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15.04.2020 | Original Article

Strategy to reduce unnecessary surgeries in thyroid nodules with cytology of Bethesda category III (AUS/FLUS): a retrospective analysis of 667 patients diagnosed by surgery

verfasst von: Yong Joon Suh, Yeon Ju Choi

Erschienen in: Endocrine | Ausgabe 3/2020

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Abstract

Purpose

Fine-needle aspiration (FNA) is widely used for the diagnosis of thyroid nodules detected by ultrasonography. However, the cytology of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) often leads to unnecessary thyroid surgery. This study aimed to identify a strategy to reduce unnecessary surgeries in patients with AUS/FLUS nodules.

Methods

Medical records of 667 patients with the cytology of AUS/FLUS who underwent surgery from January 2007 to December 2017 were retrospectively reviewed. Clinicopathological data were analyzed to identify malignant factors in thyroid nodules with AUS/FLUS. Factors were compared between patients with thyroid cancer and those with benign thyroid nodules, using stepwise multivariate logistic regression and decision tree model.

Results

Pathological thyroid cancer was identified in 193 (43.3%) patients. There was a significant difference in malignancy incidence with respect to family history, number of nodules, number of FNAs, ultrasonographic finding, lymphocytic thyroiditis, and BRAF^V600E mutation. Multivariate analysis showed that ultrasonography (K-TIRADS 5) was the most influential independent predictor of malignancy in AUS/FLUS (odds ratio = 11.02, p < 0.001), followed by possessing BRAF^V600E mutation (odds ratio = 4.54, p < 0.001). This strategy enabled 226 (89.3%) patients to avoid unnecessary surgeries based on the decision tree model. There was no node of repeated FNA in the decision tree model, which reduced the risk of malignancy (odds ratio = 0.35, p = 0.029).

Conclusion

K-TIRADS 5 and BRAF^V600E mutation were predictive of malignancy in nodules of AUS/FLUS. These factors should be considered in strategies to reduce unnecessary surgeries for AUS/FLUS.

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S.J. Kim, J. Roh, J.H. Baek, S.J. Hong, Y.K. Shong, W.B. Kim, D.E. Song, Risk of malignancy according to sub-classification of the atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) category in the Bethesda System for Reporting Thyroid. Cytopathology 28(1), 65–73 (2017)PubMed

M.K. McElroy, S. Mahooti, F. Hasteh, A single institution experience with the new Bethesda system for reporting thyroid cytopathology: correlation with existing cytologic, clinical, and histological data. Diagn. Cytopathol. 42(7), 564–569 (2014)PubMed

P. Trimboli, G. Treglia, L. Guidobaldi, E. Saggiorato, G. Nigri, A. Crescenzi, F. Romanelli, F. Orlandi, S. Valabrega, R. Sadeghi, L. Giovanella, Clinical characteristics as predictors of malignancy in patients with indeterminate thyroid cytology: a meta-analysis. Endocrine 46(1), 52–59 (2014)PubMed

L. Yassa, E.S. Cibas, C.B. Benson, M.C. Frates, P.M. Doubilet, A.A. Gawande, F.D. Moore Jr., B.W. KIM, V. Nose, E. Marqusee, P.R. Larsen, E.K. Alexander, Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer 111(6), 508–516 (2007)PubMed

E.S. Cibas, S.Z. Ali, The Bethesda System for Reporting Thyroid Cytopathology. Thyroid 19(11), 1159–1165 (2009)PubMed

E.A. Krauss, M. Mahon, J.M. Fede, L. Zhang, Application of the Bethesda classification for thyroid fine-needle aspiration: institutional experience and meta-analysis. Arch. Pathol. Lab. Med. 140(10), 1121–1131 (2016)PubMed

P. Erivwo, C. Ghosh, Atypia of undetermined significance in thyroid fine-needle aspirations: follow-up and outcome experience in Newfoundland, Canada. Acta Cytol. 62(2), 85–92 (2018)PubMed

P.A. VanderLaan, A.A. Renshaw, J.F. Krane, Atypia of undetermined significance and nondiagnostic rates in the Bethesda System for Reporting Thyroid Cytopathology are inversely related. Am. J. Clin. Pathol. 137(3), 462–465 (2012)PubMed

E.S. Cibas, S.Z. Ali, The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid 27(11), 1341–1346 (2017)PubMed

10.

S.H. Paek, B.S. Kim, K.H. Kang, H.S. Kim, False-negative BRAF V600E mutation results on fine-needle aspiration cytology of papillary thyroid carcinoma. World J. Surg. Oncol. 15(1), 202 (2017)PubMedPubMedCentral

11.

H.S. Hong, J.Y. Lee, Diagnostic performance of ultrasound patterns by K-TIRADS and 2015 ATA guidelines in risk stratification of thyroid nodules and follicular lesions of undetermined significance. Am. J. Roentgenol. 213(2), 444–450 (2019)

12.

B. Öcal, M.H. Korkmaz, D. Yılmazer, T. Taşkın Türkmenoğlu, Ö. Bayır, G. Saylam, E. Çadallı Tatar, S. Karahan, E. Çakal, The malignancy risk assessment of cytologically indeterminate thyroid nodules improves markedly by using a predictive model. Eur. Thyroid J. 8(2), 83–89 (2019)PubMed

13.

R. Nayar, M. Ivanovic, The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute thyroid fine needle aspiration state of the science conference. Cancer 117(3), 195–202 (2009)PubMed

14.

J.C. Chen, S.C. Pace, B.A. Chen, A. Khiyami, C.R. McHenry, Yield of repeat fine-needle aspiration biopsy and rate of malignancy in patients with atypia or follicular lesion of undetermined significance: the impact of the Bethesda System for Reporting Thyroid Cytopathology. Surgery 152(6), 1037–1044 (2012)PubMed

15.

I.S. Jan, Y.T. Lee, C.M. Wang, T.Y. Cheng, C.Y. Wang, T.C. Chang, S.R. Shih, The surgery and repeat aspiration outcomes of the atypia of undetermined significance/follicular lesion of undetermined significance category in the Bethesda System for Reporting Thyroid Cytopathology. Asian J. Surg. 42(1), 144–147 (2019)PubMed

16.

P.A. VanderLaan, E. Marqusee, J.F. Krane, Clinical outcome for atypia of undetermined significance in thyroid fine-needle aspirations: should repeated FNA be the preferred initial approach? Am. J. Clin. Pathol. 135(5), 770–775 (2011)PubMed

17.

J.F. Krane, P.A. Vanderlaan, W.C. Faquin, A.A. Renshaw, The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio: a proposed performance measure for reporting in the Bethesda System for Thyroid Cytopathology. Cancer Cytopathol. 120(2), 111–116 (2012)PubMed

18.

Y.J. Choi, J.H. Baek, C.H. Suh, W.H. Shim, B. Jeong, J.K. Kim, D.E. Song, T.Y. Kim, K.W. Chung, J.H. Lee, Core-needle biopsy versus repeat fine-needle aspiration for thyroid nodules initially read as atypia/follicular lesion of undetermined significance. Head Neck 39(2), 361–369 (2017)PubMed

19.

S.H. Jeong, H.S. Hong, E.H. Lee, J.G. Cha, J.S. Park, J.J. Kwak, Outcome of thyroid nodules characterized as atypia of undetermined significance or follicular lesion of undetermined significance and correlation with ultrasound features and BRAF(V600E) mutation analysis. AJR Am. J. Roentgenol. 201(6), W854–W860 (2013)PubMed

20.

C.M. Kiernan, C.C. Solorzano, Bethesda category III, IV, and V thyroid nodules: can nodule size help predict malignancy? J. Am. Coll. Surg. 225(1), 77–82 (2017)PubMed

21.

K.H. Lee, J.H. Shin, Y.L. Oh, S.Y. Hahn, Atypia of undetermined significance in thyroid fine-needle aspiration cytology: prediction of malignancy by US and comparison of methods for further management. Ann. Surg. Oncol. 21(7), 2326–2331 (2014)PubMed

22.

B. Kuru, A. Atmaca, I.A. Tarim, M. Kefeli, K. Topgul, S. Yoruker, M. Elmali, M. Danaci, Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category III (AUS/FLUS). Eur. J. Surg. Oncol. 42(1), 87–93 (2016)PubMed

23.

M. Mileva, B. Stoilovska, A. Jovanovska, A. Ugrinska, G. Petrushevska, S. Kostadinova-Kunovska, D. Miladinova, V. Majstorov, Thyroid cancer detection rate and associated risk factors in patients with thyroid nodules classified as Bethesda category III. Radiol. Oncol. 52(4), 370–376 (2018)PubMedPubMedCentral

24.

J.H. Yoon, H.S. Lee, E.K. Kim, H.J. Moon, J.Y. Kwak, A nomogram for predicting malignancy in thyroid nodules diagnosed as atypia of undetermined significance/follicular lesions of undetermined significance on fine needle aspiration. Surgery 155(6), 1006–1013 (2014)PubMed

25.

S.C. Chin, H. Rice, P.M. Som, Spread of goiters outside the thyroid bed: a review of 190 cases and an analysis of the incidence of the various extensions. Arch. Otolaryngol. Head. Neck Surg. 129(11), 1198–1202 (2003)PubMed

26.

A.Y. Chen, V.J. Bernet, S.E. Carty, T.F. Davies, I. Ganly, W.B. Inabnet III, A.R. Shaha, American Thyroid Association statement on optimal surgical management of goiter. Thyroid 24(2), 181–189 (2014)PubMed

27.

J.H. Shin, J.H. Baek, J. Chung, E.J. Ha, J.H. Kim, Y.H. Lee, H.K. Lim, W.J. Moon, D.G. Na, J.S. Park, Y.J. Choi, S.Y. Hahn, S.J. Jeon, S.L. Jung, D.W. Kim, E.K. Kim, J.Y. Kwak, C.Y. Lee, H.J. Lee, J.H. Lee, J.H. Lee, K.H. Lee, S.W. Park, J.Y. Sung,Korean Society of Thyroid Radiology and Korean Society of Radiology, Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J. Radiol. 17 (3), 370–395 (2016)PubMedPubMedCentral

28.

E. Horvath, S. Majlis, R. Rossi, C. Franco, J.P. Niedmann, A. Castro, M. Dominguez, An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J. Clin. Endocrinol. Metab. 94(5), 1748–1751 (2009)PubMed

29.

P. Valderrabano, B. Mclver, Evaluation and management of indeterminate thyroid nodules: the revolution of risk stratification beyond cytological diagnosis. Cancer Control 24(5), 1073274817729231 (2017)PubMedPubMedCentral

30.

S. Ahn, J. Lee, J.Y. Sung, S.Y. Kang, S.Y. Ha, K.T. Jang, Y.L. Choi, J.S. Kim, Y.L. Oh, K.M. Kim, Comparison of three BRAF mutation tests in formalin-fixed paraffin embedded clinical samples. Korean J. Pathol. 47(4), 348–354 (2013)PubMedPubMedCentral

31.

B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G.W. Randolph, A.M. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D.L. Steward, R.M. Tuttle, L. Wartofsky, 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1), 1–133 (2016)PubMedPubMedCentral

32.

D.S. Cooper, G.M. Doherty, B.R. Haugen, R.T. Kloos, S.L. Lee, S.J. Mandel, E.L. Mazzaferri, B. McIver, F. Pacini, M. Schlumberger, S.I. Sherman, D.L. Steward, R.M. Tuttle, Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Thyroid 19(11), 1167–1214 (2009)PubMed

33.

D.S. Cooper, G.M. Doherty, B.R. Haugen, R.T. Kloos, S.L. Lee, S.J. Mandel, E.L. Mazzaferri, B. McIver, S.I. Sherman, R.M. Tuttle, Management guidelines for patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines taskforce. Thyroid 16(2), 109–142 (2006)PubMed

34.

A. Crowe, A. Linder, O. Hameed, C. Salih, J. Roberson, J. Gidley, I.A. Eltoum, The impact of implementation of the Bethesda System for Reporting Thyroid Cytopathology on the quality of reporting, “risk” of malignancy, surgical rate, and rate of frozen sections requested for thyroid lesions. Cancer Cytopathol. 119(5), 315–321 (2011)PubMed

35.

N. Dincer, S. Balci, A. Yazgan, G. Guney, R. Ersoy, B. Cakir, G. Guler, Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology. Cytopathology 24(6), 385–390 (2013)PubMed

36.

E.S. Cibas, S.Z. Ali, The Bethesda system for reporting thyroid cytopathology. Am. J. Clin. Pathol. 132(5), 658–665 (2009)PubMed

37.

M. Bongiovanni, A. Spitale, W.C. Faquin, L. Mazzucchelli, Z.W. Baloch, The Bethesda system for reporting thyroid cytopathology: a meta-analysis. Acta Cytol. 56(4), 333–339 (2012)PubMed

38.

H.K. Su, L.L. Dos Reis, M.A. Lupo, M. Milas, L.A. Orloff, J.E. Langer, E.M. Brett, E. Kazam, S.L. Lee, G. Minkowitz, E.H. Alpert, E.H. Dewey, M.L. Urken, Striving toward standardization of reporting of ultrasound features of thyroid nodules and lymph nodes: a multidisciplinary consensus statement. Thyroid 24(9), 1341–1349 (2014)PubMed

39.

P. Seifert, R. Gorges, M. Zimny, M.C. Kreissl, S. Schenke, Interobserver agreement and efficacy of consensus reading in Kwak-, EU-, and ACR-thyroid imaging recording and data systems and ATA guidelines for the ultrasound risk stratification of thyroid nodules. Endocrine 67(1), 143–154 (2020)PubMed

40.

G. Grani, L. Lamartina, V. Cantisani, M. Maranghi, P. Lucia, C. Durante, Interobserver agreement of various thyroid imaging reporting and data systems. Endocr. Connect. 7(1), 1–7 (2018)PubMed

41.

H.G. Kim, J.Y. Kwak, E.K. Kim, S.H. Choi, H.J. Moon, Man to man training: can it help improve the diagnostic performances and interobserver variabilities of thyroid ultrasonography in residents? Eur. J. Radiol. 81(3), e352–e356 (2012)PubMed

42.

R.L. Ferris, Z. Baloch, V. Bernet, A. Chen, T.J. Fahey III, I. Ganly, S.P. Hodak, E. Kebebew, K.N. Patel, A. Shaha, D.L. Steward, R.P. Tufano, S.M. Wiseman, S.E. Carty,American Thyroid Association Surgical Affairs Committee, American Thyroid Association statement on surgical application of molecular profiling for thyroid nodules: current impact on perioperative decision making. Thyroid 25(7), 760–768 (2015).PubMedPubMedCentral

43.

H. Lasolle, B. Riche, M. Decaussin-Petrucci, E. Dantony, V. Lapras, C. Cornu, J. Lachuer, J.L. Peix, J.C. Lifante, O.M. Capraru, S. Selmi-Ruby, B. Rousset, F. Borson-Chazot, P. Roy, Predicting thyroid nodule malignancy at several prevalence values with a combined Bethesda-molecular test. Transl. Res. 188, 58–66.e1 (2017)PubMed

44.

M.Y. Roth, R.L. Witt, D.L. Steward, Molecular testing for thyroid nodules: review and current state. Cancer 124(5), 888–898 (2018)PubMed

45.

E.D. Rossi, L. Pantanowitz, W.C. Faquin, The role of molecular testing for the indeterminate thyroid FNA. Genes 10(10), 736 (2019)PubMedCentral

46.

M.N. Nikiforova, A.I. Wald, S. Roy, M.B. Durso, Y.E. Nikiforov, Targeted next-generation sequencing panel (ThyroSeq) for detection of mutations in thyroid cancer. J. Clin. Endocrinol. Metab. 98(11), E1852–E1860 (2013)PubMedPubMedCentral

47.

R.S. Mehta, S.E. Carty, N.P. Ohori, S.P. Hodak, C. Coyne, S.O. LeBeau, M.E. Tublin, M.T. Stang, J.T. Johnson, K.L. McCoy, M.N. Nikiforova, Y.E. Nikiforov, L. Yip, Nodule size is an independent predictor of malignancy in mutation-negative nodules with follicular lesion of undetermined significance cytology. Surgery 154(4), 730–736 (2013). discussion 736–738PubMed

48.

R. Carr, B. Ustun, D. Chhieng, K. Schofield, C. Theoharis, L. Hammers, A.J. Adeniran, Radiologic and clinical predictors of malignancy in the follicular lesion of undetermined significance of the thyroid. Endocr. Pathol. 24(2), 62–68 (2013)PubMed

49.

M. Jinih, N. Foley, O. Osho, L. Houlihan, A.A. Toor, J.Z. Khan, A.A. Achakzai, H.P. Redmond, BRAF(V600E) mutation as a predictor of thyroid malignancy in indeterminate nodules: a systematic review and meta-analysis. Eur. J. Surg. Oncol. 43(7), 1219–1227 (2017)PubMed

50.

P.S. Sullivan, S.L. Hirschowitz, P.C. Fung, S.K. Apple, The impact of atypia/follicular lesion of undetermined significance and repeat fine-needle aspiration: 5 years before and after implementation of the Bethesda system. Cancer Cytopathol. 122(12), 866–872 (2014)PubMed

51.

Y. Ozluk, E. Pehlivan, M.G. Gulluoglu, A. Poyanli, A. Salmaslioglu, N. Colak, Y. Kapran, D. Yilmazbayhan, The use of the Bethesda terminology in thyroid fine-needle aspiration results in a lower rate of surgery for nonmalignant nodules: a report from a Reference Center in Turkey. Int. J. Surg. Pathol. 19(6), 761–771 (2011)PubMed

52.

A.S. Ho, E.E. Sarti, K.S. Jain, H. Wang, I.J. Nixon, A.R. Shaha, J.P. Shah, D.H. Kraus, R. Ghossein, S.A. Fish, R.J. Wong, O. Lin, L.G. Morris, Malignancy rate in thyroid nodules classified as Bethesda category III (AUS/FLUS). Thyroid 24(5), 832–839 (2014)PubMedPubMedCentral

53.

V.Y. Park, E.K. Kim, J.Y. Kwak, J.H. Yoon, H.J. Moon, Malignancy risk and characteristics of thyroid nodules with two consecutive results of atypia of undetermined significance or follicular lesion of undetermined significance on cytology. Eur. Radiol. 25(9), 2601–2607 (2015)PubMed

54.

S.H. Hong, H. Lee, M.S. Cho, J.E. Lee, Y.A. Sung, Y.S. Hong, Malignancy risk and related factors of atypia of undetermined significance/follicular lesion of undetermined significance in thyroid fine needle aspiration. Int. J. Endocrinol. 2018, 4521984 (2018)PubMedPubMedCentral

55.

L.Q. Wong, V.A. LiVolsi, Z.W. Baloch, Diagnosis of atypia/follicular lesion of undetermined significance: an institutional experience. CytoJournal 11, 23 (2014)PubMedPubMedCentral

56.

M. Kim, M.J. Jeon, M. Han, J.H. Lee, D.E. Song, J.H. Baek, T.Y. Kim, W.B. Kim, Y.K. Shong, W.G. Kim, Tumor growth rate does not predict malignancy in surgically resected thyroid nodules classified as Bethesda category III with architectural atypia. Thyroid 29(2), 216–221 (2019)PubMed

57.

A.M. Manning, H. Yang, M. Falciglia, J.R. Mark, D.L. Steward, Thyroid ultrasound-guided fine-needle aspiration cytology results: observed increase in indeterminate rate over the past decade. Otolaryngol. Head. Neck Surg. 156(4), 611–615 (2017)PubMed

58.

B. Miller, S. Burkey, G. Lindberg, W.H. Snyder III, F.E. Nwariaku, Prevalence of malignancy within cytologically indeterminate thyroid nodules. Am. J. Surg. 188(5), 459–462 (2004)PubMed

59.

J. Smith, R.E. Cheifetz, N. Schneidereit, K. Berean, T. Thomson, Can cytology accurately predict benign follicular nodules? Am. J. Surg. 189(5), 592–595 (2005). discussion 595PubMed

60.

M.S. Deveci, G. Deveci, V.A. LiVolsi, Z.W. Baloch, Fine-needle aspiration of follicular lesions of the thyroid. Diagnosis and follow-up. CytoJournal 3, 9 (2006)PubMedPubMedCentral

Titel: Strategy to reduce unnecessary surgeries in thyroid nodules with cytology of Bethesda category III (AUS/FLUS): a retrospective analysis of 667 patients diagnosed by surgery
verfasst von: Yong Joon Suh
Yeon Ju Choi
Publikationsdatum: 15.04.2020
Verlag: Springer US
Erschienen in: Endocrine / Ausgabe 3/2020
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-020-02300-w

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