Acta cytologica · 2025
The Association between Subcategorization, Cytomorphological Features, and Ultrasonographic Characteristics with Surgical Outcomes of Atypia of Undetermined Significance Thyroid Nodules.
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Soyer Ahmet Kursat, Altinboga Aysegul Aksoy, Ertuna Gokcen Nailer, Baser Husniye, Cuhaci Seyrek Fatma Neslihan, Tam Abbas Ali, Korukluoglu Birol, Topaloglu Oya, Ersoy Reyhan, Cakir Bekir
Аннотация
INTRODUCTION: We aimed to investigate malignancy rates in atypia of undetermined significance (AUS) subcategories and their association with cytomorphologic and ultrasonographic features.
METHODS: A total of 201 thyroid nodules with AUS cytology that underwent surgical resection were analyzed, including 169 AUS-nuclear (AUS-N) and 32 AUS-other (AUS-O) nodules. Cytomorphological and ultrasonographic features, along with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classifications, were analyzed to assess the association between malignancy and AUS subcategories.
RESULTS: The overall risk of malignancy (ROM) for AUS nodules was 19.4%, with a significantly higher rate observed in the AUS-N subgroup compared to AUS-O (21.9% vs. 6.3%, p = 0.04). A significantly higher ROM was observed in nodules with irregular margin, taller-than-wide shape, microcalcification, hypoechogenicity, and solid composition (OR = 9.63, 5.81, 3.33, 2.14, and 2.07, respectively). A statistically significant difference in ROM was observed across ACR-TIRADS and EU-TIRADS categories within the AUS nodules (p < 0.001 for both) and the AUS-N group (p = 0.001 and <0.001). A marked increase in ROM was observed with nuclear overlapping, pseudoinclusions, and enlargement (OR: 9.16, 4.47 and 2.80, respectively), while oncocytic atypia was associated with a reduced risk (OR: 0.44). In multivariate analysis, nuclear overlapping, pseudoinclusions, and sonographic irregular margins remained as independent predictors of malignancy (OR = 6.97, 6.09, and 5.79, respectively).
CONCLUSION: To our knowledge, this is the first study to demonstrate a significant association between ACR-TIRADS classification and malignancy risk in the AUS-N subcategory.
METHODS: A total of 201 thyroid nodules with AUS cytology that underwent surgical resection were analyzed, including 169 AUS-nuclear (AUS-N) and 32 AUS-other (AUS-O) nodules. Cytomorphological and ultrasonographic features, along with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classifications, were analyzed to assess the association between malignancy and AUS subcategories.
RESULTS: The overall risk of malignancy (ROM) for AUS nodules was 19.4%, with a significantly higher rate observed in the AUS-N subgroup compared to AUS-O (21.9% vs. 6.3%, p = 0.04). A significantly higher ROM was observed in nodules with irregular margin, taller-than-wide shape, microcalcification, hypoechogenicity, and solid composition (OR = 9.63, 5.81, 3.33, 2.14, and 2.07, respectively). A statistically significant difference in ROM was observed across ACR-TIRADS and EU-TIRADS categories within the AUS nodules (p < 0.001 for both) and the AUS-N group (p = 0.001 and <0.001). A marked increase in ROM was observed with nuclear overlapping, pseudoinclusions, and enlargement (OR: 9.16, 4.47 and 2.80, respectively), while oncocytic atypia was associated with a reduced risk (OR: 0.44). In multivariate analysis, nuclear overlapping, pseudoinclusions, and sonographic irregular margins remained as independent predictors of malignancy (OR = 6.97, 6.09, and 5.79, respectively).
CONCLUSION: To our knowledge, this is the first study to demonstrate a significant association between ACR-TIRADS classification and malignancy risk in the AUS-N subcategory.