The role of ultrasound findings in the management of thyroid nodules with atypia or follicular lesions of undetermined significance

摘要

Background Atypia or follicular lesions of undetermined significance (AUS/FLUS) is a broad cytological category in the Bethesda system for classifying thyroid cytology. This study investigated the diagnostic accuracy of ultrasound (US) analysis of thyroid nodules with AUS/FLUS. Patients and Methods Of 5062 subjects with nodules subjected to fine-needle aspiration cytology (FNACs) at our institution from January 2010 through May 2012, 383 met the Bethesda criteria for AUS/FLUS. After excluding subjects who had a history of thyroid cancer, who only underwent repeat FNA or who underwent no further examinations, we selected 249 subjects who had subsequently undergone a core-needle biopsy and/or surgery. Of these, 100 were found to have malignant nodules (40.2%), 122 had benign nodules (49%), and 27 had nodules with indeterminate status (10.8%). We compared specific US parameters, including size, location, content, shape, margin, echogenicity, echotexture and calcification across these subject groups. Results Multivariate analysis revealed that malignancy was associated with taller-than-wide shape (TDW) (OR = 8.43, P = 0.002), ill-defined margin (OR = 3.23, P = 0.002) and marked hypoechogenicity. (OR = 3.61, P = 0.001). The specificity and positive predictive values of TDW were 98% and 90.6%,respectively. The specificity and positive predictive values of 'TDW and marked hypoechogenicity' were both 100%. Conclusion US findings play a complementary role in the diagnosis of thyroid nodules with AUS/FLUS. In case of highly suspicious US findings such as 'TDW and marked hypoechogenicity', could be very helpful in the diagnosis of malignancy.