Endocrine Abstracts

Background: AUS/FLUS (atypia/follicular lesion of undetermined significance) carries a malignancy risk reaching up to 50%. Based on the reported malignancy rate in a given population, the clinical practice towards such a category varies. We hereby identify clinical parameters for risk stratification to aid in decision making for either surgical referral or a clinical follow up.

Our aim is to calculate the malignancy risk in Bethesda III category and to identify clinical parameters that guided both clinicians and patients at our institutions to reach a clinical decision.

Methods: A retrospective review of patients with Bethesda III category thyroid nodules from tertiary centres in the Emirate of Abu Dhabi during January 2011 through December 2015 was carried out. Malignancy risk in Bethesda category III nodules and repeat FNA utility were calculated. Parameters guided referral to surgery were studied.

Results: Two hundred and two cases were included in the study. Of these, 101 cases underwent surgery initially following the first FNA and 10 cases following FNA repeat. Histology confirmed malignancy in (41%) of cases that went initially to surgery and in (40%) of cases that underwent a repeat FNA. Repeat FNA resulted in, 17 (44.74%) cases being re-classified into benign category, 10 (26.3%) being AUS/FLUS category, 6 (15.7%) being both suspicious and malignant, and 5 (13.16%) being unsatisfactory. Repeating FNA resulted in a definitive diagnostic utility in 50% of the cases.

Conclusion: The relatively high malignancy rate in our institutions, the suspicious radiographic features and the repeat FNA predictive value stratified Bethesda III category nodules for appropriate referrals to surgery.

Keywords: AUS/FLUS, thyroid FNA, thyroid cancer, Bethesda category III