1. Spectrum of Risk of Malignancy in Subcategories of ‘Atypia of Undetermined Significance’
- Author
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Douglas P. Clark, Matthew T. Olson, Syed Z. Ali, and Yener S. Erozan
- Subjects
Adult ,Male ,Risk ,medicine.medical_specialty ,Histology ,Biopsy, Fine-Needle ,Thyroid Gland ,Lower risk ,Malignancy ,Pathology and Forensic Medicine ,Thyroid carcinoma ,Terminology as Topic ,Atypia ,medicine ,Carcinoma ,Humans ,Thyroid Nodule ,Nuclear atypia ,Aged ,Neoplasm Staging ,Retrospective Studies ,Gynecology ,business.industry ,Thyroid ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Bethesda system for reporting thyroid cytopathology ,Cell Transformation, Neoplastic ,medicine.anatomical_structure ,Practice Guidelines as Topic ,Female ,business - Abstract
Objective: To determine if focal ‘nuclear atypia’ or ‘microfollicular architecture’ portends a higher risk of malignancy than other subcategories of atypia of undetermined significance (AUS) in thyroid fine-needle aspirations (FNAs). Study Design: The frequencies of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) categories were calculated from 3,956 thyroid FNAs interpreted over a 26-month period at The Johns Hopkins Hospital after adoption of TBSRTC. TBSRTC criteria were applied strictly. The risk of malignancy, specifically for AUS subcategories, was analyzed by cyto-histo correlation. Results: Of the 133 cases diagnosed as AUS, 32% were found to have stageable carcinoma (not incidental microcarcinoma) on resection. When the subset of AUS with ‘nuclear atypia’ (AUS-N) was separated from other AUS cases, 48% (30/62) of them had stageable carcinoma on resection; of the AUS subset with ‘microfollicular architecture’ (AUS-F), 27% (8/30) were malignant on resection. The ‘suspicious for papillary thyroid carcinoma’ (SPTC) group maintained a higher risk of malignancy versus AUS-N (relative risk, RR 1.57; 95% CI 1.23–1.81). Conclusion: The subcategory of ‘nuclear atypia’ within AUS indicates a higher risk of malignancy than other subcategories of AUS but has a lower risk of malignancy than SPTC does. Thus, it is an important distinction with potential clinical implications.
- Published
- 2011
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