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Risk of Malignancy According to the Sub-classification of Atypia of Undetermined Significance and Suspicious Follicular Neoplasm Categories in Thyroid Core Needle Biopsies

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Abstract

The objective of this study was to evaluate the risk of malignancy (ROM) associated with atypia of undetermined significance (AUS) and suspicious follicular neoplasm (SFN) core needle biopsy (CNB) categories after further sub-classification. Data from 2267 thyroid nodules evaluated by ultrasound-guided CNB, from January to December 2015, were retrospectively reviewed. AUS nodules (n = 556) were sub-classified as follows: (1) architectural atypia (AUS-A; n = 369, 66.4%), (2) cytologic atypia (AUS-C; n = 35, 6.3%), (3) cytologic/architectural atypia (AUS-C/A; n = 85, 15.3%), or (4) oncocytic atypia (AUS-O; n = 67, 12.1%). SFN nodules (n = 172) were sub-classified as follows: (1) architectural atypia only (SFN-A; n = 110, 64%), (2) cytologic/architectural atypia (SFN-C/A; n = 24, 14%), or (3) oncocytic atypia (SFN-O; n = 38, 22%). Diagnostic surgery was performed in 162 (30.2%) AUS cases and 105 (61%) SFN cases. The ROM of each sub-category was evaluated. The overall ROM was 15.3–52.5% in AUS nodules and 35.5–58.1% in SFN nodules. The ROM was higher in the AUS-C (22.9–88.9%) and AUS-C/A (32.9–90.3%) groups than AUS-A (11.9–40%) and AUS-O (7.5–41.7%). In the SFN category, ROM in the SFN-C/A group was also higher than SFN-A or SFN-O (37.5–75%, 40–57.9%, and 21.1–47.1%, respectively). Our study shows that the ROM was higher in AUS or SFN sub-categories with cytologic atypia than those without cytologic atypia. Because of the heterogeneous nature of AUS and SFN categories, sub-classification may be a more effective approach for risk stratification, allowing optimal management of patients with thyroid nodules.

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Authors and Affiliations

  1. Departments of Radiology Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea

    Sae Rom Chung, Jung Hwan Baek & Jeong Hyun Lee

  2. Departments of Surgery Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea

    Yu-Mi Lee, Tae-Yon Sung, Ki-Wook Chung & Suck Joon Hong

  3. Departments of Internal Medicine Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea

    Min Ji Jeon, Tae Yong Kim, Young Kee Shong, Won Bae Kim & Won Gu Kim

  4. Departments of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Dong Eun Song

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  1. Sae Rom Chung
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Correspondence to Dong Eun Song.

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This retrospective study was approved by the institutional review board. Informed consent was obtained from all patients prior to thyroid CNB.

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The authors declare that they have no conflict of interest.

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Chung, S.R., Baek, J.H., Lee, J.H. et al. Risk of Malignancy According to the Sub-classification of Atypia of Undetermined Significance and Suspicious Follicular Neoplasm Categories in Thyroid Core Needle Biopsies. Endocr Pathol 30, 146–154 (2019). https://doi.org/10.1007/s12022-019-9577-4

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