Analysis of Cytopathology of Fine Needle Aspiration Biopsy of the Thyroid according to Bethesda Classification and Clinical Implication of Atypical Cells of Undetermined Significance / 대한내분비외과학회지

PURPOSE: The frequency of diagnosis of each nodule category under the Bethesda classification was studied, and the differences in the results between cytopathologic and histopathologic analyses of same patients were assessed. Special attention was paid to the atypical cells of undetermined significance (ACUS), which is an intermediate category. The histopathology of ACUS specimens was confirmed to examine the clinical implication. METHODS: Patients (n=417) who underwent thyroid ultrasonography and fine needle aspiration of the thyroid since the application of Bethesda classification (November 2009 to August 2010) in this institution was enrolled in the study. RESULTS: According to the Bethesda criteria, of the 640 nodules there were 56 cases (8.8%) of ACUS, 14 cases (2.2%) of follicular neoplasm, 13 cases (2.0%) were suspicious for malignancy, and 37 cases (5.8%) were positive of malignancy. A total of 102 surgically-excised specimens were obtained, of which 40 specimens were previously categorized cytopathologically as ACUS. Of these 40 specimens, 16 cases (40%) were found to be malignant. CONCLUSION: A precise understanding of each diagnostic category seems to be necessary, which may help with treatment of patients with thyroid mass. This is especially true for ACUS, which was previously understood as an intermediate specimen, but which is actually a heterogeneous mix of benign specimen, benign specimen with various atypia, and malignancy. In case of ACUS, an extensive and accurate diagnostic approach utilizing various examination methods may be beneficial for the patient treatment.

Clinical Implication and Evaluation and Management of Women with Low-Grade Cytologic Abnormality ( ASCUS/LSIL ) / 대한산부인과학회잡지

The evaluation of women with low-grade cytologic abnormalities including atypical cells of undetermined significance(ASCUS) and low-grade squamous intraepithelial lesion (LSIL) is a topic of considerable controversy. Some women with low-grade cytologic abnormalities will have high-grade intraepithelial neoplasia(CIN II or III) or even invasive cancer. Now, it is almost universally accepted that the majority of invasive cervical cancer and high-grade intraepithelial neoplasia are associated with Human papillomavirus(HPV). Because of this, there has been increasing tendancy on using another triaging methods for evaluating women with a low grade abnormal Papanicolaou smear. Traditionally colposcopy was used and recently HPV DNA test and cervicography was widely used as a triaging methods. This study used the data gained from 151 evaluable women with ASCUS and LSIL in the Department of Obstetrics and Gynecology, Catholic University Medical College, Kangnam St. Mary's Hospital from March 1995 to April 1996. 11,401 women had done cytology during this period and result was like this; 10,501 patients had normal cytology(92.1%), 244 patients had ASCUS(2.14%), 35 had AGCUS (atypical glandular cells of undetermined significance: 0.31%), 191 had LSIL(1.68%), 170 had HSIL(1.49%), and 160 had cervical cancers(1.41%). Patients with ASCUS were showed that CIN I WAS 5.6%(4/72), CIN II 4.2%(3/72) and CIN III 15.3%(11/72). Patients with LSIL were showed that CIN I was 5.1%(4/79), CIN II 7.6(6/79), CIN III 15.2%(12/79) and invasive cancer 7.6%(6/79). We adopted three management algorithms for evaluating women with ASCUS and LSIL. Three methods were like this; Colpscopy only or HPV DNA testing using hybrid capture which were used with DNAs extracted from the cerval swabs and tested with two pooled probes(probes containing HPV types of low oncogenic risk; 6, 11, 42, 43 and 44 or HPV types of high oncogenic risk; 16, 18, 31, 33, 35, 45, 51, 52 and 56) for HPV detection or both. We adopted only positive result with high risk HPV-probes in this article. At ASCUS group, sensitivity and specificity were 90.0% ad 32.5% in 62 women with colposcopy and 71.4%, 75% in 28 women with Hybrid Capture System. 27 women with colposcopy and Hybrid Capture System showed that sensitivity was 100%, and specificity was 26.3%. At LSIL group, sensitivity and specificity were 92.6% and 22.7% in 71 women with colposcopy and 69.2%, 65.4% in 39 women with Hybrid Capture System, 37 women with colposcopy and Hybrid Capture System showed that sensitivity was 91.7%, and specificity was 12%. Our result indicate that patients with smears showing some of ASCUS and LSIL are evaluated as CIN I, II, III and even invasive cancer. Therefore as a triage methods, the combination with colposcopy and HPV DNA test in women referred for low-grade abnormal cytology would be used as a sensitive methods for the detection of CINs. However, low -specificity of this combination approach was also considered as problem. This approach provides another information to differentiating ASCUS and LSIL into high- or low-risk group of progression.