Proposal for Clinical Management of Nodules Diagnosed as Atypia of Undetermined Significance via Thyroid Fine-Needle Aspiration Cytology in the Absence of Molecular Testing

IF 1.2 4区医学 Q4 CELL BIOLOGY

Cytopathology Pub Date : 2025-01-10 DOI:10.1111/cyt.13467

Ayana Suzuki, Mitsuyoshi Hirokawa, Makoto Kawakami, Takumi Kudo, Akira Miyauchi, Takashi Akamizu

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Abstract

Objective

Molecular testing is recommended for risk stratification of atypia of undetermined significance (AUS) nodules in the USA; however, it is not routinely performed in some countries owing to limited availability and affordability. Here, we propose a risk stratification algorithm for AUS nodules when molecular testing is unavailable.

Methods

We examined 304 (4.3%) AUS nodules among 7073 thyroid fine-needle aspiration cytology specimens examined at Kuma Hospital from January 2020 to December 2020. Clinical data were obtained from the medical records of Kuma Hospital.

Results

AUS with nuclear atypia and AUS-other each accounted for half of the total AUS nodules. The repeat aspiration rate was 19.7%; 61.7% of the nodules were reclassified as benign or malignant upon repeat aspiration. Resection rate and overall risk of malignancy (ROM) were 32.6% and 12.8%, respectively. Architectural atypia showed the lowest (1.1%) overall ROM in the AUS nodules. For AUS with nuclear atypia, nodules ≤ 10 mm in size showed significantly lower overall ROM than those of > 10 mm, and nodules with ultrasonographically low suspicion showed significantly lower overall ROM than those with intermediate to high suspicion. AUS nodules with atypical lymphoid cells, possible medullary thyroid carcinoma, or possible parathyroid lesion were confirmed using flow cytometry, biochemical testing using needle washout fluid or immunocytochemistry, respectively.

Conclusions

Our proposed clinical management algorithm for each subdivision according to cytological findings, based on repeat aspiration rates, ROM, ultrasound findings and results of ancillary tests except for molecular testing, should be useful for the clinical management of AUS nodules.

Abstract Image

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在没有分子检测的情况下，甲状腺细针穿刺细胞学诊断为意义不明的异型结节的临床处理建议。

目的：在美国，分子检测被推荐用于不确定意义（AUS）非典型性结节的风险分层；但是，由于供应有限和负担不起，在一些国家并不经常进行这种检查。在此，我们提出了一种无法进行分子检测的AUS结节风险分层算法。方法：我们于2020年1月至2020年12月在熊马医院检查的7073例甲状腺细针穿刺细胞学标本中检查了304例（4.3%）AUS结节。临床资料来源于Kuma医院的病历。结果：合并核异型型的AUS和其他类型的AUS各占AUS结节总数的一半。重复吸入率为19.7%；61.7%的结节经重复抽吸后重新分类为良性或恶性。切除率为32.6%，总恶性风险（ROM）为12.8%。建筑非典型性显示AUS结节的总体ROM最低（1.1%）。对于核非典型性AUS，小于10 mm的结节总体ROM明显低于小于10 mm的结节，超声低怀疑结节总体ROM明显低于中高怀疑结节。AUS结节伴非典型淋巴样细胞、可能的甲状腺髓样癌或可能的甲状旁腺病变，分别用流式细胞术、针冲洗液生化检测或免疫细胞化学方法确诊。结论：我们提出的基于细胞学检查、重复抽吸率、ROM、超声检查和除分子检查外的辅助检查结果的每个细分的临床管理算法，应该对AUS结节的临床管理有用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cytopathology 生物-病理学

CiteScore

2.30

自引率

15.40%

发文量

107

审稿时长

6-12 weeks

期刊介绍： The aim of Cytopathology is to publish articles relating to those aspects of cytology which will increase our knowledge and understanding of the aetiology, diagnosis and management of human disease. It contains original articles and critical reviews on all aspects of clinical cytology in its broadest sense, including: gynaecological and non-gynaecological cytology; fine needle aspiration and screening strategy. Cytopathology welcomes papers and articles on: ultrastructural, histochemical and immunocytochemical studies of the cell; quantitative cytology and DNA hybridization as applied to cytological material.