Influence of descriptive terminology on management of atypical thyroid fine-needle aspirates
We acknowledge the help of Paul VanderLaan, MD, with the collection of study cases and selected clinical information.
The Bethesda System category of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is used to classify a variety of mild abnormalities in thyroid FNAs. Modifying terminology is often added to FNA reports, but it is unknown whether specific phrases affect clinical management. To answer this question, the authors correlated treatment of patients who had initial AUS/FLUS diagnoses from Baptist Hospital (Miami, Fla) (BH) and Brigham and Women's Hospital (Boston, Mass) (BWH) with the language used in pathology reports.
In total, 146 FNAs from BH, including 115 women and 31 men with a median age of 53 years (range, 21-79 years), and 300 FNAs from BWH, including 241 women and 59 men with a median age of 66 years (range, 10-85 years), were included. FNA reports were evaluated for predetermined descriptive phrases and were correlated with subsequent management.
More patients with available follow-up underwent excision at BH than at BWH (86% vs 8%; P < .001), and fewer underwent a repeat biopsy (14% vs 92%; P < .001). Qualifiers associated with differing malignancy risk affected patient management (P < .05) at BH, but not at BWH. Reports indicating a scant or limited specimen increased rebiopsy rates at BH (100% vs 4.8%; P < .05), but not at BWH (93% vs 91%; P = .67), as did explicit recommendation for rebiopsy at BH (35% vs 14%; P = .03). No other phrases affected patient management (P > .05).
In practice settings that follow The Bethesda System management guidelines, descriptive report terminology does not modify patient treatment. In less standardized settings, terminology associated with differing risk of malignancy on subsequent excision, pathologist recommendations, and phrases indicative of limited sampling significantly alter patient management. Cancer (Cancer Cytopathol) 2014;122:175–181. © 2013 American Cancer Society.