Significance of Atypical Cells of Undetermined Significance in Fine Needle Aspiration of Thyroid A Retrospective Study
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Issue Date
2012
Authors
Okpa, Nwayigwe '12
Degree
MS in Cytotechnology and Molecular Cytology
Advisor
Morgenstern, Nora
Committee Members
Balachandran, Indra
Coleman, Arlixer
El-Fawal, Hassan
Sugrue, Chiara
Coleman, Arlixer
El-Fawal, Hassan
Sugrue, Chiara
Journal Title
Journal ISSN
Volume Title
Abstract
The Atypical cells of undetermined Significance (AUS)/Follicular Lesion of Undetermined Significance (FLUS) is a heterogeneous category in the Bethesda system for reporting thyroid cytopathology without clearly defined cytologic criteria. The ambiguity in the AUS/FLUS poses limitations to thyroid cytology making clinical management of such cases a challenge. Approximately ~5-15 percent of cases with AUS diagnosis lead to malignancy.1, 2, 3 The current management guidelines for patients with a diagnosis of Atypical Cells of Undetermined Significance category is follow-up with repeat fine needle aspiration (FNA) at an appropriate interval to ascertain the risk of malignancy. Some authors have proposed that different patterns within the AUS categories are associated with different risk of malignancy. The current study was a retrospective study of about 100 archived thyroid FNA slides performed and reported as AUS at North Shore Long Island Jewish hospital from 2009 to 2011. The study assessed the cytomorphological features for each of these archived AUS cases after blinded review by 8 independent reviewers (5 pathologists, 2 cytotechnologist and 1 cytotechnologist student) and reclassified using a consensus diagnosis of the independent case reviewers into the current existing diagnostic category of the 2010 Bethesda System for Reporting Thyroid Cytopathology for assessing the relative risk of thyroid malignancy among patients with diagnosis of AUS. Follow-up of these newly reclassified archived AUS cases was performed using the Laboratory Information System at the Medical Center and also patient records and relative risk of malignancy for patients was assessed. The risk of malignancy in this study was 13%. The study also assessed the inter-observer variability based on years of experience among the reviewers for the 18 morphologic criteria selected for this study and found that the differences between the two groups of independent reviewers to be statistically significant. This study also analyzed the predictive value of three of the 18 morphologic criteria, i.e., irregular nuclear membrane, nuclear pallor and grooves for risk of thyroid malignancy and determined to be not of statistical significance. It is assumed that the results of this study might make a significant impact by suggesting revisions of the current clinical management of patients with AUS diagnosis.
Citation
Okpa, Nwayigwe. "Significance of Atypical Cells of Undetermined Significance in Fine Needle Aspiration of Thyroid : A Retrospective Study." Albany College of Pharmacy and Health Sciences, New York, Proquest/UMI, 2013.
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