title: Assessment of malignancy for atypia of undetermined significance in thyroid fine-needle aspiration biopsy evaluated by whole-slide image analysis.
abstract: Atypia of undetermined significance (AUS) in thyroid fine-needle aspiration (FNA) has a low to intermediate incidence of malignancy, and objective criteria could allow for improved assessment of malignancy. Consecutive thyroid FNA AUS cases with surgical excision were selected. Whole-slide images (WSIs) were evaluated for basic criteria by image analysis, including total groups and nuclear/cytoplasmic (N/C) ratio. The 44 cases encompassed 23 benign and 21 malignant entities. Seventeen (81%) of 21 malignant cases and 11 (48%) of 23 benign cases had an N/C ratio of 0.50 or less. An N/C ratio of 0.50 or less had an odds ratio for malignancy of 4.64 (P = .03). A combined category of an N/C ratio of 0.50 or less and greater than 20 cell groups had an odds ratio for malignancy of 7.0 (P = .04). Establishing defined objective WSI criteria has the potential to provide an assessment of malignancy for AUS thyroid FNA cases.
authors.affiliation: Dept of Pathology and Immunology, Washington University School of Medicine, Campus Box 8118, 660 S Euclid Ave, St Louis, MO 63110-1093, USA. bcollins@path.wustl.edu
authors.forename: Brian T
authors.initials: BT
authors.lastname: Collins
authors.forename: Laura E
authors.initials: LE
authors.lastname: Collins
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D013961:Thyroid Gland / Q000473:pathology* / Q000601:surgery; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D016606:Thyroid Nodule / Q000473:pathology* / Q000601:surgery
keywords: Assessment of malignancy; Atypia of undetermined significance; Bethesda reporting system; Fine-needle aspiration; Image analysis; Thyroid; Whole-slide image