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Diagnosis and Management of Thyroid Nodules with Atypia: A Three-year Study at an Institution in Taiwan | OMICS International| Abstract

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  • Research Article   
  • Diagn Pathol Open 2016, Vol 1(1): 105
  • DOI: 10.4172/2476-2024.1000105

Diagnosis and Management of Thyroid Nodules with Atypia: A Three-year Study at an Institution in Taiwan

Yi-Ting Kuo1, Ming-Chen Chang2, Yuh-Min Song3, Chia-Lin Lee3, Chia-Po Fu3, Jun-Sing Wang3, I-Te Lee3,8, Li-Nien Tseng4, Cheng-Chung Wu5,6,7, Chin-I Wu2, Shih-Yi Lin9* and Wayne Huey-Herng Sheu3,8,10,11
1Department of Internal Medicine, Taichung Veterans General Hospital Wanqiao Branch, , Chiayi, Taiwan
2Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, , Taichung, Taiwan
3Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, , Taichung, Taiwan
4Division of Endocrinology, Department of Internal Medicine, Cheng Ching General Hospital, , Taichung, Taiwan
5Department of Surgery, Taichung Veterans General Hospital, , Taichung, Taiwan
6Department of Surgery, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan
7Department of Surgery, Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
8School of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan
9Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, , Taiwan, Taiwan
10Department of Medicine, National Defense Medical Center, , Taipei, Taiwan
11Institute of Medical Technology, College of Life Science, National Chung Hsing University, Taichung, Taiwan
*Corresponding Author : Shih-Yi Lin, Division of Endocrinology and Metabolism, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Taichung, Taiwan, Tel: +886-4-23592525 Exn. 3060, Fax: +886-4-23741318, Email: sylin@vghtc.gov.tw

Received Date: Dec 14, 2015 / Accepted Date: Jan 28, 2016 / Published Date: Feb 01, 2016

Abstract

Objective: According to Bethesda System for Reporting Thyroid Cytopathology, the category, atypia of undetermined significance (AUS), is estimated to have a low malignancy risk of around 5%-15%. Variable surgical malignancy rates of AUS have been reported in diverse populations. The present study evaluated the malignancy rate at our institution and associated demographic data to identify high-risk nodules.
Methods: In this retrospective study, thyroid nodules with initial fine-needle aspirations (FNAs) reported as AUS from April 2010 to May 2013 were analyzed. Demographic data, clinical managements, and histopathologic results were evaluated.
Results: A total of 7382 aspirations performed during the study period were analyzed; 5.7% were reported as atypia, 70.3% as benign, 1.5% as follicular neoplasm, 2.7% as suspicious for malignancy or malignant, and 19.8% as nondiagnostic. A total of 388 patients with one nodule reported as AUS were enrolled for analysis; 86 (22.2%) underwent surgical biopsy directly, 127 (32.7%) received follow-up FNAs, and 175 (45.1%) received clinical observation. The malignancy rate in the 86 patients who underwent surgical biopsy directly after first AUS was 17.4%. Out of the 127 patients who received follow-up FNAs, 105 were reclassified into the different-rank risk categories (benign, neoplasm or malignancy, and nondiagnostic) and 22 remained in AUS. Among the 33 patients out of 127 who received thyroid surgery after follow-up FNAs, the malignancy rates in the 8 patients with repeated AUS results and 11 patients with benign results in the second FNA were 50% and 9.1%, respectively. No significant difference in sex, age, nodular size, numbers, and preoperative thyroid-stimulating hormone level between the benign and malignant groups in the thyroid AUS cases was observed.
Conclusion: Repeated AUS may be associated with a higher malignancy rate in final histopathology, and other supplementary techniques are required to enhance preoperative diagnostic accuracy.

Keywords: Follicular neoplasm; Fine needle aspirations (FNA); Cytopathology

Citation: Kuo YT, Chang MC, Song YM, Lee CL, Fu CP, et al. (2016) Diagnosis and Management of Thyroid Nodules with Atypia: A Three-year Study at an Institution in Taiwan. Diagn Pathol Open 1: 105. Doi: 10.4172/2476-2024.1000105

Copyright: ©2016 Kuo YT, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Review summary

  1. Feroz Md
    Posted on Aug 24 2016 at 2:12 pm
    Thyroid nodules are quite common in clinical practice worldwide. The authors analysed the medical records of patients undergoing thyroid nodule final needle aspirations (ANS) and diagnosed with atypia of undetermined significance (AUS). The authors concluded that repeated AUS may be associated with higher malignancy rate in final histopathology or the patients.
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