Can Repeat Biopsies Change the Prognoses of AUS/FLUS Nodule?

OBJECTIVE: Experience with atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) showed that this category exhibited a marked variability in incidence and malignant outcome in resection specimens. We aimed to determine the utility of repeated fine-needle aspiration biopsies (FNABs) and ultrasonography to determine the malignancy rate in AUS/FLUS nodules. METHODS: 23,587 nodules were biopsied, and 1,288 had at least one AUS/FLUS cytology. Ultrasonographic features including solid hypoechoic status, irregular margins, microcalcifications, nodule taller than wider, or an extrathyroidal extension were also recorded. Nodules for which only 1 FNAB revealed AUS/FLUS cytology were termed Group 1; nodules that underwent 2, 3, and 4 FNABs were termed Groups 2, 3 and 4, respectively. We compared these groups according to malignancy rates. RESULTS: 576 of nodules underwent only 1 FNAB (Group 1); 505, 174, and 33 underwent 2 (Group 2), 3 (Group 3), and 4 FNABs (Group 4), respectively. Fifty-six (30.6%), 45 (27.3%), 18 (30%), and 5 (33.3%) of Groups 1-4 were malignant, respectively. The risk of malignancy was similar in each group (p > 0.05). Suspicious ultrasonographic features were encountered in malignant nodules more than benign nodules (p < 0.05, for each). CONCLUSION: Repeat biopsy of AUS/FLUS nodules did not enhance the identification of malignancy. Ultrasonographic features may be a better guide for the decision of either surveillance or diagnostic surgery.