open access

Vol 67, No 1 (2016)
Original papers
Published online: 2016-02-17
Submitted: 2015-11-10
Accepted: 2015-11-30
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Analysis of clinical significance of equivocal thyroid cytology with a special consideration for FLUS category — five years of new classification of FNA results

Dorota Słowińska-Klencka, Martyna Wojtaszek-Nowicka, Stanisław Sporny, Krzysztof Kuzdak, Marek Dedecjus, Lech Pomorski, Bożena Popowicz, Ewa Woźniak-Oseła, Jan Sopiński, Krzysztof Kaczka, Włodzimierz Koptas, Mariusz Klencki
DOI: 10.5603/EP.2016.0004
·
Endokrynologia Polska 2016;67(1):23-34.

open access

Vol 67, No 1 (2016)
Original papers
Published online: 2016-02-17
Submitted: 2015-11-10
Accepted: 2015-11-30

Abstract

Introduction: The diagnostic category of follicular lesion of undetermined significance (FLUS) was intended to allow selection of cases with low risk of malignancy from all smears with indeterminate, suspicious cytology (ISC), which can potentially take advantage from repeat fine-needle aspiration (rFNA). Aim of the study was a comparison of the risk of malignancy related to FLUS nodules and other nodules with ISC: suspected follicular neoplasm (SFN) and suspected malignancy (SM), as well as analysis of the usefulness of assessing ultrasonographic malignancy risk features (UMRF) in nodules with ISC.

Material and methods: We analysed UMRF, rFNA, and results of histopathological examination (H) in 441 FLUS, 135 SFN, and 72 SM nodules.

Results: The frequency of exposing cancer in H in FLUS nodules was 5.9%, and when cytological follow up was also included it was 2.9%. rFNAs made the diagnosis more precise in 72.7% of FLUS, and in 5.2% it was diagnosis/suspicion of cancer. The incidence of cancer in SFN nodules was 8.2%, in SM nodules with suspicion of papillary cancer — 61.1%, and in nodules with suspicion of other or unspecified malignancy — 53.8% (p < 0.0001 FLUS vs. both groups). The presence of calcifications is the only independent UMRF for nodules with ISC (OR 4.7). Features of importance are also microcalcifications (OR 3.8), especially in the SM group, and taller-than-wide-shape (OR 2.2). FLUS and SFN nodules are characterised by particularly low value of assessing suspicious margins; analysis of hypoechogenicity is of low value in SFN nodules, like suspected vascularisation in SFN and SM nodules.

Conclusions: The risk of cancer in FLUS and SFN nodules is lower than in SM nodules. rFNAs of FLUS nodules make the diagnosis more precise in more than 70% of cases and are effective in revealing cancers. UMRFs present variable diagnostic value depending on the subcategory of ISC. (Endokrynol Pol 2016; 67 (1): 23–34)

Abstract

Introduction: The diagnostic category of follicular lesion of undetermined significance (FLUS) was intended to allow selection of cases with low risk of malignancy from all smears with indeterminate, suspicious cytology (ISC), which can potentially take advantage from repeat fine-needle aspiration (rFNA). Aim of the study was a comparison of the risk of malignancy related to FLUS nodules and other nodules with ISC: suspected follicular neoplasm (SFN) and suspected malignancy (SM), as well as analysis of the usefulness of assessing ultrasonographic malignancy risk features (UMRF) in nodules with ISC.

Material and methods: We analysed UMRF, rFNA, and results of histopathological examination (H) in 441 FLUS, 135 SFN, and 72 SM nodules.

Results: The frequency of exposing cancer in H in FLUS nodules was 5.9%, and when cytological follow up was also included it was 2.9%. rFNAs made the diagnosis more precise in 72.7% of FLUS, and in 5.2% it was diagnosis/suspicion of cancer. The incidence of cancer in SFN nodules was 8.2%, in SM nodules with suspicion of papillary cancer — 61.1%, and in nodules with suspicion of other or unspecified malignancy — 53.8% (p < 0.0001 FLUS vs. both groups). The presence of calcifications is the only independent UMRF for nodules with ISC (OR 4.7). Features of importance are also microcalcifications (OR 3.8), especially in the SM group, and taller-than-wide-shape (OR 2.2). FLUS and SFN nodules are characterised by particularly low value of assessing suspicious margins; analysis of hypoechogenicity is of low value in SFN nodules, like suspected vascularisation in SFN and SM nodules.

Conclusions: The risk of cancer in FLUS and SFN nodules is lower than in SM nodules. rFNAs of FLUS nodules make the diagnosis more precise in more than 70% of cases and are effective in revealing cancers. UMRFs present variable diagnostic value depending on the subcategory of ISC. (Endokrynol Pol 2016; 67 (1): 23–34)

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Keywords

thyroid cancer; FNA; FLUS

About this article
Title

Analysis of clinical significance of equivocal thyroid cytology with a special consideration for FLUS category — five years of new classification of FNA results

Journal

Endokrynologia Polska

Issue

Vol 67, No 1 (2016)

Pages

23-34

Published online

2016-02-17

DOI

10.5603/EP.2016.0004

Bibliographic record

Endokrynologia Polska 2016;67(1):23-34.

Keywords

thyroid cancer
FNA
FLUS

Authors

Dorota Słowińska-Klencka
Martyna Wojtaszek-Nowicka
Stanisław Sporny
Krzysztof Kuzdak
Marek Dedecjus
Lech Pomorski
Bożena Popowicz
Ewa Woźniak-Oseła
Jan Sopiński
Krzysztof Kaczka
Włodzimierz Koptas
Mariusz Klencki

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