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.
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.
Authors: David S Cooper; Gerard M Doherty; Bryan R Haugen; Bryan R Hauger; Richard T Kloos; Stephanie L Lee; Susan J Mandel; Ernest L Mazzaferri; Bryan McIver; Furio Pacini; Martin Schlumberger; Steven I Sherman; David L Steward; R Michael Tuttle Journal: Thyroid Date: 2009-11 Impact factor: 6.568
Authors: Constantine G A Theoharis; Kevin M Schofield; Lynwood Hammers; Robert Udelsman; David C Chhieng Journal: Thyroid Date: 2009-11 Impact factor: 6.568
Authors: Erik K Alexander; Giulia C Kennedy; Zubair W Baloch; Edmund S Cibas; Darya Chudova; James Diggans; Lyssa Friedman; Richard T Kloos; Virginia A LiVolsi; Susan J Mandel; Stephen S Raab; Juan Rosai; David L Steward; P Sean Walsh; Jonathan I Wilde; Martha A Zeiger; Richard B Lanman; Bryan R Haugen Journal: N Engl J Med Date: 2012-06-25 Impact factor: 91.245
Authors: Jennifer L Rabaglia; Wareef Kabbani; Lucy Wallace; Shelby Holt; Lori Watumull; Jeffrey Pruitt; William H Snyder; Fiemu E Nwariaku Journal: Surgery Date: 2010-12 Impact factor: 3.982
Authors: N Paul Ohori; Marina N Nikiforova; Karen E Schoedel; Shane O LeBeau; Steven P Hodak; Raja R Seethala; Sally E Carty; Jennifer B Ogilvie; Linwah Yip; Yuri E Nikiforov Journal: Cancer Cytopathol Date: 2010-02-25 Impact factor: 5.284
Authors: Mi Ri Yoo; Hye Mi Gweon; Ah Young Park; Kyung Eun Cho; Jeong-Ah Kim; Ji Hyun Youk; Eun Ju Son Journal: PLoS One Date: 2015-06-26 Impact factor: 3.240