Strategy to reduce unnecessary surgeries in thyroid nodules with cytology of Bethesda category III (AUS/FLUS): a retrosp
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ORIGINAL ARTICLE
Strategy to reduce unnecessary surgeries in thyroid nodules with cytology of Bethesda category III (AUS/FLUS): a retrospective analysis of 667 patients diagnosed by surgery Yong Joon Suh1 Yeon Ju Choi2 ●
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Received: 29 January 2020 / Accepted: 30 March 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Fine-needle aspiration (FNA) is widely used for the diagnosis of thyroid nodules detected by ultrasonography. However, the cytology of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) often leads to unnecessary thyroid surgery. This study aimed to identify a strategy to reduce unnecessary surgeries in patients with AUS/FLUS nodules. Methods Medical records of 667 patients with the cytology of AUS/FLUS who underwent surgery from January 2007 to December 2017 were retrospectively reviewed. Clinicopathological data were analyzed to identify malignant factors in thyroid nodules with AUS/FLUS. Factors were compared between patients with thyroid cancer and those with benign thyroid nodules, using stepwise multivariate logistic regression and decision tree model. Results Pathological thyroid cancer was identified in 193 (43.3%) patients. There was a significant difference in malignancy incidence with respect to family history, number of nodules, number of FNAs, ultrasonographic finding, lymphocytic thyroiditis, and BRAFV600E mutation. Multivariate analysis showed that ultrasonography (K-TIRADS 5) was the most influential independent predictor of malignancy in AUS/FLUS (odds ratio = 11.02, p < 0.001), followed by possessing BRAFV600E mutation (odds ratio = 4.54, p < 0.001). This strategy enabled 226 (89.3%) patients to avoid unnecessary surgeries based on the decision tree model. There was no node of repeated FNA in the decision tree model, which reduced the risk of malignancy (odds ratio = 0.35, p = 0.029). Conclusion K-TIRADS 5 and BRAFV600E mutation were predictive of malignancy in nodules of AUS/FLUS. These factors should be considered in strategies to reduce unnecessary surgeries for AUS/FLUS. Keywords Thyroid nodule Atypia of undetermined significance Follicular lesion of undetermined significance Surgery ●
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Introduction
These authors contributed equally: Yong Joon Suh, Yeon Ju Choi Supplementary information The online version of this article (https:// doi.org/10.1007/s12020-020-02300-w) contains supplementary material, which is available to authorized users. * Yong Joon Suh [email protected] 1
Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea
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Research Cooperation Center, Hallym University, Chuncheon 24252, Republic of Korea
Fine needle aspiration (FNA) is widely used for the diagnosis of thyroid nodules detected by ultrasonography [1]. FNA is a reliable procedure to identify thyroid nodules that require surgery or conservative treatment [2, 3]. Selecting appropriate management depends on the FNA report. The Bethes
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