title: Radiologic and clinical predictors of malignancy in the follicular lesion of undetermined significance of the thyroid.
abstract: Various ultrasonographic characteristics of thyroid nodules have been associated with a higher likelihood of malignancy, and certain clinical features may also increase the likelihood of malignancy in patients. This study is designed to determine the ultrasonographic and clinical predictors of malignancy in the atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category. A search through the cytology files at our institution was made for cases with diagnosis of AUS/FLUS. The clinical and radiologic findings were correlated with the final surgical pathology diagnosis. A total of 140 cases of AUS/FLUS with corresponding surgical intervention were identified (112 females and 28 males). There was a 79 % malignancy rate in nodules with irregular contours, compared to 51 % in nodules with regular outlines. Nodules demonstrating calcifications showed a 57 % malignancy rate, compared to 50 % in nodules without calcifications. Sixty-one percent of cases with an ultrasonographic diagnosis of indeterminate to suspicious were malignant following surgical resection. The rates of malignancy in patients with radiation exposure, symptomatic nodules, and positive family history of thyroid cancer were 22, 59, and 33 %, respectively. BRAF mutation was demonstrated in 57 % of malignant cases and in none of benign cases. No single clinical or ultrasonographic feature or combination of features is adequately sensitive or specific to identify all malignant nodules. However, a combination of solid nodules, nodules with irregular contours, symptomatic nodules, and positive BRAF mutation has high predictive value for malignancy in patients with a cytologic diagnosis of AUS/FLUS.
authors.affiliation: Department of Pathology, Yale University School of Medicine, New Haven, CT 06519, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Carr
authors.forename: Berrin
authors.initials: B
authors.lastname: Ustun
authors.forename: David
authors.initials: D
authors.lastname: Chhieng
authors.forename: Kevin
authors.initials: K
authors.lastname: Schofield
authors.forename: Constantine
authors.initials: C
authors.lastname: Theoharis
authors.forename: Lynwood
authors.initials: L
authors.lastname: Hammers
authors.forename: Adebowale J
authors.initials: AJ
authors.lastname: Adeniran
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics / Q000601:surgery; D044963:Biopsy, Fine-Needle; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009154:Mutation; D011237:Predictive Value of Tests; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics / Q000601:surgery; D013965:Thyroidectomy; D014463:Ultrasonography
chemical_list: C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf