Endocrinol Metab.  2024 Apr;39(2):300-309. 10.3803/EnM.2023.1818.

The Diagnostic Role of Repeated Biopsy of Thyroid Nodules with Atypia of Undetermined Significance with Architectural Atypia on Core-Needle Biopsy

• Moon HH
• Chung SR
• Choi YJ
• Sung TY
• Song DE
• Kim TY
• Lee JH
• Baek JH

• KMID: 2554635
• DOI: http://doi.org/10.3803/EnM.2023.1818

Abstract

Background
We aimed to evaluate the utility of repeat biopsy of thyroid nodules classified as atypia of undetermined significance with architectural atypia (IIIB) on core-needle biopsy (CNB).
Methods
This retrospective study evaluated patients with thyroid nodules categorized as IIIB on CNB between 2013 and 2015. Demographic characteristics, subsequent biopsy results, and ultrasound (US) images were evaluated. The malignancy rates of nodules according to number of CNBs and the number of IIIB diagnoses was compared. Demographic and US features were evaluated to determine factors predictive of malignancy.
Results
Of 1,003 IIIB nodules on CNB, the final diagnosis was determined for 328 (32.7%) nodules, with 121 of them confirmed as malignant, resulting in a malignancy rate of 36.9% (95% confidence interval, 31.7% to 42.1%). Repeat CNB was performed in 248 nodules (24.7%), with 75 (30.2%), 131 (52.8%), 13 (5.2%), 26 (10.5%), one (0.4%), and two (0.8%) reclassified into categories II, IIIB, IIIA, IV, V, and VI, respectively. Malignancy rates were not significantly affected by the number of CNBs (P=0.291) or the number of IIIB diagnoses (P=0.473). None of the nodules confirmed as category II on repeat CNB was malignant. US features significantly associated with malignancy (P<0.003) included solid composition, irregular margins, microcalcifications, and high suspicion on the US risk stratification system.
Conclusion
Repeat biopsy of nodules diagnosed with IIIB on CNB did not increase the detection of malignancy but can potentially reduce unnecessary surgery. Repeat biopsy should be performed selectively, with US features guiding the choice between repeat biopsy and diagnostic surgery.

Keyword

Thyroid; Thyroid nodule; Ultrasonography; Core needle biopsy

Figure

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  Fig. 1. Representative histologic images for specimen classified as category IIIB (atypia of undetermined significance with architectural atypia). The specimen shows compact microfollicular proliferative follicular cells without a definite tumor capsule (H&E stain, ×12.5 and ×100).

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  Fig. 2. Outcome of atypia of undetermined significance with architectural atypia (IIIB) nodules according to number of core-needle biopsies (CNBs) performed.

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  Fig. 3. Results of second core-needle biopsy (CNB) of 248 atypia of undetermined significance with architectural atypia (IIIB) nodules.

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