Consensual Review Minimizes the Diagnosis of “Follicular Lesion of Undetermined Significance” and Improves Reproducibility and Cyto-Histologic Concordance.
Xin Jing, Stewart M Knoepp, Michael H Roh, Kim Hookim, Jeremiah Placido, Robertson D Davenport, Rodolfo FH Rasche, Claire W Michael. University of Michigan Health System, Ann Arbor
Background: There has been considerable variation among both pathologists and institutions in using the terminology of "atypia of undetermined significance/follicular lesion of undetermined significance" (AUS/FLUS). The Bethesda System for Reporting Thyroid cytology (BSRTC) defines the diagnostic criteria for AUS/FLUS and advises that AUS/FLUS should not be used indiscriminately. The current study was conducted to investigate if consensual review may minimize AUS/FLUS and may also improve reproducibility and cyto-histologic concordance.
Design: A SNOMED search of the electronic pathology database for the period of January 1998-June 2010 retrieved a total of 217 aspirates in which the original interpretation of AUS/FLUS was rendered and followed by hemi- or total thyroidectomies. The retrieved aspirates were retrospectively reviewed using the BSRTC as a guideline. A group of reviewers who were blinded to the corresponding histologic findings simutaneously evaluated slides of each aspirate at a multi-headed microscope and a consensus diagnosis was reached at the end of the group review. Interobserver agreement was calculated by dividing diagnosis of the majority by the total. The Cyto-histologic correlation was then performed between the consensus diagnoses and the corresponding histologic diagnoses. This is an ongoing study and a total of 50 aspirates have been reviewed.
|Cytologis Diagnosis||Interobserver Agreement (%)||benign||follicular adenoma||follicular carcinoma||PTC||TOTAL(%)|