Oncopathology Research Center, Department of Molecular Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Pathology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Front Endocrinol (Lausanne). 2023 May 29;14:1135196. doi: 10.3389/fendo.2023.1135196. eCollection 2023.
Bethesda category III - atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is a heterogeneous class of the Bethesda system for thyroid nodules. In order to clarify the therapeutic road for clinicians, this category was subclassified based on the cytopathological features. In this study, we evaluated the risk of malignancy, surgical outcome, demographic characteristics, and correlation of ultrasound features with the final outcome in patients with thyroid nodules based on AUS/FLUS subclassification.
After evaluating 867 thyroid nodules from three different centers, 70 (8.07%) were initially diagnosed as AUS/FLUS. The cytopathologists re-interpreted the FNA samples and subclassified them into five subcategories: architectural atypia, cytologic atypia, cytologic and architectural atypia, and Hürthle cell AUS/FLUS, and atypia, which was not specified. Based on the suspicious ultrasound features, an appropriate ACR TI-RADS score was allocated to each nodule. Finally, the malignancy rate, surgical outcomes, and ACR TI-RADS scores were evaluated among Bethesda category III nodules.
Among the 70 evaluated nodules, 28 (40%) were subclassified as Hürthle cell AUS/FLUS, 22 (31.42%) as cytologic and architectural atypia, 8 (11.42%) as architectural atypia, 7 (10%) as cytologic atypia, and 5 (7.14%) as atypia which was not specified. The overall malignancy rate was 34.28%, and the architectural atypia and Hürthle cell nodules displayed lower malignancy compared to other groups (P-Value<0.05). Utilizing ACR TI-RADS scores showed no statistical significance between Bethesda III subcategorization and ACR TI-RADS scores. However, ACR TI-RADS can be a reliable predictor for Hürthle cell AUS/FLU nodules.
ACR TI-RADS helps evaluate malignancy only in the Hürthle cell AUS/FLUS subcategory of AUS/FLUS. Besides, cytopathological reporting based on the suggested AUS/FLUS subclassification could help clinicians take appropriate measures to manage thyroid nodules.
贝塞斯达分类系统第 III 类——不明确意义的滤泡性肿瘤/不典型滤泡性病变（AUS/FLUS）是甲状腺结节贝塞斯达系统的一个异质类别。为了明确临床医生的治疗路径，该类别根据细胞病理学特征进行了亚分类。在这项研究中，我们根据 AUS/FLUS 的亚分类评估了甲状腺结节患者的恶性风险、手术结果、人口统计学特征以及超声特征与最终结果的相关性。
在对来自三个不同中心的 867 个甲状腺结节进行评估后，最初有 70 个（8.07%）被诊断为 AUS/FLUS。细胞病理学家重新解读了 FNA 样本，并将其分为五类：结构异型性、细胞学异型性、细胞学和结构异型性、Hürthle 细胞 AUS/FLUS 和未特指的异型性。根据可疑的超声特征，为每个结节分配适当的 ACR TI-RADS 评分。最后，评估了贝塞斯达第 III 类结节中的恶性率、手术结果和 ACR TI-RADS 评分。
在评估的 70 个结节中，28 个（40%）被分类为 Hürthle 细胞 AUS/FLUS、22 个（31.42%）为细胞学和结构异型性、8 个（11.42%）为结构异型性、7 个（10%）为细胞学异型性，5 个（7.14%）为未特指的异型性。总的恶性率为 34.28%，结构异型性和 Hürthle 细胞结节的恶性率低于其他组（P 值<0.05）。使用 ACR TI-RADS 评分，贝塞斯达第 III 亚分类与 ACR TI-RADS 评分之间没有统计学意义。然而，ACR TI-RADS 可以作为 Hürthle 细胞 AUS/FLUS 结节恶性的可靠预测指标。
ACR TI-RADS 仅有助于评估 Hürthle 细胞 AUS/FLUS 亚类别的恶性程度。此外，基于建议的 AUS/FLUS 亚分类的细胞病理学报告可以帮助临床医生采取适当的措施来管理甲状腺结节。
