World Congress on Thyroid Cancer 4.0
July 29 – August 1, 2021
OP48 – Selection of Atypia/Follicular Lesion of Unknown Significance Patients for Surgery versus Active Surveillance, without Using Genetic Testing: a Single Institute Experience, Prospective Analysis and Recommendations
Cohen, Oded 1,2; Tzelnick, Sharon1 ; Lahav, Yonatan1,2 ; Schindel, Doron1,2; Halperin, Doron1,2; Yehuda, Moshe1,2,3,4
1 Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
2 Hadassah School of Medicine, Hebrew University in Jerusalem, Rehovot, Israel
3 Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
4 Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Background: The recommended management of Atypia/follicular lesion of unknown significance (AUS/FLUS) includes active surveillance (AS), repeated fine needle aspiration (RFNA), diagnostic surgery or genetic testing
Purpose: To assess the management of AUS/FLUS patients in without implementing genetic testing.
Methods: A single institute cohort study of all adult patients who underwent ultrasound-guided FNA (USGFNA) between January 2009 and January 2013 and were followed until January 2016.
Results: The median follow-up time was 4.6 years (range 3.2-6.8). Forty-eight patients (57%) were referred to AS, and 36 patients (43%) were referred for diagnostic surgery. Thirty-six of the AS group (75%) underwent RFNA. An additional eight patients from the AS group subsequently underwent diagnostic surgery. Malignancies rate in the diagnostic surgical samples was 34% (15/44). 61.1% of RFNAs resulted in benign cytology. Analysis of adherence to follow-up in the 36 AS patients showed an adherence rate of only 53%. Men demonstrated better compliance (31.6% vs. 5.8%, respectively, p=0.052), especially males in their 6th decade of life.
Discussion: Quality patient selection for surgery based on clinical, sonographic and cytological considerations is feasible, reaching malignancy rate of 34%. RFNA was shown to be a reliable and important tool in the management of these patients, yet active surveillance should be offered after careful assessment of the patient and the nodule’s characteristics
Conclusion: When Genetic tests these tests are not feasible, careful management of AUS/FLUS patients may still offer good results. Compliance to follow-up schedules should be a major consideration when selecting patients for AS.
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