Subclassification of the Bethesda Category III (AUS/FLUS): A Study of thyroid FNA cytology based on ThinPrep slides from the National Cancer Center in China
Subclassification of the Bethesda Category III (AUS/FLUS): A Study of thyroid FNA cytology based on ThinPrep slides from the National Cancer Center in China
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DOI：
10.1002/cncy.22417
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发表时间：
2021-06-17
影响因子：
3.4
通讯作者：
Zhang, ZhiHui
中科院分区：
文献类型：
--
作者：
Zhao, Huan;Guo, HuiQin;Zhang, ZhiHui
背景Bethesda甲状腺细胞病理学报告系统（TBSRTC）中的意义不明/意义不明滤泡性病变（AUS/FLUS）分类是一个异质性分类，包括各种细胞类型。2017年TBSRTC建议了AUS/FLUS的子分类。然而，与不同亚组相关的恶性肿瘤（ROM）风险仍未得到解决。方法回顾性分析2013年7月至2018年12月行细针穿刺活检（FNA）的所有病例。在12，913例甲状腺FNA中，1053例（8.2%）为AUS/FLUS。根据2017年TBSRTC的建议，对222例接受手术随访的AUS/FLUS患者的载玻片进行了审查和细分。有195例抽吸物被一致诊断为AUS/FLUS，并被细分为细胞学异常1（AUS-C1）;细胞学异常2（AUS-C2）;结构性异常（AUS-A）;细胞学和结构性异常（AUS-C & A）; Hurthle细胞抽吸物（AUS-H）;结果在222例AUS/FLUS结节中，83.3%（185/222）的淋巴结为非典型淋巴样细胞。AUS-C1组最常见（62.1%），其次是AUS-C&A（12.8%）、AUS-C2（10.8%）、AUS-H（6.7%）、AUS-NOS（5.6%）、AUS-L（1.5%）和AUS-A（0.5%）组。AUS-C1组的ROM最高（92.6%），与AUS-C&A组（P = .171）、AUS-C2组（P =.001）、AUS-H组（P = .001）和AUS-NOS组（P < .001）相比差异显著。AUS/FLUS的亚分类可能有助于识别该类别中具有高ROM的结节并改善此类结节的管理。
Background The atypia of an undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a heterogeneous category, which includes various cell patterns. The subclassification of AUS/FLUS was suggested in the 2017 TBSRTC. However, the risk of malignancy (ROM) associated with different subgroups remains unresolved. Herein, AUS/FLUS aspirates were subclassified, from which the ROM of each subgroup was determined.Methods All cases undergoing fine-needle aspiration (FNA) from July 2013 to December 2018 were reviewed. Of 12,913 thyroid FNAs, 1053 (8.2%) were AUS/FLUS. The slides of 222 patients with AUS/FLUS with surgical follow-up were reviewed and subclassified according to the recommendations of the 2017 TBSRTC. There were 195 aspirates consistently diagnosed as AUS/FLUS and subclassified as cytologic atypia 1 (AUS-C1); cytologic atypia 2 (AUS-C2); architectural atypia (AUS-A); cytologic and architectural atypia (AUS-C & A); Hurthle cell aspirates (AUS-H); atypia, not otherwise specified (AUS-NOS); and atypical lymphoid cells, rule out lymphoma (AUS-L).Results Malignancy was identified in 83.3% (185 of 222) of the AUS/FLUS nodules. The AUS-C1 group was the most common (62.1%), followed by the AUS-C&A (12.8%), AUS-C2 (10.8%), AUS-H (6.7%), AUS-NOS (5.6%), AUS-L (1.5%), and AUS-A (0.5%) groups. AUS-C1 had the highest ROM (92.6%) among the groups and varied significantly from that of the AUS-C&A (P = .171), AUS-C2 (P = .001), AUS-H (P = .001), and AUS-NOS (P < .001) groups.Conclusions As a heterogeneous category of TBSRTC, the ROM for AUS/FLUS varies greatly among medical centers. Subclassification of AUS/FLUS might be helpful in identifying nodules with a high ROM in this category and improving the management of such nodules.