Introduction: Intermediate cytology comprises unclear result form Bethesda III and IV category. This category is still present in the general results of thyroid cytology, with 218% AUS/FLUS and 25% FN. The attitude after such a results is not standardize, follow up, lobectomy or thyroidectomy being the possible indications to solve such a case. The current paper presents the value of predictive value of ultrasound techniques in the final judgment of these cases.
Methods: Elastography is incorporated in some current used models for thyroid nodules risk stratification; high stiffness is considered a risk factor. Our Center uses Russs risk stratification model, using high stiffness as the 6th risk criteria, besides hipoecogenicity, homogeneity, margins, shape and calcifications, using a Hitachi Preirus machine, with a 5 cm wide multifrequency linear probe, equipped with strain elastography technique.
Results: Study evaluated the FNAC results from 2017 to 2018: comprising 52 cases with intermediate cytology results: 31 AUS, 14 FLUS, 7 FN. In the FLUS/AFLUS cases (45 cases), cancer was confirmed 13 cases, respectively 6 cases with borderline follicular neoplasia, 17 of these cases being classified as high risk on ultrasound. The 26 benign cases were classified as low risk (8 cases) and intermediate US risk (18 cases). In the FN group, 4 cases where identified as cancer, 3 as benign. The diagnostic quality was Sensitivity of 30% with a very high specificity of 89.5 (for FLUS /AFLUS case) respectively sensitivity of 25% with a excellent specificity of 100% for FN cases. High-risk cases, are suggestive for malignancy, both in AUS/FLUS and FN cytology reports.
Conclusion: The ultrasound analysis of nodules with intermediate cytology identifies the vast majority of cancer cases. High-risk category, defined as conventional high risk and increased stiffness identify the vast majority of cancers in intermediate cytology group.