Predictive Factors for Malignancy in Atypiai of Undetermined Significance (AUS) Thyroid Nodules: A Comprehensive Retrospective Analysis

This retrospective study aimed to identify predictive factors for malignancy in thyroid nodules classified as atypia or follicular lesion of undetermined significance (AUS/FLUS). The analysis included 165 patients who underwent thyroid nodule surgery at Ankara Numune Training and Research Hospital. Data on demographics, surgical procedures, ultrasonographic features, and pathology results were extracted and analyzed. The cohort consisted predominantly of women (79.39%) with a mean age of 46.68 years. Surgeries performed included total thyroidectomy (88%), total thyroidectomy with central lymph node dissection (6%), and modified radical neck dissection (3%). Malignancies, largely papillary thyroid carcinoma (PTC), were identified in 81 cases. Univariate analysis revealed significant associations between malignancy and ultrasonographic features like calcification, spiculated margins, and nuclear inclusions. Multivariate analysis pinpointed calcification as the only independent risk factor. Histopathological findings indicated heterogeneity within malignancies, noting lymphovascular and capsular invasion in PTC cases. These findings emphasize calcification as a key predictor of malignancy in AUS thyroid nodules and underscore the role of surgical intervention in this challenging diagnostic category, contributing to enhanced risk stratification and clinical decision-making for managing AUS/FLUS thyroid nodules.