TY - JOUR
T1 - Nodule size is an independent predictor of malignancy in mutation-negative nodules with follicular lesion of undetermined significance cytology
AU - Mehta, Rohtesh S.
AU - Carty, Sally E.
AU - Ohori, N. Paul
AU - Hodak, Steven P.
AU - Coyne, Christopher
AU - Lebeau, Shane O.
AU - Tublin, Mitchell E.
AU - Stang, Michael T.
AU - Johnson, Jonas T.
AU - McCoy, Kelly L.
AU - Nikiforova, Marina N.
AU - Nikiforov, Yuri E.
AU - Yip, Linwah
N1 - Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2013/10
Y1 - 2013/10
N2 - Background In thyroid nodule fine-needle aspiration (FNA) cytology, the atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) category has a 5-15% malignancy risk that increases to 85-99% when mutation testing for BRAF, RAS, RET/PTC, or PAX8/PPARγ is positive. However, negative testing does not exclude malignancy. The study objective was to identify clinical and imaging features that predict cancer in mutation-negative AUS/FLUS thyroid nodules. Methods All patients were reviewed (April 2007 to April 2009) who had AUS/FLUS cytology, negative prospective molecular testing of FNA, and histopathology. Results Of the 230 nodules, 12 (5.2%) were malignant in 11 of 190 patients, and known clinical risk factors for thyroid cancer did not predict malignancy. On preoperative imaging, ≥1 suspicious ultrasound feature was identified in 33% of nodules and occurred regardless of histology (P =.23). Malignant mutation-negative AUS/FLUS nodules were larger than benign nodules (mean maximum diameter, 33.6 vs 24.0 mm; P =.007). On multivariate analysis, nodule size remained an independent predictor of malignancy (odds ratio, 1.043; P =.018). We observed no malignancies in 88 mutation-negative AUS/FLUS nodules <18.5 mm. Conclusion Size is an independent predictor of malignancy in mutation-negative AUS/FLUS nodules and the risk increased 4.3% with every millimeter increase in nodule size. Selected patients with small, mutation-negative AUS/FLUS thyroid nodules may be managed with ultrasound surveillance in lieu of thyroidectomy.
AB - Background In thyroid nodule fine-needle aspiration (FNA) cytology, the atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) category has a 5-15% malignancy risk that increases to 85-99% when mutation testing for BRAF, RAS, RET/PTC, or PAX8/PPARγ is positive. However, negative testing does not exclude malignancy. The study objective was to identify clinical and imaging features that predict cancer in mutation-negative AUS/FLUS thyroid nodules. Methods All patients were reviewed (April 2007 to April 2009) who had AUS/FLUS cytology, negative prospective molecular testing of FNA, and histopathology. Results Of the 230 nodules, 12 (5.2%) were malignant in 11 of 190 patients, and known clinical risk factors for thyroid cancer did not predict malignancy. On preoperative imaging, ≥1 suspicious ultrasound feature was identified in 33% of nodules and occurred regardless of histology (P =.23). Malignant mutation-negative AUS/FLUS nodules were larger than benign nodules (mean maximum diameter, 33.6 vs 24.0 mm; P =.007). On multivariate analysis, nodule size remained an independent predictor of malignancy (odds ratio, 1.043; P =.018). We observed no malignancies in 88 mutation-negative AUS/FLUS nodules <18.5 mm. Conclusion Size is an independent predictor of malignancy in mutation-negative AUS/FLUS nodules and the risk increased 4.3% with every millimeter increase in nodule size. Selected patients with small, mutation-negative AUS/FLUS thyroid nodules may be managed with ultrasound surveillance in lieu of thyroidectomy.
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U2 - 10.1016/j.surg.2013.05.015
DO - 10.1016/j.surg.2013.05.015
M3 - Article
C2 - 24074409
AN - SCOPUS:84884841363
SN - 0039-6060
VL - 154
SP - 730
EP - 738
JO - Surgery (United States)
JF - Surgery (United States)
IS - 4
ER -