{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:28:24Z","timestamp":1760059704317,"version":"build-2065373602"},"reference-count":29,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The necessity of repeat fine-needle aspiration biopsy (FNAB) in nodules diagnosed as atypia of undetermined significance (AUS) remains debated. This study evaluates the role of a second FNAB in surgical decision making. Materials and Methods: A retrospective analysis was conducted on 131 patients (105 females and 26 males) who underwent surgery following an AUS diagnosis between 2020 and 2024. Patients were grouped based on whether surgery was performed after the first or second FNAB. Demographics, pathology, and ultrasound findings were compared. Results: Of the patients, 66 (50.7%) underwent surgery after the first FNAB and 65 (50.3%) after a second AUS diagnosis. Malignancy was detected in 47 out of 66 (71.2%) patients in the single biopsy group and in 44 out of 65 (67.7%) patients in the repeat biopsy group (p = 0.804). T1a tumors were more frequent in the first FNAB group (63.8% vs. 37.2%, p = 0.021). The EU-TIRADS classifications showed no significant differences. Conclusions: The malignancy rate observed (71.2%) exceeds reported rates in the literature, suggesting regional variability. Early-stage cancers were more frequent in patients operated on after the first FNAB, questioning the necessity of repeat biopsy and indicating a potential need to revise current guidelines.<\/jats:p>","DOI":"10.3390\/medicina61071196","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T10:03:48Z","timestamp":1751277828000},"page":"1196","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the Necessity of Repeat Biopsy in Patients with Thyroid Nodules Classified as Atypia of Undetermined Significance (AUS) Based on Fine-Needle Aspiration Biopsy Results"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9755-8163","authenticated-orcid":false,"given":"Yi\u011fit","family":"T\u00fcrk","sequence":"first","affiliation":[{"name":"Department of General Surgery, Ege University Faculty of Medicine Hospital, \u0130zmir 35100, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bahad\u0131r Emre","family":"Baki","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ege University Faculty of Medicine Hospital, \u0130zmir 35100, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00d6zer","family":"Makay","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Ozel Saglik Hospital, \u0130zmir 35000, T\u00fcrkiye"},{"name":"School of Medicine, Aristotle University, 54124 Thessaloniki, Greece"},{"name":"Instituto Portugu\u00eas de Oncologia de Coimbra Francisco Gentil, 3000075 Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00f6khan","family":"\u0130\u00e7\u00f6z","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ege University Faculty of Medicine Hospital, \u0130zmir 35100, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murat","family":"\u00d6zdemir","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ege University Faculty of Medicine Hospital, \u0130zmir 35100, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1764","DOI":"10.1056\/NEJMcp031436","article-title":"Clinical Practice. The Thyroid Nodule","volume":"351","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer","volume":"26","author":"Haugen","year":"2016","journal-title":"Thyroid"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1210\/jc.2008-1724","article-title":"An Ultrasonogram Reporting System for Thyroid Nodules Stratifying Cancer Risk for Clinical Management","volume":"94","author":"Horvath","year":"2009","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1089\/thy.2017.0500","article-title":"The 2017 Bethesda System for Reporting Thyroid Cytopathology","volume":"27","author":"Cibas","year":"2017","journal-title":"Thyroid"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e230067","DOI":"10.1530\/ETJ-23-0067","article-title":"2023 European Thyroid Association Clinical Practice Guidelines for Thyroid Nodule Management","volume":"12","author":"Durante","year":"2023","journal-title":"Eur. Thyroid J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1159\/000333231","article-title":"The Frequency of \u201catypia of Undetermined Significance\u201d Interpretations for Thyroid Fine-Needle Aspirations Is Negatively Correlated with Histologically Proven Malignant Outcomes","volume":"55","author":"Vanderlaan","year":"2011","journal-title":"Acta Cytol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1089\/thy.2017.0685","article-title":"The Bethesda System for Reporting Thyroid Cytopathology Explained for Practitioners: Frequently Asked Questions","volume":"28","author":"Bongiovanni","year":"2018","journal-title":"Thyroid"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/cncy.20192","article-title":"The Atypia of Undetermined Significance\/Follicular Lesion of Undetermined Significance: Malignant Ratio","volume":"120","author":"Krane","year":"2012","journal-title":"Cancer Cytopathol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s12022-019-09583-4","article-title":"Systematic Review and Meta-Analysis of the Impact of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on Cytological Diagnosis and Thyroid Cancer Prevalence","volume":"30","author":"Ruanpeng","year":"2019","journal-title":"Endocr. Pathol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1089\/thy.2015.0305","article-title":"Impact of the Multi-Gene ThyroSeq Next-Generation Sequencing Assay on Cancer Diagnosis in Thyroid Nodules with Atypia of Undetermined Significance\/Follicular Lesion of Undetermined Significance Cytology","volume":"25","author":"Nikiforov","year":"2015","journal-title":"Thyroid"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1089\/thy.2011.0255","article-title":"Is 18F-Fluorodeoxyglucose-PET\/CT Useful for the Presurgical Characterization of Thyroid Nodules with Indeterminate Fine Needle Aspiration Cytology?","volume":"22","author":"Deandreis","year":"2012","journal-title":"Thyroid"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.asjsur.2018.02.008","article-title":"The Surgery and Repeat Aspiration Outcomes of the Atypia of Undetermined Significance\/Follicular Lesion of Undetermined Significance Category in The Bethesda System for Reporting Thyroid Cytopathology","volume":"42","author":"Jan","year":"2019","journal-title":"Asian J. Surg."},{"key":"ref_13","unstructured":"G\u00fcltekin, M., and Bozta\u015f, G. (2014). T\u00fcrkiye Kanser Istatistikleri, Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131, T\u00fcrkiye Halk Sa\u011fl\u0131\u011f\u0131 Kurumu."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4521984","DOI":"10.1155\/2018\/4521984","article-title":"Malignancy Risk and Related Factors of Atypia of Undetermined Significance\/Follicular Lesion of Undetermined Significance in Thyroid Fine Needle Aspiration","volume":"2018","author":"Hong","year":"2018","journal-title":"Int. J. Endocrinol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1089\/thy.2013.0317","article-title":"Malignancy Rate in Thyroid Nodules Classified as Bethesda Category III (AUS\/FLUS)","volume":"24","author":"Ho","year":"2014","journal-title":"Thyroid"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1309\/AJCPO0BQ2YSKPXXP","article-title":"Usefulness of Diagnostic Qualifiers for Thyroid Fine-Needle Aspirations with Atypia of Undetermined Significance","volume":"136","author":"VanderLaan","year":"2011","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E1210","DOI":"10.1002\/hed.24193","article-title":"Institution-Specific Risk of Papillary Thyroid Carcinoma in Atypia\/Follicular Lesion of Undetermined Significance","volume":"38","author":"Bernstein","year":"2016","journal-title":"Head Neck"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Yaprak Bayrak, B., and Eruyar, A.T. (2020). Malignancy Rates for Bethesda III and IV Thyroid Nodules: A Retrospective Study of the Correlation between Fine-Needle Aspiration Cytology and Histopathology. BMC Endocr. Disord., 20.","DOI":"10.1186\/s12902-020-0530-9"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1007\/s12020-016-0982-x","article-title":"Malignancy Is Associated with Microcalcification and Higher AP\/T Ratio in Ultrasonography, but Not with Hashimoto\u2019s Thyroiditis in Histopathology in Patients with Thyroid Nodules Evaluated as Bethesda Category III (AUS\/FLUS) in Cytology","volume":"54","author":"Topaloglu","year":"2016","journal-title":"Endocrine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1111\/cyt.12438","article-title":"Thyroid Nodules Classified as Atypia or Follicular Lesions of Undetermined Significance Deserve Further Research: Analysis of 305 Surgically Confirmed Nodules","volume":"28","author":"Turkyilmaz","year":"2017","journal-title":"Cytopathology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1002\/dc.24771","article-title":"Outcome of Atypia of Undetermined Significance\/Follicular Lesion of Undetermined Significance in Thyroid Fine-Needle Aspirations: A Six-Year Institutional Experience","volume":"49","author":"Xu","year":"2021","journal-title":"Diagn. Cytopathol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s40463-021-00530-0","article-title":"Rate of Malignancy for Thyroid Nodules with AUS\/FLUS Cytopathology in a Tertiary Care Center\u2014A Retrospective Cohort Study","volume":"50","author":"Hathi","year":"2021","journal-title":"J. Otolaryngol.\u2014Head Neck Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1159\/000333230","article-title":"Repeatedly Nondiagnostic Thyroid Fine-Needle Aspirations Do Not Modify Malignancy Risk","volume":"55","author":"Jo","year":"2011","journal-title":"Acta Cytol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1159\/000504705","article-title":"Can Repeat Biopsies Change the Prognoses of AUS\/FLUS Nodule?","volume":"9","author":"Aydin","year":"2020","journal-title":"Eur. Thyroid J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1007\/s40618-024-02510-3","article-title":"Clinical Management of Indeterminate Thyroid Nodules Needs to Be Revisited. New Evidence for a Personalized Approach to the Problem","volume":"48","author":"Piticchio","year":"2024","journal-title":"J. Endocrinol. Investig."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1007\/s12020-024-03953-7","article-title":"Timing of the Repeat Thyroid Fine-Needle Aspiration Biopsy: Does Early Repeat Biopsy Change the Rate of Nondiagnostic or Atypia of Undetermined Significance Cytology Result?","volume":"86","author":"Sacikara","year":"2024","journal-title":"Endocrine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"39","DOI":"10.4183\/aeb.2024.39","article-title":"The Impact of Patient Anxiety and Pain Perception on The Adequacy of Thyroid Fine-Needle Aspiration Biopsy Samples: A Prospective Study","volume":"20","author":"Erbatur","year":"2024","journal-title":"Acta Endocrinol. (Buchar)"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e37978","DOI":"10.5812\/iranjradiol.37978","article-title":"Evaluation of Stress Scores throughout Radiological Biopsies","volume":"13","author":"Turkoglu","year":"2016","journal-title":"Iran. J. Radiol."},{"key":"ref_29","first-page":"253","article-title":"The Degree of Anxiety before Taking Biopsies in Patients with Thyroid Nodules","volume":"5","author":"Moon","year":"2015","journal-title":"Korean J. Fam. Pract."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/7\/1196\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:02:14Z","timestamp":1760032934000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/7\/1196"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,30]]},"references-count":29,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["medicina61071196"],"URL":"https:\/\/doi.org\/10.3390\/medicina61071196","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2025,6,30]]}}}