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Cancer risk stratification of indeterminate thyroid nodules: A cytological approach.
Thyroid. 2017 Aug 15;:
Authors: Valderrabano P, Khazai L, Thompson ZJ, Leon ME, Otto KJ, Hallanger-Johnson JE, Wadsworth JT, Wenig BM, Chung CH, Centeno BA, McIver B
Abstract
BACKGROUND: Management recommendations for thyroid nodules rely primarily on the cytological diagnosis. However, 25% of the biopsies render an indeterminate cytology for which management decision is more challenging due to heterogeneity of the specimens. We aimed to stratify the cancer risk through subcategorization of indeterminate cytology.
METHODS: We retrospectively reviewed the indeterminate cytological specimens (Bethesda-III or IV) of 518 thyroid nodules consecutively evaluated at our academic cancer center between October 2008 and September 2015, blinded to the histological outcome. Cytological specimens were subclassified into four groups: aspirates exhibiting nuclear atypia (n = 158, 31%); architectural atypia (n = 222, 43%); oncocytic features (n = 120, 23%); or other types of atypia (n = 18, 3%). The prevalence of malignancy and odds ratio for malignancy (OR) were calculated in 323 nodules with histological confirmation.
RESULTS: The prevalence of malignancy was 26% overall (20% in Bethesda-III and 29% in Bethesda-IV, P = 0.07); and 47%, 12%, 24%, and 25%, for aspirates with nuclear atypia, architectural atypia, oncocytic features or other types of atypia, respectively. The OR of nuclear atypia over architectural atypia was 6.4 (3.4-12.2; P <0.001); and 2.7 over oncocytic features (1.4-5.1; P = 0.01); whereas the OR of architectural atypia over oncocytic features was 0.4 (0.2-0.9; P = 0.03). Results were similar for Bethesda-III and IV aspirates when analyzed independently. Furthermore, cytological subcategories improved cytology-histology correlation as they were associated with distinct profiles of histological diagnoses (P<0.001).
CONCLUSIONS: Cytological subcategories can effectively stratify the risk of malignancy of thyroid nodules with indeterminate cytology and improve cytology-histology correlation.
PMID: 28806881 [PubMed - as supplied by publisher]
from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2vGd0BO
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