Diagnostic Frequency Ratios Are Insufficient to Measure Laboratory Precision with The Bethesda System for Reporting Thyroid Cytopathology

2015 ◽  
Vol 59 (3) ◽  
pp. 225-232 ◽  
Author(s):  
Roghayeh Fazeli ◽  
Eric B. Schneider ◽  
Syed Z. Ali ◽  
Martha A. Zeiger ◽  
Matthew T. Olson
Keyword(s):  
Tertiary Hospital ◽  
The Other ◽  
Observer Variability ◽  
Fine Needle ◽  
Fine Needle Aspirates ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
Frequency Ratios ◽  
Undetermined Significance

Objective: Diagnostic frequency ratios such as the atypia of undetermined significance (AUS):malignant ratio are touted to be useful for laboratory precision benchmarking. We therefore sought to examine their reproducibility and usefulness at a tertiary hospital. Methods: We reviewed thyroid fine-needle aspirates (FNA) submitted to our institution from outside laboratories and evaluated the ability of diagnostic frequency ratios to capture the complexity of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Specifically, we evaluated the ability of the AUS:malignant ratio to describe the frequencies of the other TBSRTC diagnoses. Results: A total of 2,784 cases from 19 laboratories were included. The use of the AUS category varied the most. There was insufficient reflection of the non-AUS nonmalignant TBSRTC diagnostic frequencies in our analysis, and these results do not appear to arise from observer variability in the outside laboratories. Conclusion: Diagnostic frequency ratios are not reproducible in our experience and fail to describe the other TBSRTC categories. As such, they are unlikely to prove sufficient for benchmarking laboratory precision with TBSRTC.

scholarly journals Utility of Bethesda System for Reporting Thyroid Fine Needle Aspirates

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 2356-2360
Author(s):  
Jyoti S. Tele ◽  
Rohit S. Kadam ◽  
Atul B. Hulwan ◽  
Pawar S J ◽  
Mahendra A. Patil
Keyword(s):  
Reporting System ◽  
Surgical Excision ◽  
Fine Needle ◽  
Fine Needle Aspirates ◽  
Histopathological Correlation ◽  
Significant Difference ◽  
Bethesda System ◽  
Thyroid Swelling ◽  
Thyroid Cytopathology ◽  
The Bethesda System

The present study was a two year prospective study of FNAC of total 158 palpable thyroid lesions, reported according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Out of 158 cases, 36 patients underwent surgical excision and cyto- histopathological correlation was done in these cases. Majority of the patients were females, with a ratio of female to male as 8.9:1. The duration of the palpable thyroid swelling in the present study ranged from less than 1 month period to more than 5 years. Size of thyroid swelling varied from as small as 1 cm to as large as 18 cm in diameter. The procedure was done by both aspiration and non-aspiration techniques and any significant difference in terms of the yield of material by either of the method, was not observed in the present study. TBSRTC is an excellent reporting system, as it showed specificity of 100 % in the present study, which helped to diagnose benign cases correctly and to avoid unnecessary surgery.

Should “Indeterminate” Diagnoses Be Used for Thyroid Fine-Needle Aspirates of Nodules Smaller Than 1 cm?

2013 ◽  
Vol 137 (11) ◽  
pp. 1627-1629 ◽  
Author(s):  
Andrew A. Renshaw ◽  
Edwin W. Gould
Keyword(s):  
Papillary Carcinoma ◽  
Follicular Cells ◽  
Fine Needle ◽  
Fine Needle Aspirates ◽  
Hürthle Cell ◽  
Cell Neoplasm ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
The Bethesda System ◽  
Undetermined Significance

Context.—The Bethesda System for thyroid fine-needle aspirates does not account for the size of the lesion that is aspirated. Objective.—To determine whether the size of the lesion would be helpful in order to reduce indeterminate thyroid aspirations. Design.—We correlated the results of all thyroid aspirations and surgical resection for the last 16 years at our institutions. Results.—A total of 9080 cases were aspirated and 1393 resections were performed. Of those resected, a total of 236 (17%) were classified as atypical follicular cells of undetermined significance, and 256 (18%) were classified as suspicious for a follicular/Hürthle cell neoplasm. A total of 52 incidental papillary carcinomas were identified in these indeterminate cases at resection (52 of 492; 11%). Thirty-seven (16%) atypical follicular cells of undetermined significance cases and 21 (8%) suspicious for a follicular/Hürthle cell neoplasm cases were for nodules smaller than 1 cm in diameter. When cases subtyped as atypical, a papillary carcinoma cannot be ruled out, were removed (13 cases), the remaining 24 and 21 aspirates identified 3 tumors each (13% and 14%), all papillary carcinomas. Together, the incidence of identified carcinomas was not significantly different than that of incidental carcinomas (13% versus 11%, P = .48). The rate of identified carcinomas was significantly less than for similar indeterminate cases smaller than 1 cm (excluding cases of atypical, papillary carcinoma cannot be ruled out) (88 of 330 cases; 27%; P = .05). Conclusions.—For nodules smaller than 1 cm in our series, indeterminate aspirates without features of papillary carcinomas have the same risk of malignancy as benign aspirates.

scholarly journals Thyroid Cytopathology Reporting by the Bethesda System: A Two-Year Prospective Study in an Academic Institution

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Payal Mehra ◽  
Anand Kumar Verma
Keyword(s):  
Prospective Study ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Fine Needle ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
Undetermined Significance

Background. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has attempted to standardize reporting and cytological criteria in aspiration smears. Aims. The objective of this study was to analyze the thyroid cytology smears by TBSRTC, to determine the distribution of diagnostic categories and subcategories, to analyze cytological features, and to correlate the cytopathology with histopathology, wherever surgery was done. Materials and Methods. This was a prospective study of 225 fine needle aspirations (FNA) of thyroid nodules. All fine needle aspiration cytology (FNAC) diagnoses were classified according to the features given in the monograph of TBSRTC into nondiagnostic/unsatisfactory (ND/UNS), benign, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm/suspicious of a follicular neoplasm (FN/SFN), suspicious for malignancy (SFM), and malignant. Cytohistological correlation was done, when surgical material was available. Results. The distribution of various categories from 225 evaluated thyroid nodules was as follows: 7.2% ND/UNS, 80.0% benign, 4.9% AUS/FLUS, 2.2% FN, 3.5% SFM, and 2.2% malignant. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Conclusions. TBSRTC is an excellent reporting system for thyroid FNA. It also provides clear management guidelines to clinicians to go for follow-up FNA or surgery and also the extent of surgery.

Atypia of Undetermined Significance in Thyroid Fine-Needle Aspirations: Follow-Up and Outcome Experience in Newfoundland, Canada

2018 ◽  
Vol 62 (2) ◽  
pp. 85-92 ◽  
Author(s):  
Polycarp Erivwo ◽  
Chandrani Ghosh
Keyword(s):  
Needle Aspiration ◽  
Molecular Testing ◽  
Eastern Health ◽  
Histologic Diagnosis ◽  
Fine Needle ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
Undetermined Significance

Introduction: The rates of atypia of undetermined significance (AUS) by fine-needle aspiration (FNA) and malignant outcomes have been estimated at < 7% and 5–15%, respectively. Initial AUS diagnosis is followed up clinically with serial ultrasounds, repeat FNA, molecular testing, or direct surgery. We investigated the incidence, follow-up modalities, and final outcomes of AUS in Newfoundland. Methods: All cases of AUS diagnosed at the Eastern Health Cytology Laboratory between 1 January 2010 and 31 December 2013 were identified. Electronic medical records were examined for follow-up modalities and final histologic diagnosis. The final outcomes were reported as benign, malignant, or undetermined. Results: Out of 3,285 thyroid FNAs, 181 (5.5%) were AUS. Fifty-seven (31.5%) had repeat FNA diagnosed as benign (38.6%), AUS (29.8%), or suspicious/malignant (8.8%). Eighty-four (46.4%) had surgery after the first AUS diagnosis, 39 (46.4%) of which were malignant. Twenty-four patients (13.3%) were followed up by serial ultrasound only, 2 (1.1%) by molecular testing, and 1 (0.6%) died of unrelated disease. Thirteen (7.2%) had no follow-up record. Our malignancy rate (MR) was 29.8%. Conclusion: The MR in our population was higher than the rate proposed by The Bethesda System for Reporting Thyroid Cytopathology. Repeat FNA can reduce the rate of unnecessary surgeries, but practice guidelines should consider individual and institutional circumstances. The ratio MR:ADR (AUS diagnostic rate) may be a better indicator of performance.

scholarly journals Reporting of thyroid fine needle aspiration cytology with the use of the Bethesda System (TBS) of 150 cases

2018 ◽  
Vol 6 (11) ◽  
pp. 3586
Author(s):  
Mandakini M. Patel ◽  
Mubim I. Patel ◽  
Bhavna G. Gamit ◽  
Sharmistha M. Patel
Keyword(s):  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Bethesda System ◽  
Thyroid Swelling ◽  
Needle Aspiration Cytology ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
Undetermined Significance

Background: Fine needle aspiration cytology (FNAC) is very simple, rapid, cost effective diagnostic test to evaluate thyroid swelling. The Bethesda system for reporting thyroid cytopathology gives guidelines which remains the same while reporting the thyroid FNAC. There are six diagnostic categories of lesions: (I) Non-diagnostic/Unsatisfactory, (II) Benign, (III) Atypical follicular lesion of undetermined significance (AFLUS), (IV) Suspicious for follicular neoplasm (SFN), (V) Suspicious for malignancy (SM), (VI) Malignant.Methods: The study was carried out in Department of Pathology, Government Medical College affiliated with a Government hospital, Gujarat. It includes 150 patients, coming to the outpatient departments with a complaint of thyroid swelling from January 2017 to December 2017. The patients age ranges from 7 years to 75 years (Male-20, Female-130). The procedure was done with the patient in a supine position without a pillow. Patients were instructed not to speak or swallow during the procedure to avoid movement of the gland. The reporting was done with the current Bethesda nomenclature.Results: There were 150 cases of thyroid FNAC, 3 cases (2 %) were non-diagnostic (TBS-I), 133 cases (88.7 %) were benign (TBS-II), 6 cases (4 %) were atypical follicular lesion of undetermined significance (AFLUS) (TBS-III), 5 cases (3.4 %) were suspicious for follicular neoplasm (TBS-IV), 2 cases (1.3 %) were suspicious for malignancy (TBS-V), and 1 case (0.6 %) was malignancy (TBS-VI).Conclusions: The Bethesda system is very useful standardized system for reporting thyroid cytopathology, improving communication between cyto-pathologists and clinicians, inter-laboratory agreement, leading to more consistent management approaches. 

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