Young investigator challenge: Atypia of undetermined significance in thyroid FNA: Standardized terminology without standardized management-a closer look at repeat FNA and quality measures

Cancer Cytopathology
Tamar C BrandlerMelissa Klein

Abstract

The Bethesda system (TBS) for the reporting of thyroid cytopathology established the category of atypia of undetermined significance (AUS) with a 7% target rate and a 5% to 15% implied malignancy risk. Recent literature has reported a broad range of AUS rates, subsequent malignancy rates, and discrepant results from repeat fine-needle aspiration (FNA) versus surgical follow-up. Therefore, this study examined AUS data from the Hofstra North Shore-LIJ School of Medicine to determine the best clinical follow-up. Thyroid aspirates interpreted as AUS in 2012-2014 at the Hofstra North Shore-LIJ School of Medicine were collected. Repeat FNA and surgical follow-up data were tabulated to establish AUS, secondary AUS (diagnosed upon repeat FNA follow-up of a primary FNA AUS diagnosis), atypia of undetermined significance/malignancy (AUS:M) ratios (according to the TBS categories), and malignancy rates for AUS. The AUS rate was 8.5% (976/11,481), and there was follow-up data for 545 cases. The AUS:M ratio was 2.0. Repeat FNA was performed for 281 cases; 57 proceeded to surgical intervention. Repeat FNA reclassified 71.17% of the cases. The malignancy rates for AUS cases proceeding directly to surgery and for those receiving a surgical int...Continue Reading

References

Oct 23, 2009·American Journal of Clinical Pathology·Edmund S CibasUNKNOWN NCI Thyroid FNA State of the Science Conference
Nov 6, 2009·Thyroid : Official Journal of the American Thyroid Association·Edmund S Cibas, Syed Z Ali
Jul 14, 2011·Cancer Cytopathology·Massimo BongiovanniWilliam C Faquin
Aug 1, 2012·Acta Cytologica·Massimo BongiovanniZubair W Baloch
Aug 2, 2013·Journal of Clinical and Diagnostic Research : JCDR·Tejinder Singh BhasinParampreet Kaur
Dec 18, 2013·Thyroid : Official Journal of the American Thyroid Association·Allen S HoLuc G T Morris
Mar 4, 2014·American Journal of Surgery·Joy C ChenChristopher R McHenry
Feb 18, 2015·Pathology Research International·Payal Mehra, Anand Kumar Verma

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Citations

Dec 6, 2017·Cytopathology : Official Journal of the British Society for Clinical Cytology·M A SaiegF Costa
Jul 14, 2020·Cytopathology : Official Journal of the British Society for Clinical Cytology·Ediel ValerioMauro Saieg
Jul 18, 2017·Cytopathology : Official Journal of the British Society for Clinical Cytology·S TurkyilmazA Cinel
Feb 9, 2021·Annals of Saudi Medicine·Aseel DoubiSaleh F Al-Dhahri
Aug 8, 2021·Journal of the American Society of Cytopathology : JASC·Katharine HorbackEdmund S Cibas

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