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Both Ultrasound Features and Nuclear Atypia are Associated with Malignancy in Thyroid Nodules with Atypia of Undetermined Significance

  • Endocrine Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The optimal management of thyroid nodules that undergo fine-needle aspiration (FNA) with findings of atypia of undetermined significance (AUS) is unclear. Categorizing nodules by AUS subtype and ultrasound characteristics may improve risk stratification. Therefore, the purpose of this study is to evaluate the association between AUS subtype and ultrasound features on risk of malignancy (ROM).

Methods

We performed a review of all patients with a thyroid nodule who underwent an FNA at our institution between January 2010 and November 2015. Patients with AUS were divided into groups with (1) nuclear atypia, (2) architectural atypia, or (3) Hurthle cell atypia. Their ultrasound features were assessed using the American Thyroid Association (ATA) thyroid nodule sonographic patterns. We conducted a univariate and multivariable analysis to determine the association between AUS subtype and other variables of interest with ROM.

Results

Of the 3428 thyroid nodules that underwent FNA, 237 (6.9%) had AUS. Of the 97 surgically resected nodules, 67 (69%) were benign and 30 (31%) were malignant. On univariate analysis nuclear atypia (p < 0.01) was associated with a thyroid malignancy. On multivariable analysis, both ATA high-risk ultrasound features (p = 0.04, odds ratio [OR] 3.68) and nuclear atypia (p < 0.01, OR 11.8) were independently associated with a final diagnosis of thyroid carcinoma.

Conclusions

Nuclear atypia and ATA high-risk ultrasound features are useful in identifying patients with AUS that are at a higher risk of thyroid malignancy. Surgeons should take these factors into consideration when evaluating patients with AUS.

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Acknowledgement

The authors thank Dr. Alison Semrad and Dr. Kent Ishihara for their help reviewing and providing critical feedback on this manuscript. We would also like to thank Dr. Sandra Taylor for statistical assistance.

Funding

Department funds were used for incidental expenses.

Author information

Author notes

  1. Naseem Eisa and Ahsan Khan share first authorship on this manuscript, because they contributed equally to the project.

Authors and Affiliations

  1. Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA, USA

    Naseem Eisa MD

  2. School of Medicine, University of California, Davis Medical Center, Sacramento, CA, USA

    Ahsan Khan BS, Mutaal Akhter BS, Molly Fensterwald BS & Saba Saleem BS

  3. Department of Radiology, University of California, Davis Medical Center, Sacramento, CA, USA

    Ghaneh Fananapazir MD

  4. Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, USA

    Michael J. Campbell MD

  5. University of California, Davis, Comprehensive Cancer Center, Sacramento, CA, USA

    Michael J. Campbell MD

Authors
  1. Naseem Eisa MD
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  2. Ahsan Khan BS
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  3. Mutaal Akhter BS
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  4. Molly Fensterwald BS
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Corresponding author

Correspondence to Michael J. Campbell MD.

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Eisa, N., Khan, A., Akhter, M. et al. Both Ultrasound Features and Nuclear Atypia are Associated with Malignancy in Thyroid Nodules with Atypia of Undetermined Significance. Ann Surg Oncol 25, 3913–3918 (2018). https://doi.org/10.1245/s10434-018-6826-6

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  • DOI: https://doi.org/10.1245/s10434-018-6826-6

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