Korean J Endocr Surg.  2010 Dec;10(4):240-244. 10.16956/kjes.2010.10.4.240.

Analysis of Cytopathology of Fine Needle Aspiration Biopsy of the Thyroid according to Bethesda Classification and Clinical Implication of Atypical Cells of Undetermined Significance

• Jang JT
• Kim KM
• Park JB
• Bae KS
• Cho MY
• Kang SJ

• KMID: 2375476
• DOI: http://doi.org/10.16956/kjes.2010.10.4.240

Abstract

PURPOSE
The frequency of diagnosis of each nodule category under the Bethesda classification was studied, and the differences in the results between cytopathologic and histopathologic analyses of same patients were assessed. Special attention was paid to the atypical cells of undetermined significance (ACUS), which is an intermediate category. The histopathology of ACUS specimens was confirmed to examine the clinical implication.
METHODS
Patients (n=417) who underwent thyroid ultrasonography and fine needle aspiration of the thyroid since the application of Bethesda classification (November 2009 to August 2010) in this institution was enrolled in the study.
RESULTS
According to the Bethesda criteria, of the 640 nodules there were 56 cases (8.8%) of ACUS, 14 cases (2.2%) of follicular neoplasm, 13 cases (2.0%) were suspicious for malignancy, and 37 cases (5.8%) were positive of malignancy. A total of 102 surgically-excised specimens were obtained, of which 40 specimens were previously categorized cytopathologically as ACUS. Of these 40 specimens, 16 cases (40%) were found to be malignant.
CONCLUSION
A precise understanding of each diagnostic category seems to be necessary, which may help with treatment of patients with thyroid mass. This is especially true for ACUS, which was previously understood as an intermediate specimen, but which is actually a heterogeneous mix of benign specimen, benign specimen with various atypia, and malignancy. In case of ACUS, an extensive and accurate diagnostic approach utilizing various examination methods may be beneficial for the patient treatment.

Keyword

Fine needle aspiration cytology; Bethesda classification; Atypical cells of undetermined significance

MeSH Terms

Biopsy*
Biopsy, Fine-Needle*
Classification*
Diagnosis
Humans
Thyroid Gland*
Ultrasonography

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