Abstract
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.
Highlights
Introduction published maps and institutional affilUltrasound-guided fine-needle aspiration biopsy (UG-FNAB) is the most common and practical diagnostic tool for thyroid nodules (TNs) management [1]
All patients were qualified to UG-FNAB in accordance with American Thyroid Association Management
We evaluated five ultrasound (US) features of TNs with atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) diagnosis and compared them with the final histopathological diagnosis
Summary
We retrospectively analyzed 5024 medical records of patients admitted and surgically treated in the 1st Department and Clinic of General, Gastrointestinal and Endocrine Surgery at the Wroclaw Medical University in Poland due to TNs between January 2008 and December 2018. In each of the medical records of these individuals, we evaluated the numbers and diagnosis of all biopsies performed during the observational study time. All US features of all TNs of every single patient were accurately described and introduced into the medical data base formed for this study. We evaluated five ultrasound (US) features of TNs with AUS/FLUS diagnosis (microcalcifications, hypoechogenicity, irregular margins, taller-than-wide shape, and high vascularity defined as intranodular flow with multiple vascular poles chaotically arranged) and compared them with the final histopathological diagnosis. All evaluated patients underwent results surgery, andobtained histopathology results were obtained in all cases. Of Allone evaluated patients underwent surgery, and histopathology were in all cases Diagnosis. of Allone evaluated patients underwent surgery, and histopathology were in all cases
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