Indeterminate nodules by the Bethesda system for reporting thyroid cytopathology in Israel: Frequency, and risk of malignancy after reclassification of follicular thyroid neoplasm with papillary-like features

Introduction. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a significant step to standardize the reporting of thyroid fine needle aspiration (FNA). It has high predictive value, reproducibility, and improved clinical significance. Aim. The study was aimed to evaluate the diagnostic utility and reproducibility of “TBSRTC” at our institute. Methods and Material. The study included 646 thyroid FNAs which were reviewed by three pathologists and classified according to TBSRTC. Cytohistological correlation was done for 100 cases with surgical follow-up and the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and risk of malignancy (ROM) were calculated. The interobserver variation among three pathologists was also assessed. Results. The distribution of cases in various TBSRTC categories is as follows: I—nondiagnostic 13.8%, II—benign 75.9%, III—atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) 1.2%, IV—follicular neoplasm (FN)/suspicious for follicular neoplasm (SFN) 3.7%, V—suspicious for malignancy (SM) 2.6%, and VI—malignant 2.8%. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy are 72.4%, 94.3%, 84%, 89.2%, and 87.9%, respectively. The ROM of various TBSRTC categories were II—8.5%; III—66.7%; IV—63.6%; and V and VI—100%. Cohen’s Weighted Kappa score was 0.99 which indicates almost perfect agreement among the three pathologists. Conclusions. Our study substantiates greater reproducibility among pathologists using TBSRTC to arrive at a precise diagnosis with an added advantage of predicting the risk of malignancy which enables the clinician to plan for follow-up or surgery and also the extent of surgery.

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The Bethesda system for reporting thyroid cytopathology: An experience of 1,382 cases in a community practice setting with the implication for risk of neoplasm and risk of malignancy

Diagnostic Cytopathology ◽

10.1002/dc.21754 ◽

2011 ◽

Vol 40 (5) ◽

pp. 399-403 ◽

Cited By ~ 69

Author(s):

Howard Her-Juing Wu ◽

Crystal Rose ◽

Tarik M. Elsheikh

Keyword(s):

Practice Setting ◽

Community Practice ◽

Risk Of Malignancy ◽

Bethesda System ◽

Thyroid Cytopathology ◽

The Bethesda System

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Impact of Bethesda System of Reporting for Thyroid Cytopathology

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1145 ◽

2014 ◽

Vol 6 (1) ◽

pp. 15-22

Author(s):

Varsha Dhume ◽

Vikas Kavishwar

Keyword(s):

Healthcare Providers ◽

Needle Aspiration ◽

Management Approach ◽

Risk Category ◽

Major Step ◽

Risk Of Malignancy ◽

Bethesda System ◽

Thyroid Fna ◽

Thyroid Cytopathology ◽

The Bethesda System

ABSTRACT FNAC though considered the gold standard diagnostic test in the evaluation of a thyroid nodule, has many issues regarding the terminologies and interpretation. The National Cancer Institute (NCI) hosted the NCI Thyroid Fine needle Aspiration State of the Science Conference in 2007, which acknowledged the importance of developing a uniform terminology for reporting thyroid FNA results to facilitate effective communication among cytopathologists, endocrinologist, surgeons, radiologists and other healthcare providers. The NCI Conference concluded the terminology and morphologic criteria which formed the framework for The Bethesda system for reporting thyroid cytopathology (TBSRTC). It is a 6 tiered ‘The Bethesda System for Reporting Thyroid Cytopathology’ (TBSRTC) for unifying the terminology and morphologic criteria along with the corresponding risk of malignancy. Bethesda also offers management approach for all the categories. Bethesda system is presently widely accepted in western countries and is being introduced in rest of the world. This system of reporting undoubtedly represents a major step toward standardization, reproducibility and ultimately improvement in clinical significance, usefulness and predictive value of thyroid FNAC. The problems faced by the cytopathologist while implementing Bethesda during reporting are centred on AUS/FLUS category. The heterogeneity of this low-risk category leads to significant variability in its reported percentage as well as reported rate of malignancy. How to cite this article Dhume V, Kavishwar V. Impact of Bethesda System of Reporting for Thyroid Cytopathology. Int J Otorhinolaryngol Clin 2014;6(1):15-22.

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Rate of malignancy for thyroid nodules with AUS/FLUS cytopathology in a tertiary care center – a retrospective cohort study

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00530-0 ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Kalpesh Hathi ◽

Tarek Rahmeh ◽

Vicki Munro ◽

Victoria Northrup ◽

Ali Sherazi ◽

...

Keyword(s):

Thyroid Nodules ◽

Care Center ◽

Tertiary Care ◽

Treatment Pathway ◽

Malignancy Rate ◽

Risk Of Malignancy ◽

Bethesda System ◽

Thyroid Cytopathology ◽

The Bethesda System ◽

Undetermined Significance

Abstract Background Thyroid nodules are stratified through fine-needle aspiration (FNA) and are often categorized using The Bethesda System for Reporting Thyroid Cytopathology, which estimates the risk of malignancy for six cytopathological categories. The atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS) categories have varying malignancy rates reported in the literature which can range from 6 to 72.9%. Due to this heterogeneity, we assessed the malignancy rate and effectiveness of repeat FNA (rFNA) for AUS/FLUS thyroid cytopathology at our institution. Methods Electronic health records of patients with AUS/FLUS thyroid cytopathology on FNA at our center since the implementation of the Bethesda System on May 1, 2014–December 31, 2019 were retrospectively reviewed. Patient demographics, treatment pathway, and pathology results were collected. The treatment pathway of the nodules, the rFNA results, and the malignant histopathology results were reported. Malignancy rates were calculated as an upper and lower limit estimate. Results This study described 182 AUS/FLUS thyroid nodules from 177 patients. In total, 24 thyroid nodules were deemed malignant upon histopathology, yielding a final malignancy rate of 13.2–25.3%. All of the malignancies were variants of papillary thyroid carcinoma. The malignancy rate of the nodules which underwent resection without rFNA (21.5%) was lower than the malignancy rate of the nodules which underwent resection after rFNA (43.8%). 45.5% of the rFNA results were re-classified into more definitive categories. Conclusion The malignancy rate of AUS/FLUS thyroid cytopathology at our center is in line with the risk of malignancy stated by the 2017 Bethesda System. However, our malignancy rate is lower than some other Canadian centers and approximately half of our rFNAs were re-classified, highlighting the importance of establishing center-specific malignancy and rFNA re-classification rates to guide treatment decisions.

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