open access

Vol 72, No 2 (2021)
Brief communication
Published online: 2021-02-24
Submitted: 2020-12-20
Accepted: 2021-02-02
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Patient outcomes following surgical management of thyroid nodules classified as Bethesda category III (AUS/FLUS)

Francesk Mulita, Maria-Kerasia Plachouri, Elias Liolis, Michail Vailas, Konstantinos Panagopoulos, Ioannis Maroulis
DOI: 10.5603/EP.a2021.0018
·
Pubmed: 33749812
·
Endokrynologia Polska 2021;72(2):143-144.

open access

Vol 72, No 2 (2021)
Short communication
Published online: 2021-02-24
Submitted: 2020-12-20
Accepted: 2021-02-02

Abstract

Introduction: The Bethesda classification system for reporting thyroid cytopathology is the standard for interpreting fine needle aspirate (FNA). Because of its heterogeneity and inconsistent reporting, atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), known as Bethesda category III, is the most controversial category. Thyroid nodules that fall within Bethesda categories III–IV have an overall risk of malignancy of between 15 and 40%. The aim of this study was to determine the malignancy rate in Bethesda III nodules.

Material and methods: A retrospective study was performed for 1166 patients who underwent thyroid surgery for multinodular goitre (MNG) or solitary nodular goitre (SNG) in our institution between June 2010 and May 2020. Data retrieved included demographic characteristics of the patients, FNB cytology, thyroid function test results, type of thyroidectomy, and final histology results.

Results: During the study period, 29.5% (344/1166) of patients with an FNA categorized as AUS/FLUS underwent thyroid surgery. Of these 344 patients, 190 were diagnosed with MNG and 154 with SNG. Incidental malignancy was found in 35 of 190 cases of MNG (18.42%) and 31 of 154 cases of SNG (20.13%). The most common malignant tumour type in either category was the follicular variant of papillary thyroid carcinoma.

Conclusions: The current study demonstrates that patients with a FNA categorized as AUS/FLUS may have a higher risk of malignancy than traditionally believed. Reconsideration may be necessary to guidelines that recommend observation or repeat FNA in this category of patients.

Abstract

Introduction: The Bethesda classification system for reporting thyroid cytopathology is the standard for interpreting fine needle aspirate (FNA). Because of its heterogeneity and inconsistent reporting, atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), known as Bethesda category III, is the most controversial category. Thyroid nodules that fall within Bethesda categories III–IV have an overall risk of malignancy of between 15 and 40%. The aim of this study was to determine the malignancy rate in Bethesda III nodules.

Material and methods: A retrospective study was performed for 1166 patients who underwent thyroid surgery for multinodular goitre (MNG) or solitary nodular goitre (SNG) in our institution between June 2010 and May 2020. Data retrieved included demographic characteristics of the patients, FNB cytology, thyroid function test results, type of thyroidectomy, and final histology results.

Results: During the study period, 29.5% (344/1166) of patients with an FNA categorized as AUS/FLUS underwent thyroid surgery. Of these 344 patients, 190 were diagnosed with MNG and 154 with SNG. Incidental malignancy was found in 35 of 190 cases of MNG (18.42%) and 31 of 154 cases of SNG (20.13%). The most common malignant tumour type in either category was the follicular variant of papillary thyroid carcinoma.

Conclusions: The current study demonstrates that patients with a FNA categorized as AUS/FLUS may have a higher risk of malignancy than traditionally believed. Reconsideration may be necessary to guidelines that recommend observation or repeat FNA in this category of patients.

Get Citation

Keywords

thyroid nodule; thyroid cancer; Bethesda classification

About this article
Title

Patient outcomes following surgical management of thyroid nodules classified as Bethesda category III (AUS/FLUS)

Journal

Endokrynologia Polska

Issue

Vol 72, No 2 (2021)

Article type

Brief communication

Pages

143-144

Published online

2021-02-24

DOI

10.5603/EP.a2021.0018

Pubmed

33749812

Bibliographic record

Endokrynologia Polska 2021;72(2):143-144.

Keywords

thyroid nodule
thyroid cancer
Bethesda classification

Authors

Francesk Mulita
Maria-Kerasia Plachouri
Elias Liolis
Michail Vailas
Konstantinos Panagopoulos
Ioannis Maroulis

References (5)
  1. Kopczyński J, Suligowska A, Niemyska K, et al. The influence of the reclassification of NIFTP as an uncertain tumour on risk of malignancy for the diagnostic categories according to the Bethesda system for reporting thyroid cytopathology. Endokrynol Pol. 2019; 70(3): 232–236.
  2. Mulita F, Anjum F. Thyroid Adenoma [StatPearls]. StatPearlsPublishing, Treasure Island 2020.
  3. Kleiman DA, Beninato T, Soni A, et al. Does bethesda category predict aggressive features in malignant thyroid nodules? Ann Surg Oncol. 2013; 20(11): 3484–3490.
  4. Ho AS, Sarti EE, Jain KS, et al. Malignancy rate in thyroid nodules classified as Bethesda category III (AUS/FLUS). Thyroid. 2014; 24(5): 832–839.
  5. Suh YJ, Choi YJu. Strategy to reduce unnecessary surgeries in thyroid nodules with cytology of Bethesda category III (AUS/FLUS): a retrospective analysis of 667 patients diagnosed by surgery. Endocrine. 2020; 69(3): 578–586.

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