title: Survey of cytopathologists and cytotechnologists for the clinical impact of the use of atypia or follicular lesion of undetermined significance.
abstract: BACKGROUND
  The cytologic diagnosis of atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) is controversial because of variation in how it is applied in practice, as well as uncertainty about patient management. We aimed to assess the percentage of thyroid fine-needle aspiration biopsies (FNABs) with AUS/FLUS diagnoses in different North American and European practice settings (e.g. community, academic, etc.), assess whether patients were managed according to current guidelines, and determine patient outcomes.
  
  
  METHODS
  A detailed questionnaire survey was posted in secure websites used separately by cytopathologists and cytotechnologists. The questionnaire was posted from August 1 through December 31, 2013.
  
  
  RESULTS
  Endocrinologists and cytopathologists performed 51.7% and 37.1% of thyroid FNABs, respectively. The Bethesda reporting system for thyroid FNAB was used in 90% of practices. The rate of AUS/FLUS varied widely among institutions, with 46.1% of represented institutions reporting AUS/FLUS rates of 3-10%. The median follow-up rate of patients with an initial AUS/FLUS diagnosis was 70% (range, 10-100%). For the majority of represented institutions (86.4%), patients with initial AUS/FLUS diagnosis had follow-up with endocrinologists. Of repeat AUS/FLUS thyroid FNABs, a median of 52% was considered benign, and 18% were suspicious of or positive for malignancy (median, 10% and 7.5%, respectively).
  
  
  CONCLUSIONS
  Reporting of the AUS/FLUS category varied widely among different institutions. The median follow-up rate was lower than published guidelines. The most common follow-up diagnosis was benign thyroid nodule. Improved standardization of cytologic criteria should be adopted to reduce such variation.
authors.affiliation: Address: Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Aziza
authors.initials: A
authors.lastname: Nassar
authors.affiliation: Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Jordan P
authors.initials: JP
authors.lastname: Reynolds
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Kerr
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Jenkins
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Kandace A
authors.initials: KA
authors.lastname: Lackore
authors.affiliation: Division of Endocrinology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Bernet
keywords: Cytology; fine-needle aspiration; follicular lesion of undetermined significance; questionnaire; thyroid