World Journal of Surgery

, Volume 38, Issue 3, pp 628–633 | Cite as

Utilization and Impact of Repeat Biopsy for Follicular Lesion/Atypia of Undetermined Significance

Article

Abstract

Background

The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) created a new diagnostic category, follicular lesion/atypia of undetermined significance (FLUS/AUS). The recommended management of FLUS/AUS lesions is repeat biopsy to re-classify the lesion and guide therapy. Prior surgical studies suggest a higher than expected malignancy rate for FLUS/AUS. The present study evaluates a large institutional experience with all FLUS/AUS lesions analyzing use and impact of repeat biopsy.

Methods

A total of 322 patients with FLUS/AUS cytology have been retrospectively identified since adoption of the BSRTC (2/2009–6/2012). Patient demographics, the results of clinical follow-up, repeat biopsy, or surgical pathology results were evaluated.

Results

Among the 322 patients, 16 had concurrent cytology of higher acuity and were excluded. For the remaining 306 patients, 101 (33 %) underwent repeat biopsy, yielding 49 (48.5 %) with FLUS/AUS, 43 (42.5 %) with benign cytology, and 9 (9 %) with higher acuity cytology. Among the 205 patients without repeat biopsy, 117 (57 %) chose thyroidectomy, and 88 (43 %) are being observed. Overall, 170/306 (55.6 %) patients underwent surgery to remove the index lesion, yielding a malignancy rate of 16.5 %. In contrast, the malignancy rate for the entire cohort was 28/306 (9 %).

Conclusions

Repeat biopsy was underutilized in FLUS/AUS cases. Repeat biopsy allows a significant proportion of FLUS/AUS patients without other indications for surgery to move to surveillance. In patients who have indications for thyroidectomy regardless of FLUS/AUS results, repeat biopsy does not appear necessary. Malignancy and thyroidectomy rates were similar among patients who did or did not have a repeat biopsy. Further data must be obtained to determine the long-term outcomes for surveillance of FLUS/AUS lesions in patients who do not undergo surgical removal.

References

  1. 1.
    Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214PubMedCrossRefGoogle Scholar
  2. 2.
    Cibas ES, Ali SZ (2009) The Bethesda System for Reporting Thyroid Cytopathology. Thyroid 19:1159–1165PubMedCrossRefGoogle Scholar
  3. 3.
    Cross PA, Poller D (2010) The Bethesda thyroid terminology and progress towards international agreement on thyroid FNA cytology reporting. Cytopathology 21:71–74PubMedCrossRefGoogle Scholar
  4. 4.
    Yang J, Schnadig V, Logrono R et al (2007) Fine-needle aspiration of thyroid nodules: a study of 4,703 patients with histologic and clinical correlations. Cancer 111:306–315PubMedCrossRefGoogle Scholar
  5. 5.
    Yassa L, Cibas ES, Benson CB et al (2007) Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer 111:508–516PubMedCrossRefGoogle Scholar
  6. 6.
    Nikiforova MN, Nikiforov YE (2009) Molecular diagnostics and predictors in thyroid cancer. Thyroid 19:1351–1361PubMedCrossRefGoogle Scholar
  7. 7.
    Broome JT, Solorzano CC (2011) The impact of atypia/follicular lesion of undetermined significance on the rate of malignancy in thyroid fine-needle aspiration: evaluation of the Bethesda System for Reporting Thyroid Cytopathology. Surgery 150:1234–1241PubMedCrossRefGoogle Scholar
  8. 8.
    Mathur A, Weng J, Moses W et al (2010) A prospective study evaluating the accuracy of using combined clinical factors and candidate diagnostic markers to refine the accuracy of thyroid fine needle aspiration biopsy. Surgery 148:1170–1176 discussion 1176–1177PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Layfield LJ, Morton MJ, Cramer HM et al (2009) Implications of the proposed thyroid fine-needle aspiration category of “follicular lesion of undetermined significance”: a five-year multi-institutional analysis. Diagn Cytopathol 37:710–714PubMedCrossRefGoogle Scholar
  10. 10.
    Alexander EK, Kennedy GC, Baloch ZW et al (2012) Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N Engl J Med 367:705–715PubMedCrossRefGoogle Scholar
  11. 11.
    Rabaglia JL, Kabbani W, Wallace L et al (2010) Effect of the Bethesda System for Reporting Thyroid Cytopathology on thyroidectomy rates and malignancy risk in cytologically indeterminate lesions. Surgery 148:1267–1272 discussion 1272–1273PubMedCrossRefGoogle Scholar
  12. 12.
    Chen JC, Pace SC, Chen BA et al (2012) 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 152:1037–1044PubMedCrossRefGoogle Scholar
  13. 13.
    Deandrea M, Ragazzoni F, Motta M (2010) Diagnostic value of a cytomorphological subclassification of follicular patterned thyroid lesions: a study of 927 consecutive cases with histological correlation. Thyroid 20:1077–1083PubMedCrossRefGoogle Scholar
  14. 14.
    Theoharis CG, Schofield KM, Hammers L et al (2009) The Bethesda thyroid fine-needle aspiration classification system: year 1 at an academic institution. Thyroid 19:1215–1223PubMedCrossRefGoogle Scholar
  15. 15.
    Faquin WC, Baloch ZW (2010) Fine-needle aspiration of follicular patterned lesions of the thyroid: diagnosis, management, and follow-up according to National Cancer Institute (NCI) recommendations. Diagn Cytopathol 38:731–739PubMedGoogle Scholar
  16. 16.
    Jo VY, Stelow EB, Dustin SM et al (2010) Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol 134:450–456PubMedCrossRefGoogle Scholar
  17. 17.
    Ohori NP, Nikiforova MN, Schoedel KE et al (2010) Contribution of molecular testing to thyroid fine-needle aspiration cytology of “follicular lesion of undetermined significance/atypia of undetermined significance”. Cancer Cytopathol 118:17–23PubMedCrossRefGoogle Scholar
  18. 18.
    Nikiforov YE, Ohori NP, Hodak SP (2011) Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules: a prospective analysis of 1,056 FNA samples. J Clin Endocrinol Metab 96:3390–3397PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  1. 1.Division of Surgical Oncology and Endocrine SurgeryVanderbilt UniversityNashvilleUSA
  2. 2.Division of Anatomical PathologyVanderbilt UniversityNashvilleUSA

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