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Incidence of Malignancy in Thyroid Nodules Determined to be Follicular Lesions of Undetermined Significance on Fine-Needle Aspiration

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Abstract

Background

Fine-needle aspiration (FNA) for thyroid nodules is the most important method for determining a diagnosis. The system for reporting results is based on a cytopathologic classification that stratifies the risk of malignancy.

Methods

We retrospectively studied 197 patients who underwent FNA for diagnostic evaluation of a thyroid nodule and had their results reported as a follicular lesion of undetermined significance (FLUS) using the Bethesda classification system. The objective of the study was to analyze the incidence and histopathologic types of malignancy in these cases.

Results

The final histopathologic breakdown is as follows: 65 cases (32.9%) of follicular adenoma, 81 cases (41.1%) of microfollicular adenomatoid nodule, 19 cases (9.6%) of microfollicular adenomatoid nodule on the background of thyroiditis, 17 cases (8.6%) of follicular carcinoma, 9 cases (4.6%) of follicular variant papillary carcinoma, and 6 cases (3.1%) of classic papillary carcinoma, for a 16.2% incidence of malignancy. Beyond these diagnoses in the FNA-biopsied nodules, we observed 29 cases (14.7%) of incidental ipsilateral papillary thyroid microcarcinoma (PTM) and 13 cases (6.6%) of incidental contralateral thyroid lobe PTM.

Conclusions

This study observed a 16.2% incidence of thyroid cancer in the nodule designated FLUS compared to the 5 to 15% rate reported by the Bethesda FNA classification. The overall incidence of incidental PTM in the thyroid gland was 21.3%. These data support considering surgical intervention for at least diagnostic purposes in a patient with the FNAB diagnosis of FLUS.

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Acknowledgments

The authors thank Barbara Silver, BS, MBA for her contribution to this study.

Conflicts of interest

The authors report no potential conflicts of interest in this study.

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Authors and Affiliations

  1. Department of Oncologic Surgery/Head and Neck Surgery CEPON, R. Presidente Coutinho, 579, Sala 304, Florianopolis, SC, 88015-231, Brazil

    Gilberto V. Teixeira & Thiago Teixeira

  2. IMP Laboratory, R. Menino Deus, 63 Sala 14, Florianopolis, SC, 88000, Brazil

    Horacio Chikota

  3. University Hospital UNOESC, R. Getulio Vargas, 2125, Joacaba, SC, 89600, Brazil

    Gabriel Manfro

  4. Department of Otolaryngology/Head and Neck Surgery, Johns Hopkins Medical Institutions, 601 N Caroline Street, JHOC, 6th Floor, Baltimore, MD, 21231, USA

    Gilberto V. Teixeira, Sara I. Pai & Ralph P. Tufano

Authors
  1. Gilberto V. Teixeira
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  2. Horacio Chikota
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  3. Thiago Teixeira
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  4. Gabriel Manfro
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  5. Sara I. Pai
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  6. Ralph P. Tufano
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Correspondence to Gilberto V. Teixeira.

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Teixeira, G.V., Chikota, H., Teixeira, T. et al. Incidence of Malignancy in Thyroid Nodules Determined to be Follicular Lesions of Undetermined Significance on Fine-Needle Aspiration. World J Surg 36, 69–74 (2012). https://doi.org/10.1007/s00268-011-1336-8

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  • DOI: https://doi.org/10.1007/s00268-011-1336-8

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