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.

scholarly journals Malignancy Rate in Thyroid Nodules with Atypia or Follicular Lesion of Undetermined Significance

2020 ◽  
Vol 24 (02) ◽  
pp. e221-e226
Author(s):  
Hamdan Ahmed Pasha ◽  
Rahim Dhanani ◽  
Ainulakbar Mughal ◽  
Kaleem S. Ahmed ◽  
Anwar Suhail
Keyword(s):  
Thyroid Nodules ◽  
Follicular Carcinoma ◽  
Needle Aspiration ◽  
Diagnostic Categories ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Needle Aspiration Cytology ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
Undetermined Significance

Abstract Introduction Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) is one of the six diagnostic categories of the Bethesda System for Reporting Thyroid Cytopathology. The prevalence of malignancy among Bethesda category III cytology is variable, ranging from 5% to 37% in the literature. Objective To determine the rate of malignancy in thyroid nodules reported as Bethesda category III. Methods A total of 495 patients underwent surgical intervention for thyroid nodules from January 2015 to December 2017. The present study included 81 cases reported as Bethesda category III, and their medical records were reviewed. Results Out of 495 fine-needle aspiration cytology samples, 81 (16.4%) samples were labeled as AUS/FLUS. Among these 81 patients, the mean age was 43.0 years (± 13.9), with only 11 (14%) patients older than 55 years of age. Most of our patients were female (n = 69; 85.2%), and the rest were male. The rate of malignancy based on the final histology was of 33.3% (n = 27). The majority were 17 cases (21%) of papillary carcinoma, followed by follicular carcinoma (n = 6) (7.4%). Conclusion The risk of malignancy can be higher than it is commonly believed, and guidelines should be based on the data from the institutions themselves for a better assessment of the outcomes.

scholarly journals The Bethesda system for reporting of thyroid cytopathology and its category wise management

2019 ◽  
Vol 8 (10) ◽  
pp. 2228
Author(s):  
Varun Gupta ◽  
Pooja Singh
Keyword(s):  
Thyroid Nodules ◽  
Reporting System ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Thyroid Cytology ◽  
Bethesda System ◽  
Needle Aspiration Cytology ◽  
Thyroid Cytopathology ◽  
The Bethesda System

Background: Fine-needle aspiration cytology (FNAC) of thyroid is a rapid diagnostic test for thyroid nodules. The Bethesda system classifies thyroid FNAC into six categories. Each category is linked to a malignancy risk and has recommended clinical management. The aim of this study was to analyze the thyroid cytology smears by Bethesda system and to assess the frequency of various categories and to correlate it previous published studies. Category wise management is also discussed in detail.Methods: A total of 388 thyroid FNAC samples were examined from January 2017 to June 2018 in the Department of Pathology, in Medanta- The Medicity Gurugram.Results: A total of 388 cases were reported according to Bethesda system of reporting. Categories were as follows: I (14.69%), II (61.85%), III (11.34%), IV (2.57%), V (2.660%), VI (4.91%) nodules.Conclusions: The Bethesda System for reporting thyroid cytopathology proved to be an excellent reporting system and it puts clinician and the cytopathologist on the same page and easier to communicate regarding diagnosis.

scholarly journals A Comparative Study of the Bethesda System of Reporting of Fine Needle Aspiration Cytology Thyroid with Histopathology

2020 ◽  
Vol 7 (52) ◽  
pp. 3171-3175
Author(s):  
Kirthi Nath K.V ◽  
Geetha Sukumaran
Keyword(s):  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Thyroid Cytology ◽  
Thyroid Fine Needle Aspiration ◽  
Bethesda System ◽  
Needle Aspiration Cytology ◽  
The Bethesda System

BACKGROUND The Bethesda system of reporting thyroid cytopathology is an outstanding and systematic approach of reporting thyroid cytology samples, thereby reducing the communication gap between cytopathologist and clinician, leading to a better patient care approach. We aim to study the thyroid fine needle aspiration (FNA) using the Bethesda system and evaluate its accuracy taking histopathology as gold standard. METHODS This was a descriptive study including 200 consecutive cases which came to our cytology department between January 2014 and December 2014. All thyroid fine needle aspiration cytology (FNAC) were categorised as per the Bethesda system and followed up with corresponding histopathology. RESULTS Out of the 200 cases, adequacy criteria was met in 196 (98 %) cases. 176 (88 %) cases fell in the benign category, 4 (2 %) cases were inadequate samples, 8 (4 %) showed features of follicular neoplasm / suspicious of follicular neoplasm and 12 (6 %) were malignant lesions. Histopathology follow up was available for all cases. Statistical analysis showed a specificity of 100 % (high), sensitivity of 40 % (low). Positive predictive value was 100 %, negative predictive value was 90.4 %. Accuracy rate was 91 %. CONCLUSIONS Interpreting the thyroid FNAC results using Bethesda system allowed a superior interlaboratory agreement leading to improved clinical management. KEYWORDS Thyroid, Cytology, Bethesda

The Bethesda System for Reporting Thyroid Fine-Needle Aspiration Cytology: A Kuwaiti Experience - A Cytohistopathological Study of 374 Cases

2015 ◽  
Vol 59 (2) ◽  
pp. 133-138 ◽  
Author(s):  
Kusum Kapila ◽  
Laila Qadan ◽  
Rola H. Ali ◽  
Mohammed Jaragh ◽  
Sara S. George ◽  
...  
Keyword(s):  
Predictive Value ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Thyroid Fine Needle Aspiration ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Needle Aspiration Cytology ◽  
Sensitivity Specificity ◽  
The Bethesda System ◽  
Undetermined Significance

Introduction: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) identifies 6 diagnostic categories in which the risk of malignancy increases respectively. The aim of our study was to assess TBSRTC reporting in our hospital and to evaluate its specificity based on cytohistological correlation. Methods: A histological diagnosis was available in 374 (110 males and 264 females) out of 7,809 thyroid aspirates examined at Mubarak Al-Kabeer Hospital, Kuwait, from 2004 to 2012. The aspirates were classified in accordance with TBSRTC. Results: Thyroid aspirates were classified as nondiagnostic (n = 18; 4.8%), benign (n = 114; 30.5%); atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; n = 59; 15.8%), follicular neoplasm/suspicious for follicular neoplasm (FN/SFN; n = 17; 4.5%), suspicious for malignancy (SM; n = 80; 21.4%), or malignant (n = 86; 23.0%). In 75 of 86 malignant cases, a papillary carcinoma was detected. There were 3 (1.6%) false-positive aspirates and the sensitivity, specificity, negative predictive value, and positive predictive value were 91.0, 61.9, 84.2, and 75.3%, respectively. Conclusions: Our results are fairly comparable to those of various previous studies in the SM, AUS/FLUS, and SFN categories. The higher rates observed in the nondiagnostic and benign categories were possibly due to limited guided aspirations and a lack of on-site evaluation for all cases.

scholarly journals Classification of thyroid fine-needle aspiration cytology into Bethesda categories: An institutional experience and review of the literature

CytoJournal ◽  
2018 ◽  
Vol 15 ◽  
pp. 4 ◽  
Author(s):  
Safa Alshaikh ◽  
Zainab Harb ◽  
Eman Aljufairi ◽  
S. Ali Almahari
Keyword(s):  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Thyroid Cytology ◽  
Bethesda System ◽  
Needle Aspiration Cytology ◽  
The Bethesda System

Background: Fine-needle aspiration cytology (FNAC) of thyroid is the initial screening test for thyroid nodules. The Bethesda system classifies thyroid FNAC into six categories. Each category is linked to a malignancy risk and has a recommended clinical management. The aim of this study is to analyze the thyroid cytology smears by Bethesda system and to correlate the diagnosis of cytopathology with histopathology, whenever surgery was done. Materials and Methods: This study presents our experience with the Bethesda system in 681 thyroid FNAs from 632 patients in the period between January 2013 and December 2016. Results: Categories were as follows: 10.1% were Category I (nondiagnostic), 68.8% Category II (benign), 12.4% were Category III (atypia of undetermined significance), 2.9% were Category IV (suspicious for follicular neoplasm), 2.6% were Category V (suspicious for malignancy), and 4.1% were Category VI (malignant). Surgery was done on 126 nodules from 119 patients with an overall rate of malignancy of 27.8% (35/126 nodules). Conclusion: The Bethesda System for Reporting Thyroid Cytopathology proved to be an excellent reporting system.

Significance of Subcategory Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance Showing Both Cytologic and Architectural Atypia in Thyroid Aspiration Cytology

2015 ◽  
Vol 59 (5) ◽  
pp. 370-376 ◽  
Author(s):  
Yoon Yang Jung ◽  
Sejin Jung ◽  
Hyun-Woo Lee ◽  
Young Lyun Oh
Keyword(s):  
Medical Center ◽  
Needle Aspiration ◽  
Follicular Variant ◽  
Aspiration Cytology ◽  
Significant Difference ◽  
Bethesda System ◽  
Needle Aspiration Cytology ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
Undetermined Significance

Objective: The Bethesda System for Reporting Thyroid Cytopathology is now widely used as the standard reporting system for fine-needle aspiration cytology (FNAC). Recently, several studies have attempted to subcategorize the atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) category. We aimed to analyze the significance of a subcategory of AUS/FLUS showing both cytologic and architectural atypia (AUS/FLUS-C&A). Study Design: From April 2011 to May 2014, 18,091 patients underwent FNAC at Samsung Medical Center. For those patients we analyzed the clinical significance of the subcategory AUS/FLUS-C&A. Results: One hundred and sixty-three patients were diagnosed as AUS/FLUS-C&A. Of 71 cases with subsequent histologic confirmation, 47 (66.2%) were diagnosed with papillary thyroid carcinoma (PTC). Of the 47 PTC cases, 32 (68.1%) were follicular variant-PTC. A significant difference in the PTC rate (58.3 vs. 82.6%) and PTC size (average: 1.8 and 0.9 cm) was noted between circumscribed lesions and infiltrative lesions on ultrasonography. Conclusion: We demonstrated that the subcategory of AUS/FLUS-C&A has considerable clinical implications and one should be aware of the cytological and ultrasonographic features.

Atypia of Undetermined Significance in Thyroid Fine-Needle Aspirations: Follow-Up and Outcome Experience in Newfoundland, Canada

2018 ◽  
Vol 62 (2) ◽  
pp. 85-92 ◽  
Author(s):  
Polycarp Erivwo ◽  
Chandrani Ghosh
Keyword(s):  
Needle Aspiration ◽  
Molecular Testing ◽  
Eastern Health ◽  
Histologic Diagnosis ◽  
Fine Needle ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
Undetermined Significance

Introduction: The rates of atypia of undetermined significance (AUS) by fine-needle aspiration (FNA) and malignant outcomes have been estimated at < 7% and 5–15%, respectively. Initial AUS diagnosis is followed up clinically with serial ultrasounds, repeat FNA, molecular testing, or direct surgery. We investigated the incidence, follow-up modalities, and final outcomes of AUS in Newfoundland. Methods: All cases of AUS diagnosed at the Eastern Health Cytology Laboratory between 1 January 2010 and 31 December 2013 were identified. Electronic medical records were examined for follow-up modalities and final histologic diagnosis. The final outcomes were reported as benign, malignant, or undetermined. Results: Out of 3,285 thyroid FNAs, 181 (5.5%) were AUS. Fifty-seven (31.5%) had repeat FNA diagnosed as benign (38.6%), AUS (29.8%), or suspicious/malignant (8.8%). Eighty-four (46.4%) had surgery after the first AUS diagnosis, 39 (46.4%) of which were malignant. Twenty-four patients (13.3%) were followed up by serial ultrasound only, 2 (1.1%) by molecular testing, and 1 (0.6%) died of unrelated disease. Thirteen (7.2%) had no follow-up record. Our malignancy rate (MR) was 29.8%. Conclusion: The MR in our population was higher than the rate proposed by The Bethesda System for Reporting Thyroid Cytopathology. Repeat FNA can reduce the rate of unnecessary surgeries, but practice guidelines should consider individual and institutional circumstances. The ratio MR:ADR (AUS diagnostic rate) may be a better indicator of performance.

scholarly journals Reporting of thyroid fine needle aspiration cytology with the use of the Bethesda System (TBS) of 150 cases

2018 ◽  
Vol 6 (11) ◽  
pp. 3586
Author(s):  
Mandakini M. Patel ◽  
Mubim I. Patel ◽  
Bhavna G. Gamit ◽  
Sharmistha M. Patel
Keyword(s):  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Bethesda System ◽  
Thyroid Swelling ◽  
Needle Aspiration Cytology ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
Undetermined Significance

Background: Fine needle aspiration cytology (FNAC) is very simple, rapid, cost effective diagnostic test to evaluate thyroid swelling. The Bethesda system for reporting thyroid cytopathology gives guidelines which remains the same while reporting the thyroid FNAC. There are six diagnostic categories of lesions: (I) Non-diagnostic/Unsatisfactory, (II) Benign, (III) Atypical follicular lesion of undetermined significance (AFLUS), (IV) Suspicious for follicular neoplasm (SFN), (V) Suspicious for malignancy (SM), (VI) Malignant.Methods: The study was carried out in Department of Pathology, Government Medical College affiliated with a Government hospital, Gujarat. It includes 150 patients, coming to the outpatient departments with a complaint of thyroid swelling from January 2017 to December 2017. The patients age ranges from 7 years to 75 years (Male-20, Female-130). The procedure was done with the patient in a supine position without a pillow. Patients were instructed not to speak or swallow during the procedure to avoid movement of the gland. The reporting was done with the current Bethesda nomenclature.Results: There were 150 cases of thyroid FNAC, 3 cases (2 %) were non-diagnostic (TBS-I), 133 cases (88.7 %) were benign (TBS-II), 6 cases (4 %) were atypical follicular lesion of undetermined significance (AFLUS) (TBS-III), 5 cases (3.4 %) were suspicious for follicular neoplasm (TBS-IV), 2 cases (1.3 %) were suspicious for malignancy (TBS-V), and 1 case (0.6 %) was malignancy (TBS-VI).Conclusions: The Bethesda system is very useful standardized system for reporting thyroid cytopathology, improving communication between cyto-pathologists and clinicians, inter-laboratory agreement, leading to more consistent management approaches. 

scholarly journals The Bethesda System for Reporting Thyroid Cytopathology: A Cytohistological Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Bakiarathana Anand ◽  
Anita Ramdas ◽  
Marie Moses Ambroise ◽  
Nirmal P. Kumar
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Follicular Neoplasm ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Sensitivity Specificity ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
Undetermined Significance

Introduction. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a significant step to standardize the reporting of thyroid fine needle aspiration (FNA). It has high predictive value, reproducibility, and improved clinical significance. Aim. The study was aimed to evaluate the diagnostic utility and reproducibility of “TBSRTC” at our institute. Methods and Material. The study included 646 thyroid FNAs which were reviewed by three pathologists and classified according to TBSRTC. Cytohistological correlation was done for 100 cases with surgical follow-up and the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and risk of malignancy (ROM) were calculated. The interobserver variation among three pathologists was also assessed. Results. The distribution of cases in various TBSRTC categories is as follows: I—nondiagnostic 13.8%, II—benign 75.9%, III—atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) 1.2%, IV—follicular neoplasm (FN)/suspicious for follicular neoplasm (SFN) 3.7%, V—suspicious for malignancy (SM) 2.6%, and VI—malignant 2.8%. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy are 72.4%, 94.3%, 84%, 89.2%, and 87.9%, respectively. The ROM of various TBSRTC categories were II—8.5%; III—66.7%; IV—63.6%; and V and VI—100%. Cohen’s Weighted Kappa score was 0.99 which indicates almost perfect agreement among the three pathologists. Conclusions. Our study substantiates greater reproducibility among pathologists using TBSRTC to arrive at a precise diagnosis with an added advantage of predicting the risk of malignancy which enables the clinician to plan for follow-up or surgery and also the extent of surgery.

scholarly journals The spectrum of thyroid lesions on fine needle aspiration cytology

2020 ◽  
Vol 8 (2) ◽  
pp. 630
Author(s):  
Yashika P. Jaiswal ◽  
Sanjay Chawhan
Keyword(s):  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Bethesda System ◽  
Needle Aspiration Cytology ◽  
The Bethesda System ◽  
Thyroid Lesions

Background: Fine Needle Aspiration Cytology (FNAC) of thyroid gland is the most common preoperative investigation for diagnosis of thyroid lesions. Though various tests like thyroid profile, ultrasonography and radionuclide scan are available, they are used as adjuvant diagnostic modalities. FNAC is simple, easy to perform, non-invasive and cost-effective procedure. Primary aim is to study the spectrum of various thyroid lesions on FNAC. Also, the study is aimed to categorise the thyroid lesions according to the Bethesda system for Reporting Thyroid Cytopathology (2017).Methods: This is a retrospective observational study carried out in the pathology department at tertiary care academic institute for a period of three years. FNAC was done in a patient with thyroid swelling by non-aspiration technique. Slides were prepared, fixed in 95% ethyl alcohol and processed with routine stains.Results: Out of 210 cases, 150 cases (71.42%) were benign lesions, 15 cases (7.14%) were Follicular neoplasm/Suspicious for follicular neoplasm, 14(6.66%) cases were reported as Atypia of undetermined significance, 13 cases (6.19%) were Unsatisfactory/Nondiagnostic, 11 cases (5.2%) were malignant and 7 cases (3.3%) were suspicious for malignancy.Conclusions: FNAC is the most effective tool for the diagnosis of thyroid lesions. The Bethesda system is used to categorise the thyroid lesions and helps in better communication between clinicians and pathologists for the best surgical and medical management. The number of benign cases were higher and the number of cases in the category of suspicious for malignancy were lower with female preponderance.

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