Correlation study of thyroid nodule cytopathology and histopathology at two institutions in Jordan

Background: Fine-needle aspiration (FNA) plays a fundamental role in determining the appropriate management for patients presenting with thyroid nodules. Aims: The aims of this study are to evaluate thyroid FNA test performance parameters through a cytohistological correlation. Materials and Methods: A retrospective analysis of all thyroid FNAs received over a period of 18 months was carried out. The findings were compared to their subsequent definite diagnoses on surgical specimens as well as to their follow-up repeat FNA results. A total of 499 thyroid FNAs were collected and reviewed against The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The percentage of each diagnostic category was calculated, and the implied risk of malignancy was determined by comparing the cytology results to their definite diagnoses obtained on the resection specimens. Analytical procedures were performed using Microsoft Excel. Results: Out of 499 thyroid FNAs, a benign interpretation was found in 273 patients (54.7%), atypia of undetermined significance in 81 (16.2%), follicular neoplasm in 20 (4%), suspicious for malignancy in 36 (7.2%), malignant in 32 (6.4%) and were nondiagnostic in 57 patients (11.4%). Only 101 patients (20.2%) underwent surgical resection and 47 (9.4%) underwent a follow-up FNA. After cytohistological correlation, FNA test performance, calculated by excluding the inadequate and undetermined categories revealed test sensitivity, specificity, and diagnostic accuracy of 95.6%, 54.8%, and 78.9%, respectively. The positive predictive value was 75.4%, and the negative predictive value was 89.5%. Conclusions: Our results are comparable to those previously published figures. The rate of atypia of undetermined significance/follicular lesion of undetermined significance is higher than what is currently recommended in TBSRTC.

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Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-Year Experience in a Single Japanese Institution

Acta Cytologica ◽

10.1159/000510990 ◽

2020 ◽

pp. 1-9

Author(s):

Yukiya Hirata ◽

Kayoko Higuchi ◽

Koichi Tamashiro ◽

Keisuke Koja ◽

Yuiko Yasutomi ◽

...

Keyword(s):

Salivary Gland ◽

Predictive Value ◽

Diagnostic Category ◽

Needle Aspiration ◽

Salivary Gland Neoplasm ◽

Published Evidence ◽

Risk Of Malignancy ◽

Categorization System ◽

Sensitivity Specificity

Objective: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a recently published evidence-based categorization system for salivary gland fine-needle aspiration (FNA). We applied MSRSGC to Japanese cases and evaluated its utility. Study Design: A total of 480 FNA cases were reviewed. We recategorized each case into one of the MSRSGC categories. The risk of neoplasm (RON) and the risk of malignancy (ROM) for each diagnostic category in MSRSGC, and the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for malignancy and for neoplasms were calculated for cases with histological follow-up. In addition, the overall ROM (O-ROM) was calculated for all FNA cases. Results: RON, ROM, and O-ROM rates were as follows – non-diagnostic: 51.3, 5.1, and 1.0%; non-neoplastic: 0, 0, and 0%; atypia of undetermined significance: 83.9, 12.9, and 7.3%; neoplasm, benign: 100, 0, and 0%; salivary gland neoplasm of uncertain malignant potential: 100, 32.1, and 23.7%; suspicious for malignancy: 100, 85.7, and 60%; and malignant: 100, 100, 81.8%. The sensitivity, specificity, and accuracy with (without) indeterminate cases for malignancy were 65 (100), 99 (99), 92% (99%) and PPV and NPV were 96 and 100%, respectively, and those for neoplasms were 84 (100), 100 (100), 85% (100%), and PPV and NPV were 100 and 100%, respectively. Conclusions: The MSRSGC is useful for stratification of ROM and for promoting the performance of salivary gland FNA. The MSRSGC could be easily introduced in Japan and may improve the Japanese salivary gland FNA status.

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The Bethesda System for Reporting Thyroid Cytopathology: A Cytohistological Study

Journal of Thyroid Research ◽

10.1155/2020/8095378 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8 ◽

Cited By ~ 1

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.

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Application of the Bethesda Classification for Thyroid Fine-Needle Aspiration: Institutional Experience and Meta-analysis

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2015-0154-sa ◽

2016 ◽

Vol 140 (10) ◽

pp. 1121-1131 ◽

Cited By ~ 33

Author(s):

Elliot A. Krauss ◽

Megan Mahon ◽

Jean M. Fede ◽

Lanjing Zhang

Keyword(s):

Fine Needle Aspiration ◽

Meta Analysis ◽

Needle Aspiration ◽

Data Sources ◽

Follicular Neoplasm ◽

Fine Needle ◽

Diagnostic Categories ◽

Risk Of Malignancy ◽

Thyroid Fna ◽

Undetermined Significance

Context.—Fine-needle aspiration (FNA) biopsies have been an important component in the preoperative evaluation of thyroid nodules. Until the introduction of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in 2008, individual institutions had developed their own diagnostic categories. The BSRTC proposed 6 categories in an attempt to standardize reporting of thyroid FNA. Objective.—To present a 15-year experience of thyroid FNA at one institution, including data before and after introduction of the BSRTC. The risk of malignancy is compared with the meta-analysis of high-quality published data. Data Sources.—Data sources were PubMed, a manual search of references, and institutional data. Conclusions.—The diagnostic categories developed at our institution were similar to those proposed by the BSRTC, with best fit into the 6 categories easily accomplished and reported in the final 2 years of the study. Significant differences were noted in the frequencies of cases in diagnostic categories Benign (II; P = .003), Suspicious for follicular neoplasm/Follicular neoplasm (IV; P < .001), and Malignant (VI; P = .003) after the introduction of the BSRTC. Eighteen published articles met the criteria for inclusion in the meta-analysis. The risk of malignancy in each category in our institution was similar to that determined in the meta-analysis, except for Insufficient for diagnosis (I; 20% versus 9%–14%). Meta-analysis showed an overlapping 95% CI of risk of malignancy between Atypia of undetermined significance/Follicular lesion of undetermined significance (III; 11%–23%) and Suspicious for follicular neoplasm/Follicular neoplasm (IV; 20%–29%), suggesting similar risks of malignancy. The use of newer molecular tests for these indeterminate cases may further refine risk assessment.

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Assessment of The Bethesda System for Reporting Thyroid Cytopathology

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz076 ◽

2019 ◽

Vol 152 (4) ◽

pp. 502-511 ◽

Cited By ~ 2

Author(s):

Jennifer L Sauter ◽

Heidi Lehrke ◽

Xiaotun Zhang ◽

Osamah T Al Badri ◽

Rene Rodriguez-Gutierrez ◽

...

Keyword(s):

Predictive Value ◽

Needle Aspiration ◽

Performance Characteristics ◽

Follicular Neoplasm ◽

Bethesda System ◽

Thyroid Fna ◽

Thyroid Cytopathology ◽

The Bethesda System ◽

The Impact

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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The Bethesda System for Reporting Thyroid Fine-Needle Aspiration Cytology: A Kuwaiti Experience - A Cytohistopathological Study of 374 Cases

Acta Cytologica ◽

10.1159/000371538 ◽

2015 ◽

Vol 59 (2) ◽

pp. 133-138 ◽

Cited By ~ 4

Author(s):

Kusum Kapila ◽

Laila Qadan ◽

Rola H. Ali ◽

Mohammed Jaragh ◽

Sara S. George ◽

...

Keyword(s):

Predictive Value ◽

Needle Aspiration ◽

Follicular Neoplasm ◽

Thyroid Fine Needle Aspiration ◽

Risk Of Malignancy ◽

Bethesda System ◽

Needle Aspiration Cytology ◽

Sensitivity Specificity ◽

The Bethesda System ◽

Undetermined Significance

Introduction: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) identifies 6 diagnostic categories in which the risk of malignancy increases respectively. The aim of our study was to assess TBSRTC reporting in our hospital and to evaluate its specificity based on cytohistological correlation. Methods: A histological diagnosis was available in 374 (110 males and 264 females) out of 7,809 thyroid aspirates examined at Mubarak Al-Kabeer Hospital, Kuwait, from 2004 to 2012. The aspirates were classified in accordance with TBSRTC. Results: Thyroid aspirates were classified as nondiagnostic (n = 18; 4.8%), benign (n = 114; 30.5%); atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; n = 59; 15.8%), follicular neoplasm/suspicious for follicular neoplasm (FN/SFN; n = 17; 4.5%), suspicious for malignancy (SM; n = 80; 21.4%), or malignant (n = 86; 23.0%). In 75 of 86 malignant cases, a papillary carcinoma was detected. There were 3 (1.6%) false-positive aspirates and the sensitivity, specificity, negative predictive value, and positive predictive value were 91.0, 61.9, 84.2, and 75.3%, respectively. Conclusions: Our results are fairly comparable to those of various previous studies in the SM, AUS/FLUS, and SFN categories. The higher rates observed in the nondiagnostic and benign categories were possibly due to limited guided aspirations and a lack of on-site evaluation for all cases.

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Diagnosis of atypia/follicular lesion of undetermined significance: An institutional experience

CytoJournal ◽

10.4103/1742-6413.139725 ◽

2014 ◽

Vol 11 ◽

pp. 23 ◽

Cited By ~ 14

Author(s):

Lawrence Q. Wong ◽

Virginia A. LiVolsi ◽

Zubair W. Baloch

Keyword(s):

Surgical Excision ◽

Needle Aspiration ◽

Follicular Neoplasm ◽

Malignancy Rate ◽

Thyroid Fine Needle Aspiration ◽

Clinicopathologic Factors ◽

Institutional Experience ◽

Thyroid Fna ◽

Undetermined Significance

Background: The overall malignancy rate for the thyroid fine-needle aspiration (FNA) diagnosed as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) ranges from 5% to 30%. In this study, we present our institutional experience with thyroid nodules diagnosed as AUS/FLUS and further stratified into subcategories. In addition, we also assessed the significance of various clinicopathologic factors that may influence AUS/FLUS diagnoses and their outcomes. Design: A search of our laboratory information system was performed to identify all in-house thyroid FNA cases diagnosed as AUS/FLUS from 2008 to 2012. The data were collected and characterized by patient demographic information, cytopathology diagnosis with sub-classifiers and follow-up. Results: The case cohort included 457 cases diagnosed as AUS/FLUS. These were further sub-classified into one of six subcategories depending on the cytomorphologic findings and suspicion for or against a neoplastic process. Of the 457 cases, repeat FNA and/or surgical follow-up was available in 363 cases. There were 182 (39.8%) cases with cytologic follow-up only; 18 (9.9%) remained as AUS/FLUS, while 158 (86.8%) were re-classified with the majority being benign (142 cases). Histologic follow-up was available in 181 (39.6%) cases. There were 60 malignant cases confirmed by surgical excision, with an overall malignancy rate of 33.1%. The malignancy rate was 38.8% for cases with a repeat FNA versus 25.6% for cases that went directly to surgery without a repeat FNA. Papillary thyroid carcinoma accounted for 93.3% (56 cases) of the malignant cases. Conclusion: Based on our study, even though the malignancy rate of AUS/FLUS cases is similar to those reported for cases diagnosed as follicular neoplasm/suspicious for follicular neoplasm, we are of the belief that these comparable malignancy rates are a product of better clinical management and selection of patients diagnosed as AUS/FLUS for surgery after a repeat FNA.

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Risk of Malignancy and Risk of Neoplasia in the Bethesda Indeterminate Categories: Study on 4,532 Thyroid Fine-Needle Aspirations from a Single Institution in India

Acta Cytologica ◽

10.1159/000470825 ◽

2017 ◽

Vol 61 (2) ◽

pp. 103-110 ◽

Cited By ~ 13

Author(s):

Swati Mahajan ◽

Radhika Srinivasan ◽

Arvind Rajwanshi ◽

Bishan Radotra ◽

Naresh Panda ◽

...

Keyword(s):

Lower Bound ◽

Predictive Value ◽

Internal Quality ◽

Follicular Neoplasm ◽

Single Institution ◽

Fine Needle ◽

Risk Of Malignancy ◽

Thyroid Fna ◽

Sensitivity Specificity ◽

Undetermined Significance

Objectives: To determine the frequency of category 3 (atypia of undetermined significance [AUS]/follicular lesion of undetermined significance [FLUS]), category 4 (follicular neoplasm), and category 5 (suspicious for malignancy) of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), the risk of malignancy (ROM) and the risk of neoplasia (RON) in these categories. Study Design: A retrospective 6-year audit of 4,532 thyroid fine-needle aspirations (FNA) reported as per the TBSRTC from a single institution with cytohistological correlation in 335 cases. Results: The frequency of categories 3, 4, and 5 was 2.5, 3.9, and 0.5%, respectively; the upper and lower bound estimates of ROM being 58.3, 23.6, 75% and 5.1, 5, and 12.5%, respectively. AUS/FLUS (n = 116) cases were subcategorized as AUS, AUS-HC (Hürthle cell), AUS-PTC (AUS-papillary thyroid carcinoma not excluded), FLUS, FLUS-FH (favor hyperplasia), FLUS-HC, and FLUS-PTC. The AUS/FLUS malignancy ratio was 1:3.8. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of FNA thyroid was 80.5, 85.9, 80.7, 85.7, and 82.4%, respectively. Conclusion: Implementation of TBSRTC aided in achieving internal quality control in reporting thyroid FNA cytology. The AUS/FLUS frequency was 2.5%, which is at the lower range of the recommended rate and was associated with a higher than recommended upper bound estimate, but a comparable lower bound estimate of ROM.

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Oncocytic follicular nodules of the thyroid with or without chronic lymphocytic thyroiditis: An institutional experience

CytoJournal ◽

10.4103/1742-6413.106686 ◽

2013 ◽

Vol 10 ◽

pp. 2 ◽

Cited By ~ 9

Author(s):

Sule Canberk ◽

A. Carruth Griffin ◽

Abha Goyal ◽

He Wang ◽

Kathleen Montone ◽

...

Keyword(s):

Needle Aspiration ◽

Lesion Size ◽

Surgical Pathology ◽

Follicular Neoplasm ◽

Chronic Lymphocytic Thyroiditis ◽

Clinicopathologic Features ◽

Lymphocytic Thyroiditis ◽

Risk Of Malignancy ◽

Thyroid Fna

Background: Oncocytic follicular (OF) cells can be a prominent component of fine needle aspiration (FNA) specimens from neoplasms (adenomas and carcinomas) and nodules arising in multinodular goiter and chronic lymphocytic thyroiditis (CLT). Because OF cells can be present in non-neoplastic and neoplastic thyroid lesions it can be challenging to differentiate between these two in FNA specimens. The aims of this study were to determine the risk of malignancy in cases diagnosed as either oncocytic follicular neoplasm (OFN) or hyperplastic/adenomatoid nodule with OF on FNA and to identify clinicopathologic features that may help in predicting malignancy in such cases, especially the presence or absence of CLT. Design: We retrospectively searched the computerized laboratory information system at our institution between 1998 and 2009 for thyroid US guided FNA specimens in which the term “oncocytic/oncocytes” was mentioned in the final cytopathologic diagnosis. A total of 340 cases were selected for this study. The following data points were collected: Patient demographics, site of thyroid biopsy, size of lesion, FNA diagnosis, histopathologic follow-up and presence of CLT. Surgical pathology follow-up (SPFU) was available in 269 (79%) cases. Results: Two hundred and sixty patients were females and 80 males (average age 53 years). The lesion size was <3.0 cm in 241 (71%) and ≥ 3.0 cm in 99 (29%) cases. Cytologic diagnoses included: Follicular neoplasm with oncocytic features (FNOF) 321 and suggestive of FNOF 19 cases; a secondary cytologic diagnosis of CLT was made in 20 cases. SPFU was available in 269 (79%) cases; it was benign in 213 (213/267 = 79%) and malignant in 56 (56/269 = 21%) cases. The background thyroid showed CLT in 67 (25%) cases; 24% (48/196) neoplasms occurred with versus 76% (147/196) without CLT. The rate of malignancy was lower in nodules measuring less than 3.0 cm as compared to those equal or greater than 3.0 cm in size (17% vs. 28% respectively). The presence of CLT did not significantly alter the rate of malignancy in both FNA and surgical pathology specimens. Conclusions: Based on this study, nodule size and not CLT appears to be an important clinicopathologic features in the management of thyroid FNA specimens diagnosed as OFN.

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Classification of Male Breast Lesions According to the IAC Yokohama System for Reporting Breast Cytopathology

Acta Cytologica ◽

10.1159/000512041 ◽

2020 ◽

pp. 1-8

Author(s):

Melissa Oosthuizen ◽

Rubina Razack ◽

Jenny Edge ◽

Pawel Tomasz Schubert

Keyword(s):

Predictive Value ◽

Best Practice ◽

Internal Audit ◽

Needle Aspiration ◽

Male Breast ◽

Histopathological Diagnosis ◽

Breast Lesions ◽

Risk Of Malignancy ◽

Sensitivity Specificity

Objective: This study aims to determine the diagnostic utility of the International Academy of Cytology (IAC) Yokohama System for reporting breast cytopathology in lesions of the male breast. Study Design: Fine-needle aspiration biopsy (FNAB) reports between 2015 and 2019 were retrospectively recategorized according to the 5-tiered IAC Yokohama Reporting System. Our database yielded a total of 1,532 FNAB reports from breast lesions, obtained from 1,350 male patients. The risk of malignancy (ROM) and diagnostic performance of FNAB were determined using follow-up histopathological diagnosis and/or clinical follow-up, where available, for each category. Results: The category distribution were as follows: inadequate, 40%; benign, 57%; atypical, 0.6%; suspicious for malignancy, 0.7%; and malignant, 1.6%. The ROM in each category was nondiagnostic, 11%; benign, 3%; atypical, 28%; suspicious for malignancy, 56%; and malignant, 100%. The sensitivity, specificity, positive predictive value, and negative predictive value were recorded as 63, 100, 100, and 84.6% respectively, when only malignant cases were considered as positive tests. Conclusion: This study validates the IAC Yokohama System for reporting male breast cytopathology. In accordance with the aim of the Yokohama System to establish best practice guidelines for reporting breast cytopathology, this comprehensive scheme facilitates comparisons between local and international institutions. The ROM acts as an internal audit for quality assurance within one’s own laboratory and provides guidance for clinical management. It highlights inefficiencies such as high inadequacy rates for category 1 and also features strengths with impressive specificity for categories 4 and 5.

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