The impact of the Bethesda System for Reporting Thyroid Cytopathology

Abstract Objectives Long-term follow-up is important for determining performance characteristics of thyroid fine-needle aspiration (FNA). Methods Histologic or 3 or more years of clinical follow-up was used to calculate performance characteristics of thyroid FNA before and after implementation of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) classification was also investigated. Results Follow-up was obtained for 1,277/1,134 and 1,616/1,393 aspirates/patients (median clinical follow-up, 9.9 and 4.4 years, pre- and post-TBSRTC, respectively). Nondiagnostic, suspicious for follicular neoplasm, and suspicious for malignancy (SFM) diagnoses decreased and benign diagnoses increased post-TBSRTC, while atypical rate remained less than 1%. Negative predictive value for benign nodules and positive predictive value (PPV) for SFM increased significantly. Eleven nodules were reclassified as NIFTP, slightly decreasing PPV/risk of malignancy (ROM). Conclusions Appropriate ROM for thyroid FNA can be achieved through application of TBSRTC terminology with minimal use of atypical category.

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Cytological Diagnosis of Follicular Variant of Papillary Thyroid Carcinoma before and after the Bethesda System for Reporting Thyroid Cytopathology

Acta Cytologica ◽

10.1159/000444669 ◽

2016 ◽

Vol 60 (1) ◽

pp. 14-18 ◽

Cited By ~ 4

Author(s):

Roghayeh Fazeli ◽

Christopher J. VandenBussche ◽

Justin A. Bishop ◽

Syed Z. Ali

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Surgical Resection ◽

Follicular Neoplasm ◽

Papillary Thyroid ◽

Follicular Variant ◽

Bethesda System ◽

Thyroid Cytopathology ◽

The Bethesda System ◽

The Impact

Background: The follicular variant of papillary thyroid carcinoma (FVPTC) is the second most common subtype of papillary carcinoma after the classical variant. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has been introduced to standardize the practice of thyroid fine needle aspiration (FNA) reporting. We evaluated the impact of TBSRTC on the FNA interpretation of histologically proven FVPTCs. Method: Cytology reports of 455 histologically proven FVPTCs were reviewed. The rate of each TBSRTC category was compared between pre- and post-TBSRTC eras. Results: The distribution of FNA diagnoses for pre-TBSRTC cases included suspicious for follicular neoplasm (SFN; n = 51, 28.7%), papillary thyroid carcinoma (PTC; n = 47, 26.4%), suspicious for malignancy (SFM; n = 32, 18%), atypia of undetermined significance (AUS; n = 23, 13%), benign (n = 18, 10.1%), and nondiagnostic (ND; n = 7, 4%). Post-TBSRTC diagnoses were: AUS (n = 68, 24.6%), PTC (n = 64, 23.1%), SFM (n = 50, 18%), SFN and benign (n = 42, 15.2%) and ND (n = 11, 4%). SFN rate decreased significantly from 28.7 to 15.2% (p = 0.001) and AUS increased from 12.9 to 24.5% (p = 0.003). Conclusion: Following implementation of TBSRTC, the frequency of AUS diagnoses on FNA prior to surgical resection increased. Given that the rate of FVPTC diagnoses on thyroidectomy increased over the same period, this suggests that the use of AUS has resulted in greater surgical resection of FVPTC.

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The impact of implementation of the Bethesda System for Reporting Thyroid Cytopathology on the quality of reporting, “risk” of malignancy, surgical rate, and rate of frozen sections requested for thyroid lesions

Cancer Cytopathology ◽

10.1002/cncy.20174 ◽

2011 ◽

Vol 119 (5) ◽

pp. 315-321 ◽

Cited By ~ 43

Author(s):

Amanda Crowe ◽

Ami Linder ◽

Omar Hameed ◽

Chura Salih ◽

Janie Roberson ◽

...

Keyword(s):

Frozen Sections ◽

Quality Of Reporting ◽

Risk Of Malignancy ◽

Bethesda System ◽

Thyroid Cytopathology ◽

The Bethesda System ◽

The Impact ◽

Thyroid Lesions

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The Impact of Implementation of the Bethesda System for Reporting Thyroid Cytopathology on the Surgical Treatment of Thyroid Nodules

The American Surgeon ◽

10.1177/000313481207800627 ◽

2012 ◽

Vol 78 (6) ◽

pp. 706-710 ◽

Cited By ~ 9

Author(s):

Bryan K. Richmond ◽

Bridget A. O'brien ◽

William Mangano ◽

Stephanie Thompson ◽

Suzanne Kemper

Keyword(s):

Thyroid Nodules ◽

Needle Aspiration ◽

Published Data ◽

Final Pathology ◽

Significant Difference ◽

Bethesda System ◽

Thyroid Cytopathology ◽

The Bethesda System ◽

Original Interpretation ◽

The Impact

Published data suggest that the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) is valuable in directing therapy of thyroid nodules. Literature examining the effect of the BSRTC on management when compared with pre BSRTC is lacking, however. This study evaluates the impact of applying the BSRTC retrospectively to a series of patients who underwent surgery after a fine-needle aspiration biopsy (FNAB) classified using the pre BSRTC system, and investigates how the BSRTC application to the same population would have ultimately affected the management strategy. One hundred patients who had previously undergone both FNAB and thyroidectomy before implementation of the BSRTC were randomly selected. Each FNAB was examined by a single cytopathologist (blinded to both the original interpretation and the surgical pathology findings) and reclassified using the BSRTC. Accuracy of both systems was examined using the final pathology as the true diagnosis. Of 68 FNABs initially classified as indeterminate, 32 (47.1%) were reclassified as benign. There was no significant difference in overall rates of detection of malignancy on final pathology in specimens classified as benign, both pre and post application of the BSRTC ( P = 0.70). Application of the BSRTC resulted in a significant percentage of indeterminate specimens being reclassified as benign, presumably due to more standardized criteria for interpretation and reporting. No significant change in detection of malignancy was observed. We conclude that application of the BSRTC may result in lower rates of thyroidectomy, while preserving the same diagnostic accuracy in the detection of thyroid malignancy.

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