scholarly journals The Bethesda System for Reporting Thyroid Cytopathology: Validating at Tribhuvan University Teaching Hospital

2021 ◽  
Author(s):  
Kunjan Acharya ◽  
Shreya Shrivastav ◽  
Prashant Triipathi ◽  
Bigyan Raj Gyawali ◽  
Bijaya Kharel ◽  
...  
Keyword(s):  
Predictive Value ◽  
False Negative ◽  
Thyroid Function Test ◽  
University Teaching ◽  
Cross Sectional ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Thyroid Swelling ◽  
Thyroid Cytopathology ◽  
The Bethesda System

Abstract Introduction Fine needle aspiration cytopathology (FNAC) is widely used for the stratification of thyroid nodules. Objective The objective of the present study is to validate FNAC reporting based on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) at our institution and to calculate the risk of malignancy in each category. Methods This was a descriptive cross-sectional study conducted jointly at the Department of Ear, Nose and Throat and at the Department of Pathology for a period of 1.5 years (May 2018 to November 2018). All cases presenting with thyroid swelling in the outpatient department were investigated with ultrasonography (USG) of the neck, thyroid function test, and FNAC. All FNAC reporting was done according to TBSRTC. Results A total of 134 thyroidectomies were performed during the study period. The female to male ratio was 5.3:1. The age ranged from 11 to 74 years old. with a mean age of 51 years old. The FNAC has a specificity of 84.9%, a sensitivity of 89.4%, a positive predictive value of 86.4%, a negative predictive value of 88.2%, and an accuracy of 87.3% in detecting thyroid cancer. The implied risk of malignancy (ROM) in Bethesda II, III, IV, V and VI is 11.7%, 25%,40%,76.6% & 96%, respectively. Conclusion The four studied categories had a ROM comparable to other studies, except for the Bethesda III category. Further studies with larger sample sizes and with the use of USG guidance for the aspiration from the thyroid swelling may give better results by reducing the number of false negative and false positive cases.

scholarly journals The Bethesda System for Reporting Thyroid Cytopathology: A Cytohistological Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Bakiarathana Anand ◽  
Anita Ramdas ◽  
Marie Moses Ambroise ◽  
Nirmal P. Kumar
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Follicular Neoplasm ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Sensitivity Specificity ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
Undetermined Significance

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.

Review of the Bethesda System for Reporting Thyroid Cytopathology: A Local Study in Bohol Island, Philippines

2015 ◽  
Vol 59 (1) ◽  
pp. 77-82 ◽  
Author(s):  
Annette L. Salillas ◽  
Faye Candice S. Sun ◽  
Emelisa G. Almocera
Keyword(s):  
Kappa Statistic ◽  
Needle Aspiration ◽  
Cross Sectional Study ◽  
Kappa Statistics ◽  
Cross Sectional ◽  
Local Study ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
The Bethesda System

Objectives: The aim of this study was to evaluate the adaptability and reproducibility of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in a local setting and to determine the risk of malignancy for each category. Materials and Methods: A retrospective cross-sectional study of 80 thyroid fine-needle aspiration cytology cases using the BSRTC with corresponding histopathology was done between September 2009 and December 2012. Agreement scores were calculated using kappa statistics. Results: Consensus among two readers was attained for 73 cases (91.25%). No disagreement was noted for the malignant cases. The strength of agreement was very good, with a kappa statistic of 0.90. The risk of malignancy observed histologically was as follows: benign 3%, atypia of undetermined significance (AUS) 50%, suspicious for follicular/Hürthle cell neoplasm 50%, suspicious for malignancy 78%, and malignant 100%. Conclusion: In this study, there is an outstanding reproducibility for the classification scheme. The application of the BSRTC as the standardized reporting is readily adaptable and therefore its application in larger medical centers is highly recommended. Our findings of a higher risk of malignancy seen in AUS (50%) and malignant (100%) categories in those who underwent surgical resection corroborated other published studies. Conveying this risk to clinical colleagues is important and will facilitate optimal patient care.

scholarly journals Impact of Bethesda System of Reporting for Thyroid Cytopathology

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.

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

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.

scholarly journals Malignancy Rate in Thyroid Nodules with Atypia or Follicular Lesion of Undetermined Significance

2020 ◽  
Vol 24 (02) ◽  
pp. e221-e226
Author(s):  
Hamdan Ahmed Pasha ◽  
Rahim Dhanani ◽  
Ainulakbar Mughal ◽  
Kaleem S. Ahmed ◽  
Anwar Suhail
Keyword(s):  
Thyroid Nodules ◽  
Follicular Carcinoma ◽  
Needle Aspiration ◽  
Diagnostic Categories ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Needle Aspiration Cytology ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
Undetermined Significance

Abstract Introduction Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) is one of the six diagnostic categories of the Bethesda System for Reporting Thyroid Cytopathology. The prevalence of malignancy among Bethesda category III cytology is variable, ranging from 5% to 37% in the literature. Objective To determine the rate of malignancy in thyroid nodules reported as Bethesda category III. Methods A total of 495 patients underwent surgical intervention for thyroid nodules from January 2015 to December 2017. The present study included 81 cases reported as Bethesda category III, and their medical records were reviewed. Results Out of 495 fine-needle aspiration cytology samples, 81 (16.4%) samples were labeled as AUS/FLUS. Among these 81 patients, the mean age was 43.0 years (± 13.9), with only 11 (14%) patients older than 55 years of age. Most of our patients were female (n = 69; 85.2%), and the rest were male. The rate of malignancy based on the final histology was of 33.3% (n = 27). The majority were 17 cases (21%) of papillary carcinoma, followed by follicular carcinoma (n = 6) (7.4%). Conclusion The risk of malignancy can be higher than it is commonly believed, and guidelines should be based on the data from the institutions themselves for a better assessment of the outcomes.

scholarly journals Application of the Bethesda System for Reporting Thyroid Cytopathology in the Pediatric Population

2020 ◽  
Author(s):  
Huy Gia Vuong ◽  
Ayana Suzuki ◽  
Hee Young Na ◽  
Pham Van Tuyen ◽  
Doan Minh Khuy ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Pediatric Population ◽  
Asian Countries ◽  
Resection Rate ◽  
Fine Needle Aspirates ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
The Bethesda System

Abstract Objectives We aimed to provide the Asian experience with the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules. Methods Consecutive thyroid fine-needle aspirates (patient age, ≤18 years) were retrospectively collected from 7 tertiary centers in 5 Asian countries. Results Of 194,364 thyroid aspirates, 0.6% were pediatric cases (mean age, 15.0 years). Among 827 nodules with accessible follow-up, the resection rate and risk of malignancy (ROM) were 36.3% and 59.0%, respectively. Malignant nodules (n = 179) accounted for 59.7% of resected nodules and 21.6% of all thyroid nodules with available follow-up. Compared with the published adult series, pediatric nodules had a higher resection rate and ROM, particularly in the indeterminate categories. Conclusions Our study demonstrates that Asian pediatric thyroid nodules had higher ROM than those from adults. The prototypic outputs of TBSRTC may need to be adjusted in the pediatric population.

scholarly journals Evaluation of the positive predictive value of atypical thyroid cytology cases according to the Bethesda system taking histopathology as gold standard.

2019 ◽  
Vol 26 (11) ◽  
pp. 2015-2020
Author(s):  
Shireen Hamid ◽  
Aman ur Rehman ◽  
Muhammad Kashif Baig ◽  
Uzma Aslam ◽  
Nausheen Heena ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Thyroid Nodules ◽  
False Negative ◽  
Thyroid Function Tests ◽  
Thyroid Cytology ◽  
Bethesda System ◽  
The Bethesda System ◽  
Undetermined Significance

Objectives: For the past 20 years Fine Needle Aspiration Cytology (FNAC) has evolved as the most sensitive diagnostic tool for the initial screening of patients with thyroid nodules. Unfortunately FNAC is complicated by a recognized false negative rate of approximately 5%. The clinicians could face the difficulty in the management of patient when a cytological diagnosis is atypical only. The objective of study is to evaluate the positive predictive value (PPV) of atypical thyroid cytology cases according to the Bethesda system taking histopathology as gold standard. Study Design: Cross sectional study. Setting: Department of Pathology at Shaikh Zayed Hospital, Lahore. Period: Six months i.e. from 25.11.2014 to 25.5.2015. Materials and Methods: Patients presenting with solitary thyroid nodules in the outpatient department and fulfilling the inclusion criteria were included after evaluation by thyroid function tests and thyroid scan, FNAC was performed and reported according to Bethesda system of thyroid reporting. Later on, cases underwent lobectomy, total or hemi-thyroidectomy, the tissue was received in 10% formalin solution in our pathology department and then processed, stained and examined. FNAC results of atypical cases were then compared with the definitive histological diagnosis which were considered the gold standard. The slides were examined and any differences were sought by consensus of two pathologists. Eighty cases were observed with 95% confidence level, 11% margin of error, using non-probability purposive sampling technique for sample collection. Data was analyzed by SPSS version 15 (P value <0.05). Results: The mean age of patients was 38 years with SD ± 2.16. There were 22 (28%) males and 58 (72%) females in our study. In this study, positive predictive value for Atypia of undetermined significance/ Follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm (FN), suspicious for malignancy and positive for malignancy were 33.3%, 25%, 66.6% and 100% respectively. Overall PPV of atypical cytology was 35.71%. Overall accuracy of FNAC was 86.30%, 87.50% sensitivity and 86.15% specificity, PPV value 43.75% and negative predictive value was 98.25%. Conclusion: Results showed that Bethesda system of reporting is helpful for the management of patients who falls in to undetermined categories as it categorically divide atypical cytology cases in to three definite categories  AUS, FN and suspicious for malignancy and these categories have different risks of malignancy. Thus can help to determine a better patient outcome due to proper clinical management of thyroid swellings.

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