Abstract
Treatment and follow-up are controversial in patients whose thyroid fine needle aspiration biopsy (FNAB) is reported as atypia of undetermined significance and follicular lesion of uncertain significance (AUS/FLUS). We aimed the efficacy of the American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) in preventing unnecessary thyroidectomies in patients with FNA cytology results as AUS/FLUS. In Bolu Abant Izzet Baysal University General Surgery Clinic, case series between 2017 and 2020 were analyzed with thyroid operated. Grouping was made according to the result of postoperative pathology: those with benign results after postoperative pathology were classified as Group 1, and those with malignant results after postoperative pathology were classified as Group 2. As a result, 66 patients were found to be AUS/FLUS. A total of 28.8% of AUS/FLUS patients have been determined with cancer. In the statistical analysis of the ACR TI-RADS score between the groups, the ACR TI-RADS score in Group 1 patients (3.36) (SD 0.87) was significantly lower than that in Group 2 patients (4.11) (SD 1.04) (p=0.003). The distribution of the ACR TI-RADS scores of the patients in Group 2 was TR2: 2 (15.4%) patients, TR3: 3 (25%) patients, TR4: 5 (16.1%), TR5: 9 (90%) patients, respectively. The ACR TI-RADS score was statistically significant in predicting malignancy in AUS/FLUS patients whose follow-ups and treatments are controversial, and the ACR TI-RADS has a limited role in preventing unnecessary thyroidectomies in patients with AUS/FLUS.
Highlights
The incidence of thyroid cancer is increasing worldwide, and it is the most common cancer observed in the endocrine system[1]
We investigated the efficacy of the American College of Radiology (ACR) TI-RADS in preventing unnecessary thyroidectomies in patients with AUS/FLUS identified using Fine needle aspiration (FNA) cytology results
The FNA biopsy (FNAB) was repeated in patients whose FNAB results were presented as AUS/FLUS, and when these results were the same, the patients were scheduled for thyroidectomy, The patients whose control FNAB results were reported as AUS/FLUS and who performed thyroidectomy were included in this study
Summary
The incidence of thyroid cancer is increasing worldwide, and it is the most common cancer observed in the endocrine system[1]. Fine needle aspiration (FNA) cytology is a safe method that prevents unnecessary surgical procedures for a benign nodule[3,4]. In 2007, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was proposed[5]. In TBSRTC, the third category has been defined as atypia of undetermined significance and follicular lesion of uncertain significance (AUS/FLUS) (BETHESDA 3). This category is a group of highly heterogeneous thyroid lesions with a high limit of cellularity. The “AUS/FLUS” category in TBSRTC caused controversy. The cases in this heterogeneous group include FNA
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