scholarly journals Incidence, Clinical Characteristics, and Histopathological Results of Atypia of Undermined Significance in a Tertiary Center in UAE

2021 ◽  
Vol 27 (1) ◽  
pp. 1-5
Author(s):  
Maha Osman Shangab ◽  
Azza Abdulaziz Khalifa ◽  
Fatheya Al Awadi ◽  
Mouza Alsharhan ◽  
Alaaeldin Bashier
Keyword(s):  
Thyroid Nodules ◽  
Histopathological Diagnosis ◽  
Class Iii ◽  
Tertiary Center ◽  
Risk Of Malignancy ◽  
Estimated Risk ◽  
Time Gap ◽  
Histopathological Results ◽  
Common Malignancy

<b><i>Introduction:</i></b> Bethesda classification of thyroid nodules cytology is an agreed upon method of classifying thyroid nodules according to risk of malignancy. Among them, Bethesda class III (Atypia of Undetermined Significance, AUS) has been a topic of great controversy. The reported estimated risk of malignancy associated with it varies in different studies. Our study investigates the associated incidence of malignancy in a single tertiary center in UAE. <b><i>Methodology:</i></b> Data were retrospectively collected over a 10-year period from January 2009 till December 2018 for cytology diagnosis of AUS. Patient charts were reviewed for method of management. Surgical and histopathology records were reviewed to compare findings on cytology versus histopathology. <b><i>Results:</i></b> A total of 180 cases were diagnosed Bethesda III (AUS) with a mean age of 45.09 ± 14.7 years. One hundred cases (55.6%) of them underwent surgical resection, and histopathological diagnosis was obtained. Among the operated cases, 46 were benign and 54 were malignant. Papillary thyroid cancer was the most common malignancy, seen in 39 (72.2%) of cases, and follicular cancer was the second most common, seen in 13 (24.1%) cases. <b><i>Conclusion:</i></b> The findings highlighted in our study suggest a higher incidence of malignancy in Bethesda III category than previously reported. It also puts in question the utility and benefit behind keeping a time gap and repeating FNA as previously recommended.

Risk of malignancy in 1502 solid thyroid nodules >1 cm using the new ultrasonographic classification of the American Thyroid Association

Endocrine ◽  
2016 ◽  
Vol 56 (2) ◽  
pp. 442-445 ◽  
Author(s):  
Pedro Weslley Rosario ◽  
Alexandre Lemos da Silva ◽  
Marcelo Saldanha Nunes ◽  
Michelle Aparecida Ribeiro Borges ◽  
Gabriela Franco Mourão ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
American Thyroid Association ◽  
Risk Of Malignancy

scholarly journals Low reproducibility of equivocal categories of the Bethesda System for Reporting Thyroid Cytology makes the associated risk of malignancy specific to the diagnostic center

Endocrine ◽  
2021 ◽  
Author(s):  
Dorota Słowińska-Klencka ◽  
Mariusz Klencki ◽  
Joanna Duda-Szymańska ◽  
Jarosław Szwalski ◽  
Bożena Popowicz
Keyword(s):  
Interobserver Agreement ◽  
Histopathological Examination ◽  
Published Data ◽  
Thyroid Cytology ◽  
Diagnostic Center ◽  
Risk Of Malignancy ◽  
Estimated Risk ◽  
Bethesda System ◽  
The Bethesda System

Abstract Purpose Equivocal categories (III, IV, V) of the Bethesda System for Reporting Thyroid Cytology (BSRTC) are characterized by high variability of the estimated risk of malignancy. The aim of the study was to analyze the reproducibility of classification of nodules into an equivocal category and the frequency of malignancy (FoM) observed in such categories. Methods Five experienced cytopathologists from three centers (A, B, C) independently performed reclassification of smears obtained from 213 thyroid nodules with equivocal routine cytology and known results of the postoperative histopathological examination. Results The interobserver agreement among all cytopathologists was poor, with a Krippendorff’s alpha coefficient equaling 0.34. The intra-center agreement was higher than the inter-center (fair vs poor). Pathologists of the center A classified smears into categories II and III significantly less often and categories IV and V more often than pathologists of centers B and C. The joint FoM of nodules classified into any of categories IV–VI (regarded as an indication for surgery) was different among centers (A: 40.0%, B: 66.7%, C: 80.6%). The FoM of category III nodules with features of nuclear atypia (AUS) in center B and C was two times higher than that of other nodules of category III (FLUS), while in center A the FoM was similar. Conclusions The use of published data on the risk of malignancy in nodules of particular BSRTC categories without concern for the uniqueness of the diagnostic center may lead to erroneous conclusions.

The predictive value of structured ultrasonographic staging for thyroid nodules

2014 ◽  
Vol 128 (10) ◽  
pp. 914-921 ◽  
Author(s):  
S L Gray ◽  
G O'Neill ◽  
G McGarry
Keyword(s):  
Head And Neck ◽  
Gold Standard ◽  
Clinical Utility ◽  
Thyroid Nodules ◽  
Staging System ◽  
Histopathological Diagnosis ◽  
Multidisciplinary Team Meeting ◽  
Staging Systems ◽  
Risk Of Malignancy ◽  
Operative Ultrasound

AbstractBackground:‘R staging’ is a new ultrasonographic scoring system developed and used by our specialist head and neck radiologist for reporting sonographic risk of malignancy to those at our thyroid multidisciplinary team meeting. This study aimed to: classify the R staging system, examine its relationship with the eventual histopathological diagnosis and define its clinical utility.Methods:The pre-operative ultrasound scans of 78 patients were assigned an R status by our specialist head and neck radiologist. The final histopathology report for each thyroid nodule was used as the ‘gold standard’ for analysis.Results:When thyroid nodules were classified as low risk (R stages 1–3) or high risk (R stages 4–5) for malignancy, the sensitivity of R staging was 74.2 per cent and specificity was 80.9 per cent. An R5 status was 100 per cent predictive of malignancy.Conclusion:Our results compare favourably with other suggested ultrasonographic staging systems for thyroid nodules.

Diagnostic utility of fine needle aspiration cytology in pediatric thyroid nodules based on Bethesda Classification

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Wen Jiang ◽  
Susan A. Phillips ◽  
Robert O. Newbury ◽  
John H. Naheedy ◽  
Ron S. Newfield
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Ultrasound Guidance ◽  
Needle Aspiration ◽  
Diagnostic Utility ◽  
Class Iii ◽  
Fine Needle ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
The Bethesda System

Abstract Objectives The Bethesda system for reporting cytopathology (TBSRTC) has been widely adopted in the management of thyroid nodules. Based on the limited pediatric data available, the implied malignancy risk for each of the categories may be significantly different in pediatrics vs. adults, especially in the indeterminate categories (Bethesda Class III or IV). We report the diagnostic utility of fine needle aspiration (FNA) biopsy at our institution based on the Bethesda system and the risk of malignancy in each category. Methods We retrospectively reviewed all patients who underwent a thyroid FNA at our tertiary pediatric hospital from 12/1/2002 to 11/30/2018. FNA results were classified according to TBSRTC. Patient demographics, cytology, histopathology, radiological and clinical follow-ups were examined. Results A total of 171 patients were included with 203 cytological samples. Average age at initial FNA was 14.7 years (range 6.9–18.6 years). The numbers of nodules reported for Bethesda categories I–VI were 29, 106, 22, 14, 6 and 26, respectively, and the rate of malignancy was: 13.8, 4.7, 22.7, 35.7, 83.3 and 100%, respectively. Use of ultrasound guidance reduced the non-diagnostic rate from 38.1 to 11.5%. Introduction of on-site adequacy testing further reduced the non-diagnostic rate to 6.5% since 2014. Conclusions The risk of malignancy for thyroid nodules in this pediatric cohort is higher than reported in adults. However, rates described here are much closer to adult ranges than previously published pediatric cohorts. The addition of adequacy testing improved the non-diagnostic rate of FNA procedures performed with ultrasound guidance.

scholarly journals Atypia and Follicular Lesions of Undetermined Significance in Subsequent Biopsy Result: What Clinicians Need to Know

2021 ◽  
Vol 10 (14) ◽  
pp. 3082
Author(s):  
Krzysztof Kaliszewski ◽  
Dorota Diakowska ◽  
Marta Rzeszutko ◽  
Łukasz Nowak ◽  
Urszula Tokarczyk ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Decision Making Process ◽  
Histopathological Diagnosis ◽  
Follicular Lesions ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
The Bethesda System ◽  
Undetermined Significance

Atypia and follicular lesions of undetermined significance (AUS/FLUS) is the most controversial category of The Bethesda System. The risk of malignancy (ROM) in this group is estimated as 5–15%, however, the occurrence of two or more subsequent biopsy results with AUS/FLUS diagnosis makes these clinical situations more complex. We evaluated the ROM and prognostic value of aggressive ultrasound (US) features in 342 patients with thyroid nodules (TNs) with subsequent biopsy results of AUS/FLUS. We assessed US features and compared them with the final histopathological diagnosis. Overall, 121 (35.4%) individuals after first AUS/FLUS diagnosis underwent surgery and 221 (64.6%) patients had repeated biopsies. The ROM after first, second, and third biopsies with subsequent AUS/FLUS diagnosis were 7.4%, 18.5%, and 38.4% respectively. We demonstrated significantly higher rates of occurrence of aggressive US features in patients with malignancy (p < 0.0001). The age <55 years old was also a significant risk factor for TC (p = 0.044). Significant associations were found between aggressive US features and malignancy in patients after first diagnosis of AUS/FLUS (p < 0.05). The juxtaposition of US features with the number of biopsy repetitions of TN with consecutive AUS/FLUS diagnoses may simplify the decision-making process in surgical management. Two or three consecutive biopsy results with AUS/FLUS diagnosis increases the ROM.

The Accuracy of ACR TI-RADS Classification of Neck Ultrasound as a First-Line Diagnostic Approach for Thyroid Neoplasms in Pediatric Patients: A Retrospective Study

2018 ◽  
Vol 5 (1) ◽  
pp. 13-23
Author(s):  
Nikolai S. Grachev ◽  
Elena V. Feoktistova ◽  
Igor N. Vorozhtsov ◽  
Natalia V. Babaskina ◽  
Ekaterina Yu. Iaremenko ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Pediatric Patients ◽  
Thyroid Neoplasms ◽  
Diagnostic Methods ◽  
Diagnostic Approach ◽  
First Line ◽  
Neck Ultrasound

Background.Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the gold standard in diagnosing the pathological nature of undetermined thyroid nodules. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis.Objective.Our aim was to evaluate the effectiveness of ACR TI-RADS classification of neck ultrasound as a first-line diagnostic approach for thyroid neoplasms in pediatric patients.Methods.A retrospective analysis was made of FNA and US protocols in 70 patients who underwent the examination and treatment at Dmitry Rogachev National Research Center between January 2012 and August 2017. In the retrospective series 70% (49/70) of patients undergone FNA and 43% (30/70) of them undergone repeated FNA. All US protocols were interpreted according to ACR TI-RADS system by the two independent experts. The clinical judgment was assessed using the concordance test and the reliability of preoperative diagnostic methods was analized.Results.According to histologic examination protocols, benign nodules reported greater multimorbidity 29% (20/70), compared with thyroid cancer 17% (12/70), complicating FNA procedure. A statistically significant predictor of thyroid cancer with a tumor size ACR TI-RADS showed a significant advantage of ACR TI-RADS due to higher sensitivity (97.6 vs 60%), specificity (78.6 vs 53.8%), positive predictive value (87.2 vs 71.4%), and negative predictive value (95.7 vs 41.2%). Concordance on the interpreted US protocols according to ACR TI-RADS classification between two experts was high, excluding accidental coincidence.Conclusion.The data support the feasibility of US corresponding to the ACR TI-RADS classification as a first-line diagnostic approach for thyroid neoplasm reducing the number of unnecessary biopsies for thyroid nodules.

On the Classification of TI-RADS and Stratification of Signs of Thyroid Cancer According to Ultrasound Data

2017 ◽  
pp. 29-38 ◽  
Author(s):  
E. P. Fisenko ◽  
J. P. Sich ◽  
N. N. Vetsheva
Keyword(s):  
Thyroid Cancer ◽  
Retrospective Analysis ◽  
Thyroid Nodules ◽  
Thyroid Ultrasound ◽  
High Reproducibility ◽  
System 1

Objective:a comparative “blind” assessment of the thyroid nodules identified by ultrasound, according to the TI-RADS scale in various modifications.Materials and methods.Retrospective analysis of 149 echograms  of thyroid nodules by three independent experts was performed (the  experience of ultrasound of thyroid ultrasound for more than 7 years).Results. In solid nodules, high-specific large (more than 94%) and  small (more than 90%) ultrasound signs of thyroid cancer have been identified. The nodes are stratified according to the TI-RADS system: 1 – in the modification J.Y. Kwak et al. (2011), 2 – according to the  proposed system, taking into account small ultrasound signs of  thyroid cancer. High reproducibility of both systems are obtained. In the first system 13.7% of cancer nodes fell into the category of TI- RADS 3 (benign formations), in the second system only 5% of  cancers fell into the category of TI-RADS 3, which is important for  biopsy selection. The sensitivity of the first system was TI-RADS  82.05%, of the second system – 94.87%.Conclusions.Classification of TI-RADS can be used to interpret the  ultrasound results of thyroid nodules, taking into account both the  main large and small ultrasound signs of cancer. For its validation in  our country, it is necessary to further broad discussion of the proposed TI-RADS system.

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