Atypia of undetermined significance in thyroid cytology: Nuclear atypia and architectural atypia are associated with different molecular alterations and risks of malignancy

2021 ◽  
Author(s):  
Ryan E. Glass ◽  
Joshua J. Levy ◽  
Samaneh A. Motanagh ◽  
Louis J. Vaickus ◽  
Xiaoying Liu
Keyword(s):  
Nuclear Atypia ◽  
Thyroid Cytology ◽  
Molecular Alterations ◽  
Undetermined Significance

scholarly journals Thyroid and Molecular Testing. Advances in Thyroid Molecular Cytopathology

2021 ◽  
Vol 2 (2) ◽  
pp. 77-92
Author(s):  
Esther Diana Rossi ◽  
Philippe Vielh
Keyword(s):  
Thyroid Nodules ◽  
Adult Population ◽  
Needle Aspiration ◽  
Common Finding ◽  
Molecular Testing ◽  
Additional Tool ◽  
Thyroid Cytology ◽  
Hürthle Cell ◽  
Cell Neoplasm ◽  
Undetermined Significance

Thyroid nodules are a common finding in the adult population including the fact that more than 50% of individuals, over the age of 60, have thyroid nodules. The majority have been mostly detected with ultrasonography and 10% by palpation. The majority of these nodules are benign, whereas 5–15% of them are malignant. The pre-operative diagnosis of cancer is a critical challenge in order to ensure that each patient can be treated with the best tailored management with a reduction of unnecessary surgery for benign lesions. Fine needle aspiration cytology (FNAC) represents the first and most important diagnostic tool for the evaluation of thyroid lesions. According to the literature, FNAC is able to render a conclusive diagnosis in up to 70–80% of all cases. For the remaining 20–30% of nodules, cytological diagnoses fall into the category of indeterminate lesions mostly due to the lack of specific morphological features. According to the Bethesda system for reporting thyroid cytopathology (TBSRTC), indeterminate lesions can be sub-stratified into three different subcategories including “atypia of undetermined significance/follicular lesion of undetermined significance-AUS/FLUS”; “follicular or Hürthle cell neoplasm/suspicious for follicular or Hürthle cell neoplasm-FN/SFN”; and “suspicious for malignancy-SFM”. Many of these indeterminate lesions undergo repetition or diagnostic lobectomy. Nonetheless, the majority of these cases will have a benign diagnosis due to the fact that the rate of cancer ranges between 6 and 30%. It stands to reason that the application of ancillary technique, mostly molecular testing, emerged as a critical additional tool for those thyroid indeterminate lesions. Since the early 1990s, material collected from cytological samples yields sufficient and adequate cells for the detection of point mutation or gene fusions. Nonetheless, the further availability of new sequencing technologies such as next-generation sequencing (NGS) has led to more comprehensive molecular applications adopted now in clinical use. The current review investigates the multiple advances in the field of molecular testing applied in thyroid cytology.

Both Ultrasound Features and Nuclear Atypia are Associated with Malignancy in Thyroid Nodules with Atypia of Undetermined Significance

2018 ◽  
Vol 25 (13) ◽  
pp. 3913-3918 ◽  
Author(s):  
Naseem Eisa ◽  
Ahsan Khan ◽  
Mutaal Akhter ◽  
Molly Fensterwald ◽  
Saba Saleem ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Nuclear Atypia ◽  
Undetermined Significance ◽  
Ultrasound Features

Cytomorphologic, Imaging, Molecular Findings, and Outcome in Thyroid Follicular Lesion of Undetermined Significance/Atypical Cell of Undetermined Significance (AUS/FLUS): A Mini-Review

2018 ◽  
Vol 63 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Bita Geramizadeh ◽  
Somayeh Bos-hagh ◽  
Zahra Maleki
Keyword(s):  
Needle Aspiration ◽  
American Thyroid Association ◽  
Atypical Cell ◽  
Thyroid Cytology ◽  
Bethesda System ◽  
Needle Aspiration Cytology ◽  
The Bethesda System ◽  
Ancillary Studies ◽  
Undetermined Significance

Objectives: Since the introduction of the entity of “Atypical cell of undetermined significance /follicular lesion of undetermined significance” (AUS/FLUS) by The Bethesda System for Reporting Thyroid Cytology (TBSRTC) in 2007, there have been many published studies about the cytomorphologic criteria, subclassification, outcome, and management of patients with the diagnosis of AUS/FLUS. There have been many studies in different aspects of this indeterminate category, i.e., cytologic and molecular findings, ultrasonographic findings, and in some instances even core-needle biopsy to address a better and safer way of the management of patients with this fine-needle aspiration cytology diagnosis. The second edition of TBSRTC and the 2015 American Thyroid Association guidelines provide an update on the follow-up and management of AUS/FLUS. A multidisciplinary team consisting of pathologists, endocrinologists, surgeons, and radiologists should be involved in the diagnosis and management of AUS/FLUS, and all of them should be aware of the heterogeneity of this lesion for the prediction of the treatment and outcome. Study Design: In this review, we consider different research platforms (2008–2017) to find the best and key reports for the above-mentioned challenging aspects of AUS/FLUS. Conclusion: AUS/FLUS is now a well-defined group of thyroid lesions, which can be most accurately diagnosed and managed with cytomorphology, molecular, and ancillary studies.

Malignancy risk and reproducibility associated with atypia of undetermined significance on thyroid cytology

Surgery ◽  
2014 ◽  
Vol 156 (6) ◽  
pp. 1471-1476 ◽  
Author(s):  
Aarti Mathur ◽  
Alireza Najafian ◽  
Eric B. Schneider ◽  
Martha A. Zeiger ◽  
Matthew T. Olson
Keyword(s):  
Malignancy Risk ◽  
Thyroid Cytology ◽  
Undetermined Significance

The Role of Cell Blocks and Immunohistochemistry in Thyroid Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance Bethesda Category

2021 ◽  
pp. 1-7
Author(s):  
Mikk Abram ◽  
Roope Huhtamella ◽  
David Kalfert ◽  
Heli Hakso-Mäkinen ◽  
Marie Ludvíková ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Workup ◽  
Cytokeratin 19 ◽  
Thyroid Cytology ◽  
Immunohistochemical Markers ◽  
Galectin 3 ◽  
Nodular Lesions ◽  
Undetermined Significance

<b><i>Introduction:</i></b> Thyroid cytology is a widely accepted tool in the clinical triaging of nodular lesions. Cell blocks (CBs) can help in the diagnosis of atypical lesions, namely, thyroid Bethesda category of Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS). <b><i>Methods:</i></b> In a series of 224 AUS/FLUS thyroid samples with CB, we studied CB cellularity and feasibility of 3 immunohistochemical markers (cytokeratin 19 [CK19], HBME-1, and galectin-3) apart and in combination. <b><i>Results:</i></b> The CBs were non-diagnostic in 34 cases. Twenty-four CBs contained &#x3c;10 cells, 45 CBs 10–50 cells, and 121 CBs &#x3e;50 cells. Notably, more cellularity was found in CBs performed by plasma-thrombin and in-house techniques (<i>p</i> &#x3c; 0.001). The diagnostic accuracy to detect malignancy was 65.1% for CK19, 72.1% for HBME-1, and 70.3% for galectin-3. <b><i>Conclusion:</i></b> In conclusion, CB cellularity is essential for successful immunohistochemistry application and further diagnostic workup of AUS/FLUS cases.

scholarly journals Evaluation of the positive predictive value of atypical thyroid cytology cases according to the Bethesda system taking histopathology as gold standard.

2019 ◽  
Vol 26 (11) ◽  
pp. 2015-2020
Author(s):  
Shireen Hamid ◽  
Aman ur Rehman ◽  
Muhammad Kashif Baig ◽  
Uzma Aslam ◽  
Nausheen Heena ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Thyroid Nodules ◽  
False Negative ◽  
Thyroid Function Tests ◽  
Thyroid Cytology ◽  
Bethesda System ◽  
The Bethesda System ◽  
Undetermined Significance

Objectives: For the past 20 years Fine Needle Aspiration Cytology (FNAC) has evolved as the most sensitive diagnostic tool for the initial screening of patients with thyroid nodules. Unfortunately FNAC is complicated by a recognized false negative rate of approximately 5%. The clinicians could face the difficulty in the management of patient when a cytological diagnosis is atypical only. The objective of study is to evaluate the positive predictive value (PPV) of atypical thyroid cytology cases according to the Bethesda system taking histopathology as gold standard. Study Design: Cross sectional study. Setting: Department of Pathology at Shaikh Zayed Hospital, Lahore. Period: Six months i.e. from 25.11.2014 to 25.5.2015. Materials and Methods: Patients presenting with solitary thyroid nodules in the outpatient department and fulfilling the inclusion criteria were included after evaluation by thyroid function tests and thyroid scan, FNAC was performed and reported according to Bethesda system of thyroid reporting. Later on, cases underwent lobectomy, total or hemi-thyroidectomy, the tissue was received in 10% formalin solution in our pathology department and then processed, stained and examined. FNAC results of atypical cases were then compared with the definitive histological diagnosis which were considered the gold standard. The slides were examined and any differences were sought by consensus of two pathologists. Eighty cases were observed with 95% confidence level, 11% margin of error, using non-probability purposive sampling technique for sample collection. Data was analyzed by SPSS version 15 (P value <0.05). Results: The mean age of patients was 38 years with SD ± 2.16. There were 22 (28%) males and 58 (72%) females in our study. In this study, positive predictive value for Atypia of undetermined significance/ Follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm (FN), suspicious for malignancy and positive for malignancy were 33.3%, 25%, 66.6% and 100% respectively. Overall PPV of atypical cytology was 35.71%. Overall accuracy of FNAC was 86.30%, 87.50% sensitivity and 86.15% specificity, PPV value 43.75% and negative predictive value was 98.25%. Conclusion: Results showed that Bethesda system of reporting is helpful for the management of patients who falls in to undetermined categories as it categorically divide atypical cytology cases in to three definite categories  AUS, FN and suspicious for malignancy and these categories have different risks of malignancy. Thus can help to determine a better patient outcome due to proper clinical management of thyroid swellings.

Thyroid Fine-Needle Aspiration Reporting Rates and Outcomes Before and After Bethesda Implementation Within a Combined Academic and Community Hospital System

2013 ◽  
Vol 137 (11) ◽  
pp. 1664-1668 ◽  
Author(s):  
Aaron M. Harvey ◽  
Dina R. Mody ◽  
Mojgan Amrikachi
Keyword(s):  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Hospital System ◽  
Fine Needle ◽  
Thyroid Cytology ◽  
Before And After ◽  
Thyroid Fine Needle Aspiration ◽  
Reporting Rates ◽  
Undetermined Significance

Context.—The current study compares data from our hospital system before and after the 2008 implementation of the Bethesda System for Reporting Thyroid Cytology (BSRTC). Objective.—To show the effects the BSRTC has had on the reporting rates and outcomes for thyroid lesions. Design.—A search for thyroid fine-needle aspiration biopsies (FNABs) was performed for 2002–2005 (before BSRTC) and 2009–2011 (after BSRTC). Diagnostic outcomes were reviewed for cases with available follow-up. Results.—For 2002–2005, cytology reports for 3302 thyroid FNABs were reviewed, and 309 (9.4%) were classified as suspicious. For 2009–2011, cytology reports for 3432 thyroid FNABs were reviewed; 72 (2.1%) were classified as “atypia of undetermined significance or follicular lesion of undetermined significance” (AUS/FLUS), and 142 (4.1%) were classified as suspicious. Follow-up material was available for 31 AUS/FLUS cases (43.0%), and 6 of these cases (19%) were malignant. Follow-up material was available for 60 cases (42.3%) classified as suspicious, and 23 of these cases (38%) were malignant. Conclusions.—The AUS/FLUS rate of 2.1% at our institution is at the lower range of the &lt;7% recommended by the BSRTC, and our rate of 19% for risk of malignancy for AUS/FLUS is slightly above the BSRTC recommendation of 5% to 15%. Implementation of the BSRTC did not significantly affect our institution's reporting rates, most likely because an essentially similar classification system was employed before implementation of the BSRTC.

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