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Am J Surg. 2014 Mar;207(3):331-6; discussion 335-6. doi: 10.1016/j.amjsurg.2013.09.022. Epub 2013 Dec 25.

Should atypia of undetermined significance be subclassified to better estimate risk of thyroid cancer?

Author information

1
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
2
Department of Pathology, Lake Health, Willoughby, OH, USA.
3
Department of Pathology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
4
Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA. Electronic address: cmchenry@metrohealth.org.

Abstract

BACKGROUND:

Atypia or follicular lesion of undetermined significance (AUS) is a cytologic category of thyroid aspirates with a wide range of reported malignancy. We aimed to determine whether specific cytologic features are associated with different rates of thyroid malignancy.

METHODS:

All thyroid fine needle aspiration biopsies with AUS from 2010 to 2012 were reanalyzed. Cytologic features were correlated with final pathology. Cytopathologists were blinded to the original cytologic interpretation and final diagnosis.

RESULTS:

Seventy-six patients had AUS; 39 (54%) underwent surgery with a malignancy rate of 18%. Specimens with moderate or large amount of thin colloid and absent or few nuclear inclusions had a >88% rate of benign disease. More than rare nuclear inclusions or grooves were associated with a higher rate of cancer (75% vs 9%, P = .005; 45% vs 7%, P = .003).

CONCLUSIONS:

Patients with AUS and more than rare nuclear inclusions or grooves are at higher risk for cancer and should forego repeat fine needle aspiration biopsy and undergo thyroidectomy.

KEYWORDS:

Atypia; Cytology; Thyroid cancer; Thyroid nodule

PMID:
24581759
DOI:
10.1016/j.amjsurg.2013.09.022
[Indexed for MEDLINE]
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