Clinical and Prognostic Features of Malignant Thyroid Nodules With Atypia of Undetermined Significance Cytology: Evaluation of Nuclear Atypia-Based Subgroups.
Yusuf Öztürk, Naile Kökbudak, Muhammet Kocabaş, Melia Karaköse, Mustafa KulaksizoĞlu, Feridun Karakurt
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Abstract
Background: The aim of this study was to evaluate the clinical and prognostic characteristics of thyroid nodules that were initially diagnosed as atypia of undetermined significance (AUS) and subsequently confirmed as malignant following surgery. The study also aimed to investigate their subclassification based on nuclear atypia.
Methods: Patients who underwent thyroid surgery and were diagnosed with differentiated thyroid carcinoma between January 2016 and December 2024, and who had undergone a preoperative fine-needle aspiration biopsy (FNAB), were categorized retrospectively into three groups based on their cytological classification: AUS, suspicious for malignancy (SFM) and malignant (M). The clinicopathological and prognostic characteristics of these groups were then compared. Patients in the AUS group were also categorized according to the presence of nuclear atypia for further analysis.
Results: Of the 775 patients, 11.7% were assigned to the AUS group, 35.1% to the SFM group, and 53.2% to the M group. Nodules in the AUS group were significantly smaller in diameter and exhibited fewer invasive features compared to those in the SFM and M groups (p < 0.05). The M group showed higher rates of advanced TNM staging, lymph node metastasis, and distant metastasis. Patients in the AUS group demonstrated the highest proportion of low-risk classification (93.4%) and the highest rate of excellent response to therapy (96.7%), with no observed recurrence or progression. No significant differences in invasiveness were found between AUS-nuclear atypia (AUS-N) and AUS-other atypia (AUS-O) subgroups, both of which exhibited similarly indolent profiles.
Conclusion: Malignant nodules diagnosed as AUS exhibited an indolent course and an excellent prognosis. Our findings suggest that less aggressive, more individualized treatment strategies should be considered for AUS cases, and emphasize the potential prognostic value of nuclear atypia-based subclassification.
期刊介绍：
Diagnostic Cytopathology is intended to provide a forum for the exchange of information in the field of cytopathology, with special emphasis on the practical, clinical aspects of the discipline. The editors invite original scientific articles, as well as special review articles, feature articles, and letters to the editor, from laboratory professionals engaged in the practice of cytopathology. Manuscripts are accepted for publication on the basis of scientific merit, practical significance, and suitability for publication in a journal dedicated to this discipline. Original articles can be considered only with the understanding that they have never been published before and that they have not been submitted for simultaneous review to another publication.
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