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.

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.
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