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Thyroid nodules and atypia (Bethesda III cytology) – clinical significance and management options


Thyroid nodule and fine-needle aspiration cytology. Introduction

Thyroid nodude and atypia.- In the patient with thyroid nodule, ultrasonography and fine-needle aspiration (FNA) cytology are the two most significant diagnostic methods. Based on findings from these two diagnostic modalities, the risk of underlying malignancy can be evaluated

Bethesda reporting system

Cytology results are presented according to the Bethesda classification system. In this system, cytology noting atypia or follicular lesion of undetermined significance (AUS or FLUS) is classified as Bethesda Category III.

Clinical significance

The presence of atypia is associated with a risk of 10 – 15 % of underlying thyroid cancer within the thyroid nodule. This is an important consideration, which should be kept in mind during the discussion about management options.

Management options

Surgery

Surgery achieves accurate histologic diagnosis and radical and definitive cure.

Surveillance

Surveillance, using clinical examination and repeat ultrasonography (± repeat FNA)

Molecular testing

The aim of molecular testing is to to detect specific gene mutations. This is an expensive diagnostic test, which has been proposed to avoid overtreatment in this subgroup of patients.Results of molecular testing should be carefully be evaluated.

Other significant parameters

Other parameters should be taken into consideration in the process of management decision-making, including:

Presence of risk factors for underlying malignancy, based on

History, such as:

History of neck irradiation Strong family history of thyroid cancer Some genetic syndromes associated with thyroid cancer

Clinical findings, such as:

Hard texture/consistency of the nodule

Fixed nodule

Presence of neck lymphadenopathy

Suspicious ultrasonographic findings

Patient’s preferences.

Many patients prefer surgery as a mean to relieve the stress associated with an uncertain diagnosis.


Thyroid nodules and atypia

Thyroid nodules and atypia


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