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This retrospective study established a possible association between these cytological categories and malignancy rates in patients treated at a single institution. The authors declare no competing interests. Diagn Cytopathol. WebAccording to 2017 TBSRTC, the risk of malignancy for these Bethesda III thyroid nodules is estimated to be 10%30%, but recent studies have reported malignancy rates The feasible classification of thyroid nodules based on FNAC has provided an insight into the implications for histopathology, focused on the malignancy risk among thyroid lesions [18, 19]. All patients with nodules with two consecutive AUS/FLUS diagnoses (n=33) underwent surgery, of which 45.5% (15/33) were found to be malignant while 54.5% (18/33) were benign (Fig. Utilization and impact of repeat biopsy for follicular lesion/atypia of undetermined significance. WebBethesda Category III, IV, and V Thyroid Nodules: Can Nodule Size Help Predict Malignancy? Patients with III and IV category of the Bethesda System under levothyroxine non-suppressive therapy have a lower rate of thyroid malignancy. Our study demonstrates that patients with thyroid nodules assigned to category IV taking thyroid hormone therapy in non-suppressive doses might be monitored for longer periods of time without surgical treatment than those who are not receiving this therapy. Our findings are comparable with the literature for Bethesda category III and IV nodules, the two most controversial cytological categories, giving a range of 1030% for AUS/FLUS and 2540% for FN/SFN based on the reviewed data [4, 8]. Youve viewed {{metering-count}} of {{metering-total}} articles this month. Surgery 156, 14711476 (2014). If you wish to read unlimited content, please log in or register below. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. 2). These two categories of TBSRTC are the most controversial cytological groups and are managed completely differently by many departments. We retrospectively analyzed the medical records of 4,716 individuals and selected 532 (11.28%) patients with Bethesda System category III and IV thyroid nodules. Among them, 108 were diagnosed with AUS/FLUS (59 patients were AUS and 49 were FLUS) and 47 were diagnosed with FN/SFN (Fig. The FNAC results were compared with histopathology as the gold standard method. Astwood, E. B., Cassidy, C. E. & Aurbach, G. D. Treatment of goiter and thyroid nodules with thyroid. Others suggest that the variability in diagnosis is attributable to differences in the populations analyzed, pharmacological management, selection of TNs and classification bias1. BMC Endocr Disord. Among the malignant lesions, the most frequently diagnosed entity was papillary thyroid carcinoma, diagnosed in 81.5% of AUS/FLUS and 69.2% of FN/SFN patients (Table3). A P-value less than 0.05 was considered significant. It would be a very helpful diagnostic tool for clinicians to choose the more appropriate therapeutic approach. The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. 10 patients with FN/SFN were excluded due to other thyroid diseases such lymphomas (4/10) and secondary tumors (6/10). Ho, A. S. et al. Alexander et al. Google Scholar. https://doi.org/10.1038/s41598-019-44931-8, DOI: https://doi.org/10.1038/s41598-019-44931-8. TSH non-suppressive LT-4 therapy in the first group of patients was administered and conducted at a minimum for the last two years before surgery. 44, 394398 (2016). There are six cytological diagnostic categories, each with different suggested treatment approaches. Endocrinol. In our thyroid FNAC practice, the Bethesda III category was divided into AUS and FLUS. WebBethesda Category V is considered 60% - 75% likely to be malignant. 2016;26(1):1133. Krzysztof Kaliszewski. Investigation: K.K. There were no cases of NIFTP among our thyroidectomy patients. New Engl J Med. In such cases, the matter of unnecessary surgeries should be taken into consideration20. 2014;42:1822. Bethesda category III describes the cytological findings as atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS), while Bethesda category IV represents follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) [1, 4,5,6]. Kaliszewski, K., Diakowska, D., Wojtczak, B. et al. TI-RADS 4a category Mildly suspect nodules are both mildly hypoechoic, and no sign of high suspicion TI-RADS 4b and 4c categories Highly suspicious features include taller than wide shape irregular borders microcalcifications markedly hypoechoic high stiffness with sonoelastography (if available) Cavalheiro et al. With regard to future objectives, molecular assays are gaining importance for determining the need for surgical interventions for thyroid lesions. Head Neck. Tucker Carlson ousted at Fox News following network's $787 million settlement. This retrospective study established a possible association between these cytological categories and malignancy rates in patients treated at a single institution. Thank you for visiting nature.com. The study was approved by Kocaeli Derince Training and Research Hospital Clinical Research Ethics Committee of Health Sciences University, Turkey (Protocol number: 202031). When comparing the localisation of nodules in the AUS/FLUS and FN/SFN groups, nodules in both groups were more frequently located in the right lobe of the thyroid (60.2 and 61.7%, respectively). and Z.F. https://doi.org/10.1186/s12902-020-0530-9, DOI: https://doi.org/10.1186/s12902-020-0530-9. 2009;117:298304. Currently, we know that the oncological potential of these tumors is not clearly established, and the risk of further progression towards aggressive behavior is still uncertain. Nodules with nondiagnostic or indeterminate (Bethesda categories 1, 3, and 4) were excluded unless precise FNAB results or after resection the histologic results were available. WebBethesda classification system for thyroid fine needle aspirates comprises six categories of pathological reporting of thyroid FNA, with each category linked to a malignancy risk. reported a malignancy rate of 16% among thyroid nodules classified as Bethesda category III, and 17% among those classified as Bethesda category IV [20]. 53 individuals (53/73 additionally excluded; Fig. Among the cases in Bethesda category IV (n=440), 35 (8.0%) underwent immediate surgery, 96 (21.8%) underwent repeat FNAC in 13months, and 309 (70.2%) were observed at 3-month intervals via ultrasonography to measure the size and content of the nodule. Malignancy rate in thyroid nodules classified as Bethesda category III (AUS/FLUS). Article Mathur et al. emphasized that L-T4 is one of the most widely and commonly prescribed medications in the United States7. Huang, J. et al. Endocrinol. Frequencies were analyzed using chi-square test and Fisher exact test. However, there are controversial data about the risk of malignancies, recurrence and clinical management of nodules in Bethesda categories III and IV, as the reported risks of malignancy vary significantly, from 10 to 30% to 2540% (including noninvasive follicular thyroid neoplasm with papillary-like nuclear features [NIFTP]), respectively [4]. By submitting a comment you agree to abide by our Terms and Community Guidelines. Google Scholar. We hope youre enjoying the latest clinical news, full-length features, case studies, and more. The study authors noted that because there is heterogeneity in categorization at different institutions, it is important to determine the rates of malignancy at each institution. Lloyd RV, Osamura RY, Kloppel G. Tumours of the thyroid gland. Currently, various surgical centers have different approaches to treating these lesions4, ranging from an observation-only protocol with ultrasound-guided fine-needle aspiration biopsy (UG-FNAB) repeated at six-month intervals to surgery only5,6. Int. Eszlinger M, Lau L, Ghaznavi S, et al. The nonparametric Mann-Whitney test was used to compare quantitative variables, while the chi-square test or chi-square test for independence were used to compare dependent or independent qualitative data. Comparing the Bethesda System for Reporting Thyroid Cytopathology, the choice for the management of nodules may be determined by a cytopathological follow-up or molecular testing, which becomes instrumental to rule out cancer judiciously and reduce unnecessary thyroidectomies [25]. Walts AE, Mirocha J, Bose S. Follicular lesion of undetermined significance in thyroid FNA revisited. Conceptualization: K.K. WHO classification of Tumours of endocrine organs. Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. studied 541 AUS thyroid nodules in patients with a median age of 54years, 80.4% of whom were females, and the median nodule size was 1.9cm [8]. France: IARC, Lyon; 2017. p. 65145. Thyroid 24, 494501 (2014). Although we did not perform an analysis of the correlation of age, gender and nodule size with the malignancy rate, we believe that these results are valuable as they are consistent with the literature. All tests were two-sided and 0.05 was considered statistically significant. Endocr. Thyroid follicular lesion of undetermined significance: evaluation of the risk of malignancy using the two-tier sub-classification. Nevertheless, when examined by type of thyroid malignancy, the rate of follicular carcinoma and other rare malignancy increased with increasing nodule size. In our study 4,716 patients were analyzed with a 100% histopathological follow-up. The rate of invasion into the thyroid capsule was higher in the FN/SFN group (46.2%) compared to the AUS/FLUS group (22.2%), although there was no significant difference between groups (P=0.24). Nagarkatti SS, Faquin WC, Lubitz CC, Garcia DM, Barbesino G, Ross DS, Hodin RA, Daniels GH, Parangi S. Management of thyroid nodules with atypical cytology on fine-needle aspiration biopsy. A significant relationship between two binary variables and two levels of confounding factors (Bethesda System categories III and IV) was demonstrated (p=0.007). Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Non-diagnostic/unsatisfactory, 2. Gharib, H. et al. No significant difference was seen in this regard for Bethesda IV nodules. Bethesda categories II, V and VI are well established, and therefore not subject to any disagreement in terms of their malignancy rates [6]. Therefore, the authors recommended surgical resection for this cytological condition [22]. statement and Am. The Baron of Hell is a massive and brutal, dangerous warrior and contender for the throne of Hell. Overall, 4.2% (2630/11627) of all thyroid FNAs performed during the study period were classified as AUS/FLUS (Fig. The other important issue that the large group of malignant tumors assigned to Bethesda System categories III and IV turned out to be microcarcinomas. In our study, we demonstrated a lower rate of thyroid malignancy in patients with thyroid nodules assigned to AUS/FLUS category taking TSH non-suppressive dose of L-T4 compared with patients in the same category, but without thyroid hormone therapy. Thyroid 26, 1133 (2016). Diagn. 136, 572577 (2011). Cytopathol. The majority of patients were female (85.2%) and 13.8% were male. FNAC outcomes are routinely classified using the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), facilitating appropriate clinical management. Nat Rev Endocrinol. Shi Y, Ding X, Klein M, Sugrue C, Matano S, Edelman M, Wasserman P. Thyroid fine-needle aspiration with atypia of undetermined significance: a necessary or optional category? Differences in malignancy rates may be related to variability in randomisation, between institutions or in pathologic interpretation.

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