PATIENTS CHARACTERISTICS AND SONOGRAPHIC FEATURES IN THYROID NODULES WITH INDETERMINATE CYTOPATHOLOGY
AACE ePoster Library. Anabtawi A. 05/13/15; 97820; 1007
Abeer Anabtawi
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Abstract
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Objective: The Bethesda System (TBS) for thyroid cytopathology recommend limiting the use of indeterminate cytology or atypia of undetermined significance/follicular lesion of undetermined significance (AFLUS) to less than 7% of fine needle aspiration (FNA) cases as such finding represents diagnostic dilemma. None of the available biomarkers or gene mutation studies have accurate estimate of malignancy risk in this group making management plan to be dictated by the overall clinical impression. This study evaluated the rate of reporting AFLUS in a tertiary thyroid center and evaluated patients’ characteristics and sonographic features for thyroid nodules with AFLUS cytopathology to see if these findings can assist in management planning.
Methods: Retrospective study. An 833 ultrasound-guided FNA cases were performed at a tertiary center from January 2010 to January 2012. We randomly selected 200 patients which reflected 273 FNA cases. Documented patient characteristics included: age, gender, race, comorbidities, radiation exposure, and family history of thyroid cancer. Cytology findings were classified per TBS: benign, AFLUS, suspicious, malignant, and nondiagnostic. Sonographic features included solid or cystic component, size, echogenicity, microcalicifications, vascularity, margins, and length to width ratio. Mann-Whitney, chi-square and exact fisher tests were used in statistical analysis.
Results: A 273 thyroid nodules were evaluated in 200 patients (51 Males, 149 Females), median age 54 years (47-67). FNA results included: Benign 221 (80.9%), AFLUS (13.6%), malignant 5 (1.8%), and non-diagnostic 10 (3.7%). No significant difference in patients’ characteristics comparing benign nodule group to AFLUS group. In comparison to benign nodules, AFLUS nodules were not significantly different in size, hypoechogenicity [56% vs. 54%, p=0.9], microcalcifications [56% vs. 33%, p=0.2], vascularity [25.7% vs. 255, p=0.96], infiltrative margins [42.4% vs. 42.8%, p=0.58], or having taller than wide dimensions [32% vs. 29%, p=0.46]. AFLUS nodules were more likely to be solid or have solid component [AFLUS 43.2% vs. benign 21.6%, p=0.002].
Discussion: Study reflects the difficulty in achieving recommended rate of reporting AFLUS even in tertiary center. No patient characteristic or sonographic feature helped in differentiating such cases from those with benign nodules except for the presence of solid nodule component.
Conclusion: Application of quality control measures and consultation with expert cytopathologist are some options to ensure meeting guidelines requirements. Clinical judgment is the ultimate factor in formulating management plan in such cases.
Methods: Retrospective study. An 833 ultrasound-guided FNA cases were performed at a tertiary center from January 2010 to January 2012. We randomly selected 200 patients which reflected 273 FNA cases. Documented patient characteristics included: age, gender, race, comorbidities, radiation exposure, and family history of thyroid cancer. Cytology findings were classified per TBS: benign, AFLUS, suspicious, malignant, and nondiagnostic. Sonographic features included solid or cystic component, size, echogenicity, microcalicifications, vascularity, margins, and length to width ratio. Mann-Whitney, chi-square and exact fisher tests were used in statistical analysis.
Results: A 273 thyroid nodules were evaluated in 200 patients (51 Males, 149 Females), median age 54 years (47-67). FNA results included: Benign 221 (80.9%), AFLUS (13.6%), malignant 5 (1.8%), and non-diagnostic 10 (3.7%). No significant difference in patients’ characteristics comparing benign nodule group to AFLUS group. In comparison to benign nodules, AFLUS nodules were not significantly different in size, hypoechogenicity [56% vs. 54%, p=0.9], microcalcifications [56% vs. 33%, p=0.2], vascularity [25.7% vs. 255, p=0.96], infiltrative margins [42.4% vs. 42.8%, p=0.58], or having taller than wide dimensions [32% vs. 29%, p=0.46]. AFLUS nodules were more likely to be solid or have solid component [AFLUS 43.2% vs. benign 21.6%, p=0.002].
Discussion: Study reflects the difficulty in achieving recommended rate of reporting AFLUS even in tertiary center. No patient characteristic or sonographic feature helped in differentiating such cases from those with benign nodules except for the presence of solid nodule component.
Conclusion: Application of quality control measures and consultation with expert cytopathologist are some options to ensure meeting guidelines requirements. Clinical judgment is the ultimate factor in formulating management plan in such cases.
Objective: The Bethesda System (TBS) for thyroid cytopathology recommend limiting the use of indeterminate cytology or atypia of undetermined significance/follicular lesion of undetermined significance (AFLUS) to less than 7% of fine needle aspiration (FNA) cases as such finding represents diagnostic dilemma. None of the available biomarkers or gene mutation studies have accurate estimate of malignancy risk in this group making management plan to be dictated by the overall clinical impression. This study evaluated the rate of reporting AFLUS in a tertiary thyroid center and evaluated patients’ characteristics and sonographic features for thyroid nodules with AFLUS cytopathology to see if these findings can assist in management planning.
Methods: Retrospective study. An 833 ultrasound-guided FNA cases were performed at a tertiary center from January 2010 to January 2012. We randomly selected 200 patients which reflected 273 FNA cases. Documented patient characteristics included: age, gender, race, comorbidities, radiation exposure, and family history of thyroid cancer. Cytology findings were classified per TBS: benign, AFLUS, suspicious, malignant, and nondiagnostic. Sonographic features included solid or cystic component, size, echogenicity, microcalicifications, vascularity, margins, and length to width ratio. Mann-Whitney, chi-square and exact fisher tests were used in statistical analysis.
Results: A 273 thyroid nodules were evaluated in 200 patients (51 Males, 149 Females), median age 54 years (47-67). FNA results included: Benign 221 (80.9%), AFLUS (13.6%), malignant 5 (1.8%), and non-diagnostic 10 (3.7%). No significant difference in patients’ characteristics comparing benign nodule group to AFLUS group. In comparison to benign nodules, AFLUS nodules were not significantly different in size, hypoechogenicity [56% vs. 54%, p=0.9], microcalcifications [56% vs. 33%, p=0.2], vascularity [25.7% vs. 255, p=0.96], infiltrative margins [42.4% vs. 42.8%, p=0.58], or having taller than wide dimensions [32% vs. 29%, p=0.46]. AFLUS nodules were more likely to be solid or have solid component [AFLUS 43.2% vs. benign 21.6%, p=0.002].
Discussion: Study reflects the difficulty in achieving recommended rate of reporting AFLUS even in tertiary center. No patient characteristic or sonographic feature helped in differentiating such cases from those with benign nodules except for the presence of solid nodule component.
Conclusion: Application of quality control measures and consultation with expert cytopathologist are some options to ensure meeting guidelines requirements. Clinical judgment is the ultimate factor in formulating management plan in such cases.
Methods: Retrospective study. An 833 ultrasound-guided FNA cases were performed at a tertiary center from January 2010 to January 2012. We randomly selected 200 patients which reflected 273 FNA cases. Documented patient characteristics included: age, gender, race, comorbidities, radiation exposure, and family history of thyroid cancer. Cytology findings were classified per TBS: benign, AFLUS, suspicious, malignant, and nondiagnostic. Sonographic features included solid or cystic component, size, echogenicity, microcalicifications, vascularity, margins, and length to width ratio. Mann-Whitney, chi-square and exact fisher tests were used in statistical analysis.
Results: A 273 thyroid nodules were evaluated in 200 patients (51 Males, 149 Females), median age 54 years (47-67). FNA results included: Benign 221 (80.9%), AFLUS (13.6%), malignant 5 (1.8%), and non-diagnostic 10 (3.7%). No significant difference in patients’ characteristics comparing benign nodule group to AFLUS group. In comparison to benign nodules, AFLUS nodules were not significantly different in size, hypoechogenicity [56% vs. 54%, p=0.9], microcalcifications [56% vs. 33%, p=0.2], vascularity [25.7% vs. 255, p=0.96], infiltrative margins [42.4% vs. 42.8%, p=0.58], or having taller than wide dimensions [32% vs. 29%, p=0.46]. AFLUS nodules were more likely to be solid or have solid component [AFLUS 43.2% vs. benign 21.6%, p=0.002].
Discussion: Study reflects the difficulty in achieving recommended rate of reporting AFLUS even in tertiary center. No patient characteristic or sonographic feature helped in differentiating such cases from those with benign nodules except for the presence of solid nodule component.
Conclusion: Application of quality control measures and consultation with expert cytopathologist are some options to ensure meeting guidelines requirements. Clinical judgment is the ultimate factor in formulating management plan in such cases.
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