Thyroid cancer detection rate and associated risk factors in patients with thyroid nodules classified as Bethesda category III

Abstract

Background Ultrasound guided fine-needle aspiration (FNA) is a standard procedure for thyroid nodules management and selecting patients for surgical treatment. Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS), as stated by The Bethesda System for Reporting Thyroid Cytopathology, is a diagnostic category with an implied malignancy risk of 5-15%. The aim of our study was to review cytology and histopathology reports, as well as clinical and ultrasound data, for thyroid nodules reported as AUS/FLUS, in order to evaluate the malignancy rate and to assess factors associated with malignant outcome. Patients and methods A total of 112 AUS/FLUS thyroid nodules in 105 patients were evaluated, of which 85 (75.9%) were referred to surgery, 21 (18.8%) were followed-up by repeat FNA and 6 nodules (5.3%) were clinically observed. Each was categorized in two final diagnostic groups - benign or malignant, which were further compared to clinical data of patients and ultrasonographic features of the nodules. Results Final diagnosis of malignancy was reached in 35 cases (31.2%) and 77 (68.8%) had benign lesions. The most frequent type of cancer was papillary thyroid carcinoma (PTC) - 58.1% PTC and 25.8% had follicular variant of PTC. Patients' younger age, smaller nodule size, hypoechoic nodule and presence of calcifications were shown to be statistically significant risk factors for malignancy. Conclusions The rate of malignancy for the AUS/FLUS diagnostic category in our study was higher than estimated by the Bethesda System. Clinical and ultrasound factors should be considered when decision for patient treatment is being made.

Keywords: cytology; fine-needle aspiration; thyroid carcinoma; thyroid nodule; ultrasonography.

Figure 1

Histologic outcomes of Bethesda Category III nodules from patients who underwent direct surgical treatment. Malignancies were found in 36.1% of AUS/FLUS nodules who were managed with surgery without a repeat cytology. Papillary Thyroid Carcinoma and its Follicular variant were the most common types of cancer, accounting for a total of 83.9% of all malignancies. Among the benign lesions, Follicular adenomas presented in 50% of these cases, and Nodular hyperplasia was second in line with a frequency of 31.5%.