Page 1 of 19

Thyroid Bethesda Categorization of Thyroid Nodule Cytology & Prediction of Thyroid Cancer Type and Prognosis (doi: 10.1089/thy.2015.0376) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.

1

Bethesda Categorization of Thyroid Nodule Cytology and Prediction of Thyroid Cancer Type and Prognosis Authors: Xiaoyun Liu1,2, Marco Medici5, Norra Kwong1, Trevor E. Angell1, Ellen Marqusee1, Matthew I. Kim1, P. Reed Larsen1, Nancy L. Cho4, Matthew A. Nehs4, Daniel T. Ruan4, Atul Gawande4, Francis Moore, Jr.4, Justine Barletta3, Jeffrey F. Krane3, Edmund S. Cibas3, Tao Yang2, Erik K. Alexander1 From: 1Thyroid Unit, Dept of Medicine, 3Dept of Pathology and 4 Dept of Surgery, Brigham & Women’s Hospital and Harvard Medical School, Boston, USA; 2 Department of Endocrinology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China, 5Rotterdam Thyroid Center and Dept of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands Address Correspondence to: Erik K. Alexander, MD Chief, Thyroid Unit, Division of Endocrinology, Metabolism and Diabetes, Brigham and Women’s Hospital 75 Francis Street, PBB-B4. Room 417 Boston, MA 02115 617-732-4148 (phone) 617-264-6346 (fax) Email: [email protected] – Preferred method of contact Address all reprint requests to: Erik K. Alexander, MD (address above)

Disclosure: All authors above have no relevant disclosures. Funding: The research was supported by the NIH T32 DK007529 training grant.

Submitted: September 21, 2015 Abstract word count: 300 Manuscript word count: 2602

1

Page 2 of 19

Thyroid Bethesda Categorization of Thyroid Nodule Cytology & Prediction of Thyroid Cancer Type and Prognosis (doi: 10.1089/thy.2015.0376) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.

2 Abstract: Background: Since its inception, the Bethesda System for Reporting Thyroid Cytopathology (TBS) has been widely adopted. Each category conveys a risk of malignancy and recommended next steps, though it is unclear if each category also predicts the type and extent of malignancy. If so, this would greatly expand the utility of TBS by providing prognostic information in addition to baseline cancer risk. Methods: We analyzed all patients prospectively enrolled into our thyroid nodule database from 1995-2013 with histologically-proven malignancy. We correlated the primary ultrasound-guided fine needle aspiration (UG-FNA) cytology (Atypia of unknown significance: AUS; Follicular neoplasm: FN: Suspicious: SUSP; M: Malignant) with the type of thyroid cancer and histological features known to impact prognosis and recurrence, including lymph node metastasis (LNM), lymphovascular invasion (LVI) and extrathyroidal extension (ETE). We separately correlated primary cytology with higher risk malignancy. Results: 1291 malignancies were identified, with primary cytology AUS in 130 cases, FN in 241 cases, SUSP in 411 cases, and M in 509 cases. AUS, SUSP, and M cytology were progressively associated with an increasing risk of high risk disease (p

Bethesda Categorization of Thyroid Nodule Cytology and Prediction of Thyroid Cancer Type and Prognosis.

Since its inception, the Bethesda System for Reporting Thyroid Cytopathology (TBS) has been widely adopted. Each category conveys a risk of malignancy...
565B Sizes 0 Downloads 8 Views