Gray zone Bethesda category III - Atypia of undetermined significance lesions of the thyroid: Potential diagnostic issues and image morphometry as a useful adjunct to cytomorphology.
Tarunpreet Saini, Reetu Kundu, Manish Rohilla, Parikshaa Gupta, Nalini Gupta, Radhika Srinivasan, Uma Nahar Saikia, Pranab Dey
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Abstract
Objective: Atypia of undetermined significance (AUS) is an indeterminate category which presents a significant challenge for pathologists and clinicians. The management options are dependent on the rate of malignancy for a given populace.
Material and methods: This is a retrospective analysis of 61 cases of the AUS Bethesda category III with grouping into neoplastic and non-neoplastic according to the histopathology data and clinical follow-up. Detailed cytomorphological features were analyzed and image morphometry was done using image J software. Student's t-test was used.
Results: Out of the total 61 cases, 35 were neoplastic cases of AUS (histopathology proven), and 26 were non-neoplastic (on follow-up) cases. The risk of neoplasia and risk of malignancy observed were 57.4% and 47.5%, respectively. Neoplastic cases displayed prominent intranuclear inclusions (54%) and pseudopapillary clusters (20%). Majority of non-neoplastic cases revealed fine chromatin (96%) and pale chromatin (4%) while among neoplastic cases, 14% showed pale chromatin. Neoplastic cases showed moderate to marked nuclear pleomorphism (20%) compared to non-neoplastic cases which were monomorphic to mildly pleomorphic. None of the non-neoplastic cases exhibited frequent nuclear overlapping, nuclear grooving, or nucleoli which emphasizes the need for scrutiny of smears for these features. On image morphometry, cases with malignant outcome had larger nuclear area, perimeter, diameter, and nuclear density which were statistically significant.
Conclusion: The study illustrates the importance of identifying subtle cytomorphological features and usefulness of image morphometry as an adjunctive objective tool in AUS cases. This helps in making an accurate cytological diagnosis which guides the treating clinician regarding surgical management or need for clinical follow-up.
目的：意义未定的不典型性（AUS）是一个不确定的类别，给病理学家和临床医生带来了巨大挑战。处理方案取决于特定人群的恶性肿瘤发生率：这是一项对 61 例 AUS Bethesda III 类病例的回顾性分析，根据组织病理学数据和临床随访将其分为肿瘤性和非肿瘤性两类。分析了详细的细胞形态学特征，并使用图像 J 软件进行了图像形态计量。采用学生 t 检验：结果：在总共 61 个病例中，35 例为 AUS 肿瘤病例（组织病理学证实），26 例为非肿瘤病例（随访）。肿瘤风险和恶性风险分别为 57.4% 和 47.5%。肿瘤病例显示出突出的核内包涵体（54%）和假乳头状簇（20%）。大多数非肿瘤病例显示精细染色质（96%）和苍白染色质（4%），而在肿瘤病例中，14%显示苍白染色质。肿瘤病例表现为中度到明显的核多形性（20%），而非肿瘤病例则表现为单形到轻度多形性。非肿瘤性病例中没有一个表现出频繁的核重叠、核沟纹或核小体，这强调了对涂片进行这些特征检查的必要性。在图像形态测量方面，恶性病例的核面积、周长、直径和核密度均较大，这在统计学上有显著意义：这项研究说明了识别细微细胞形态学特征的重要性，以及图像形态测量法作为 AUS 病例辅助客观工具的实用性。这有助于做出准确的细胞学诊断，为临床医生的手术治疗或临床随访提供指导。
期刊介绍：
The CytoJournal is an open-access peer-reviewed journal committed to publishing high-quality articles in the field of Diagnostic Cytopathology including Molecular aspects. The journal is owned by the Cytopathology Foundation and published by the Scientific Scholar.
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