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.

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 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.

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.

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