Objective: The goal of this study was to report an experience with thyroid fine-needle aspiration (FNA) cases that can be placed into National Cancer Institute-designated thyroid FNA diagnostic categories for follicular patterned lesions divided into three diagnostic categories: follicular lesion of undetermined significance/atypia of undetermined significance (AUS/FLUS), suspicious for follicular neoplasm (SFON), and suspicious for malignancy. Study Design: The study cohort included 4,284 cases for the period between January 2007 and July 2011 and all available follow-up data was obtained. All cases classified as ‘atypical’ and ‘rule out follicular neoplasm’ were included in the AUS/FLUS category (n = 3,903), whereas cases classified as ‘suspicious for’ or ‘consistent with follicular or Hürthle cell neoplasm’ (n = 381) were included in the SFON diagnostic category and compared with histopathologic follow-up. Results: During this period, 14,628 thyroid FNAs were reported in 12,238 patients. Repeat FNA (RFNA) was performed in 1,366/3,903 (35%) patients classified as AUS/FLUS. Histologic outcome data was available in 1,756/3,903 (45%) cases diagnosed as AUS/FLUS and 243/381 (64%) cases diagnosed as SFON. The rate of malignancy in AUS/FLUS cases with and without RFNA was 29 and 14% respectively, and it was 26% in SFON cases. Conclusion: The current data shows that the malignancy rates differ between categories and AUS/FLUS cases are best managed by RFNA for selection of cases that can benefit from surgical excision.

Keywords:
Bethesda, Fine-needle aspiration, Follicular patterned lesions, Thyroid
1.
Faquin WC: Diagnosis and reporting a follicular-patterned thyroid lesions by fine needle aspiration. Head and Neck Pathol 2009;3:82–85.
2.
VanderLaan PA, Marqusse E, Krane JF: Clinical outcome for atypia of undetermined significance in thyroid fine-needle aspirations: should repeated FNA be the preferred initial approach? Am J Clin Pathol 2011;135:770–775.
3.
Faquin WC, Baloch ZW: Fine-needle aspiration of follicular patterned lesions of the thyroid: diagnosis, management, and follow- up according to National Cancer Institute (NCI) recommendations. Diagn Cytopathol 2010;38:731–739.
4.
Yassa L, Cibas ES, Benson CB, et al: Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer 2007;111:508–516.
5.
Somma J, Schlecht NF, Fink D, et al: Thyroid fine needle aspiration cytology: follicular lesions and the grey zone. Acta Cytol 2010;54:123–131.
6.
Marcheusky AM, Walts AE, Bose S, et al: Evidence based evaluation of the risks of malignancy predicted by thyroid fine-needle aspiration biopsies. Diagn Cytopathol 2010;38:252–259.
7.
Baloch ZW, Fleisher S, LiVolsi VA, Gupta PK: Diagnosis of ‘follicular neoplasm’: a gray zone in thyroid fine-needle aspiration cytology. Diagn Cytopathol 2002;26:41–44.
8.
Baloch ZW, Livolsi VA: Follicular-patterned lesions of the thyroid: the bane of the pathologist. Am J Clin Pathol 2002;117:143–150.
9.
Zacks JF, de las Morenas A, Beazley RM, O’Brien MJ: Fine-needle aspiration cytology diagnosis of colloid nodule versus follicular variant of papillary carcinoma of the thyroid. Diagn Cytopathol 1998;18:87–90.
10.
Oertel YC, Burman K, Boyle L, et al: Integrating fine-needle aspiration into a daily practice involving thyroid disorders: the Washington Hospital Center approach. Diagn Cytopathol 2002;27:120–122.
11.
Wang HH: Reporting thyroid fine-needle aspiration: literature review and a proposal. Diagn Cytopathol 2006;34:67–76.
12.
Lewis CM, Chang KP, Pitman M, Faquin WC, Randolph GW: Thyroid fine-needle aspiration biopsy: variability in reporting. Thyroid 2009;19:717–723.
13.
Cooper DS, Doherty GM, Haugen BR, et al: Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006;16:109–142.
14.
Cooper DS, Doherty GM, Haugen BR, et al: Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167–1214.
15.
Baloch ZW, Cibas ES, Clark DP, et al: The National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference: a summation. Cytojournal 2008;5:6.
16.
Ali SZ, Cibas ES: The Bethesda System for Reporting Thyroid Cytopathology. New York, Springer, 2010.
17.
Goellner JR, Gharib H, Grant CS, Johnson DA: Fine needle aspiration cytology of the thyroid. Acta Cytol 1987;31:587–590.
18.
Greenblatt DY, Woltman T, Harter J, et al: Fine needle aspiration optimizes surgical management in patients with thyroid cancer. Ann Surg Oncol 2006;13:859–863.
19.
Schlinkert RT, van Heerden JA, Goellner JR, et al: Factors that predict malignant thyroid lesions when fine-needle aspiration is ‘suspicious for follicular neoplasm’. Mayo Clin Proc 1997;72:913–916.
20.
Goodell WM, Saboorian MH, Ashfaq R: Fine-needle aspiration diagnosis of the follicular variant of papillary carcinoma. Cancer 1998;84:349–354.
21.
Renshaw AA: Follicular lesions of the thyroid. Am J Clin Pathol 2001;115:782–785.
22.
Mijovic T, Rochon L, Gologan O, et al: Fine-needle aspiration biopsies in the management of indeterminate follicular and Hurthle cell thyroid lesions. Otolaryngol Head Neck Surg 2009;140:715–719.
23.
Elsheikh TM, Asa SL, Chan JK, et al: Interobserver and intraobserver variation among experts in the diagnosis of thyroid follicular lesions with borderline nuclear features of papillary carcinoma. Am J Clin Pathol 2008;130:736–744.
24.
Baloch ZW, LiVolsi VA, Asa SL, et al: Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 2008;36:425–437.
25.
Baloch Z, LiVolsi VA, Jain P, et al: Role of repeat fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules. Diagn Cytopathol 2003;29:203–206.
26.
Renshaw AA: An estimate of risk of malignancy for a benign diagnosis in thyroid fine-needle aspirates. Cancer Cytopathol 2010;118:190–195.
27.
Renshaw AA: Does a repeated benign aspirate change the risk of malignancy after an initial atypical thyroid fine-needle aspiration? Am J Clin Pathol 2010;134:788–792.
28.
Renshaw AA: Non-diagnostic rates for thyroid fine-needle aspiration are negatively correlated with positive for malignancy rates. Acta Cytol 2011;55:38–41.
29.
Flanagan MB, Ohori NP, Carty SE, Hunt JL: Repeat thyroid nodule fine-needle aspiration in patients with initial benign cytologic results. Am J Clin Pathol 2006;125:698–702.
30.
Nayar R, Ivanovic M: The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer Cytopathol 2009;117:195–202.
31.
Renshaw A: Misclassification of cytologic diagnoses in patients with follicular lesions or follicular neoplasms of the thyroid gland. Cancer 2003;99:318–319, author reply 319–320.
32.
Renshaw AA: Accuracy of thyroid fine-needle aspiration using receiver operator characteristic curves. Am J Clin Pathol 2001;116:477–482.
33.
Renshaw AA: Focal features of papillary carcinoma of the thyroid in fine-needle aspiration material are strongly associated with papillary carcinoma at resection. Am J Clin Pathol 2002;118:208–210.
34.
Mesonero CE, Jugle JE, Wilbur DC, Nayar R: Fine-needle aspiration of the macrofollicular and microfollicular subtypes of the follicular variant of papillary carcinoma of the thyroid. Cancer 1998;84:235–244.
35.
Baloch ZW, Gupta PK, Yu GH, Sack MJ, LiVolsi VA: Follicular variant of papillary carcinoma: cytologic and histologic correlation. Am J Clin Pathol 1999;111:216–222.
36.
Jain M, Khan A, Patwardhan N, Reale F, Safran M: Follicular variant of papillary thyroid carcinoma: a comparative study of histopathologic features and cytology results in 141 patients. Endocr Pract 2001;7:79–84.
37.
Tulecke MA, Wang HH: ThinPrep for cytologic evaluation of follicular thyroid lesions: correlation with histologic findings. Diagn Cytopathol 2004;30:7–13.
38.
Clary KM, Condel JL, Liu Y, Johnson DR, Grzybicki DM, Raab SS: Interobserver variability in the fine needle aspiration biopsy diagnosis of follicular lesions of the thyroid gland. Acta Cytol 2005;49:378–382.
39.
Carling T, Udelsman R: Follicular neoplasms of the thyroid: what to recommend. Thyroid 2005;15:583–587.
40.
Smith J, Cheifetz RE, Schneidereit N, Berean K, Thomson T: Can cytology accurately predict benign follicular nodules? Am J Surg 2005;189:592–595, discussion 595.
41.
Yang GC, Liebeskind D, Messina AV: Diagnostic accuracy of follicular variant of papillary thyroid carcinoma in fine-needle aspirates processed by ultrafast Papanicolaou stain: histologic follow-up of 125 cases. Cancer 2006;108:174–179.
42.
Kurian EM, Dawlwtt M, Wang J, et al: The triage efficacy of fine needle aspiration biopsy for follicular variant of papillary thyroid carcinoma using the Bethesda reporting guidelines. Diagn Cytopathol 2011, DOI: 10.1002/dc.21718.
43.
Renshaw AA, Gould EW: Why there is the tendency to ‘overdiagnose’ the follicular variant of papillary thyroid carcinoma. Am J Clin Pathol 2002;117:19–21.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.