了2012年至2019年在单一机构进行的980例AUS/FLUS细针穿刺抽吸活检（FNA）。我们将这些抽吸物分为四组：AUS-N（核非典型性）、AUS-A（结构非典型性）、AUS-H（许特尔细胞改变）和AUS-O（其他）。核特征被详细地进一步分类；大小和形状（增大、伸长和重叠）、膜不规则（轮廓不规则、沟、假包涵体）和染色质特征（淡染色质）。计算每个亚组的估计恶性风险（ROM）。
在980例AUS/FLUS病例中，有209例可获得随访组织学结果数据。在这些病例中，估计的ROM为27.8%。AUS-N、A和H组的ROM分别为26.4%、15.4%和22.5%。与ROM相关的最常见核表现为核沟（67.9%）；轮廓不规则（76.9%）、疑似假包涵体（100%）和重叠（56%）（P<0.001）。但核增大、轻度多形性或淡染色质等核表现与结构非典型性的ROM相似。
虽然已知AUS/FLUS结节中存在细胞学非典型性会增加估计的恶性风险，但并非所有核特性在预测恶性风险方面都同样有效。在AUS病例报告中强调核非典型性细节可能是识别具有高恶性风险结节的更敏感方法。
