The Bethesda system for reporting thyroid fine needle aspirates: A cytologic study with histologic follow-up

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.

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BRAF Testing of Thyroid Fine Needle Aspirates Diagnosed on ThinPrep Using the Bethesda System for Reporting Thyroid Cytopathology

Journal of the American Society of Cytopathology ◽

10.1016/j.jasc.2013.08.009 ◽

2013 ◽

Vol 2 (1) ◽

pp. S5 ◽

Cited By ~ 1

Author(s):

Jeffrey F. Krane ◽

Markus Eszlinger ◽

Edmund Cibas ◽

Ralf Paschke

Keyword(s):

Fine Needle ◽

Fine Needle Aspirates ◽

Bethesda System ◽

Thyroid Cytopathology ◽

The Bethesda System

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

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa182 ◽

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.

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Follow-Up Strategies for Thyroid Nodules with Benign Cytology on Ultrasound-Guided Fine Needle Aspiration: Malignancy Rates of Management Guidelines Using Ultrasound Before and After the Era of the Bethesda System

Thyroid ◽

10.1089/thy.2018.0769 ◽

2019 ◽

Vol 29 (9) ◽

pp. 1227-1236

Author(s):

Jung Hyun Yoon ◽

Hye Sun Lee ◽

Eun-Kyung Kim ◽

Hee Jung Moon ◽

Vivian Youngjean Park ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Ultrasound Guided ◽

Management Guidelines ◽

Fine Needle ◽

Before And After ◽

Bethesda System ◽

The Bethesda System

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Utility of Bethesda System for Reporting Thyroid Fine Needle Aspirates

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl4.4474 ◽

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.

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

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0575-oa ◽

2013 ◽

Vol 137 (11) ◽

pp. 1627-1629 ◽

Cited By ~ 8

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.

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

Acta Cytologica ◽

10.1159/000486779 ◽

2018 ◽

Vol 62 (2) ◽

pp. 85-92 ◽

Cited By ~ 4

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.

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