[13] The higher percentage of this category may reflect our pathologistsâ carefulness in avoiding both false positive and false negative results. Dr. Eman Aljufairi conceived the study and participated in its design and coordination and helped draft the manuscript. There were 15 Bethesda I nodules (nondiagnosis) with follow-up histopathology. Most of the FNAs were performed under ultrasound guidance by a consultant radiologist, usually with on-site adequacy assessment. That is because of the lack of documentation of the radiologic findings and targeted nodules at the time of ultrasound-guided FNAs. Each category is linked to a malignancy risk and has a recommended clinical management. It is a simple, safe, quick and cost-effective outpatient procedure. Lastly, the nondiagnostic category (DC I) was assigned to 13% of the FNAs (range, 2 to 24); 16% had histologic follow-up and 16.8% were malignant. Until the introduction of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in 2008, individual institutions had developed their own diagnostic categories. We use cookies to ensure that we give you the best experience on our website. Background: The Bethesda System has been used to classify thyroid cytology in 6 categories besides presenting malignancy rates and respective approaches. Aims. In patients in the suspicious for malignancy category, the data also show that there is a very high percentage of malignancy, 75%. The high risk of malignancy (15%) noticed in Category II (benign) which should not exceed 3% needs further evaluation including both radiological and pathological correlation to exclude cases with incidental malignancy. We did not review FNA cases again, but we relied on the original interpretation given by the five different cytopathologists that were working in Salmaniya Medical Complex in the period studied. Each category is linked to a malignancy risk and has a recommended clinical management. [2] These categories are nondiagnostic, benign, atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS), follicular neoplasm/suspicious for follicular neoplasm (SFN), suspicious for malignancy, and malignant. The BSRTC proposed 6 categories in an attempt to standardize reporting of thyroid FNA. Eight published studies that included a total of 25,445 thyroid FNAs were selected for the meta-analysis. Rapid assessment of adequacy was done by Diff-Quick staining. It is a rapid, cost-effective, and very useful method in classifying thyroid nodules as either benign nodules, reducing unnecessary surgery, or malignant nodules requiring surgery. Smears made were both fixed in alcohol and stained by Papanicolaou stain or air dried and stained with Giemsa stain. A publication of the American Thyroid Association THYROID NODULES The Bethesda classification for thyroid biopsies is effective for clinical management of thyroid nodules final pathology, 4. The data summarized in the current report show considerable variability among institutions with regard to the frequency of the various categories. Bethesda classification Mostly AUS and SFN Mostly SUS and M “Despite differences in the cytological classification and molecular profiles between NIFTP and IFVPTC, the degree of overlap makes it unlikely that most cases of NIFTP and IFVPTC can be accurately distinguished with FNAB” Reference centers have validated its use by comparing its proposed malignancy rates with those in in their populations. Epub August 31, 2011. doi: 10.1210/jc.2011-1469. The benign category (DC II) was assigned to 59% of the FNAs (range, 39 to 74); 10.4% had histologic follow-up and 3.7% were malignant. According to the management guidelines for Bethesda Category III nodules, repeat biopsy after 3 months should be done. Although the three categories of AUS/FLUS, FN/SFN, and suspicious for malignancy had previously been lumped together to comprise an “indeterminate” class (2), it is clear that when the FNA is in the suspicious for malignancy category (DC V), the patient should undergo thyroidectomy. All slides were interpreted by one of five qualified cytopathologists. For clarity of communication, TBSRTC recommends that each report begin with 1 of 6 general diagnostic … It might also be related to the increased number of indeterminate FNACs undergoing surgery. Nikiforov YE, Ohori NP, Hodak SP, Carty SE, LeBeau SO, Ferris RL, Yip L, Seethala RR, Tublin ME, Stang MT, et al. Dr. S. Ali Almahari helped in data collection and drafting the manuscript. The comparison shows variable results in both the distribution of cases and the associated risk of malignancy with each category. It can be divided into six categories: Thyroid cytopathology of Bethesda category III with clotting artifact This was a prospective study of 2… Thyroid nodules are common and may be found in up to 60% of the population. However, to the best of … This study presents our experience with the Bethesda system in 681 thyroid FNAs from 632 patients in the period between January 2013 and December 2016. Of the remaining cases, there were one Hurthle cell neoplasm, two follicular adenomas, and four adenomatoid nodules in multinodular goiter. Of these, malignancy was found in only one case, which was a papillary thyroid microcarcinoma (6.67%, 1/15). From January 2013, the Department of Pathology in Salmaniya Medical Complex, Ministry of Health in Bahrain, has reported all thyroid FNAs using the Bethesda system and followed the guidelines in the diagnostic manual âThe Bethesda System for Reporting Thyroid Cytopathology â This pathology department receives around 150 cases of thyroid FNAs per year referred from specialist endocrinologists and general surgeons. The Bethesda System for Reporting Thyroid Cytopathology. [78] The differences in terminologies used in these schemes are summarized in Table 4. The most significant difference between the 5-tiered and 6-tiered systems was the decrease in percentage of cases classified as benign (83.9% vs. 55.4%), mainly due to the introduction of AUS/FLUS category. The authors state that there are no conflicts of interest. The authors reviewed reports published between January 2008 and September 2011 that classified thyroid cytopathology according to the Bethesda System and included surgical histopathology. In comparison to the TBSRTC, the frequency of malignancy in our study was comparable for Category I (6.7% compared to 1%â4%), slightly higher in both Category II (15% compared to 0%â3%) and Category III (28% compared to 5%â15%), and close to TBSRTC in Category IV (22.2% compared to 15%â30%), Category V (72.8% compared to 60%â75%, and Category VI (100% compared to 97%â99%). The malignant category (DC VI) was assigned to 5.4% of the FNAs (range, 2 to 16); 74% had histologic follow-up and 98.6% were malignant. This study was conducted with approval from the Research and Ethics Committee in the Salmaniya Medical Complex in the Ministry of Health in Bahrain. Suspicious for follicular cancer - 10.1% (range, 1-25%) - of those 26.1% were cancerous at final pathology, 5. reported also an increase in the number of preoperative thyroid FNACs after the adoption of TBSRTC and an increase in patients undergoing thyroid surgery for indeterminate FNAC results. HomeBrowse Articles About UsEditorial BoardFor AuthorsReviewer CornerSubscribeContact Us. Introduction. 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. [78] Unfortunately, it was difficult to compile data before 2013 to compare our experience with TBSRTC to the British system. III ... • ATA initiatives to reduce the extent of surgery for many low- risk thyroid cancers (4 cm or smaller, without extra -thyroidal extension and lacking ... raise the possibility for lobectomy as initial surgical management. The frequency of diagnosis of each Bethesda category reported in our institution is within the ranges reported in other cohorts, even the high frequency of diagnosis of Bethesda Category III (AUS/FLUS). This is the first study to be published on the implementation of the TBSRTC in Bahrain and its diagnostic correlation with histopathology diagnosis. [910] The new category of AUS/FLUS in TBSRTC includes a subset of lesions not easily classified as benign, suspicious or malignant, while SFN category is reserved for specimens suspicious of follicular carcinoma. 3 High Serum Thyrotropin Concentrations within the Reference Range: A Predictor of Malignancy in Nodular Thyroid … The Royal College of Pathologists system uses the Thy1-5 originally suggested categories but with expanded specifications for each category. Bethesda Classification of Thyroid Nodule Fine Needle Aspirations I. Nondiagnostic or Unsatisfactory In these biopsies not enough thyroid cells were obtained to render a diagnosis. Bongiovanni et al. Acta Cytol. The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) resulted from a conference held at the National Institutes of Health in 2007. The Bethesda system assigns a risk of malignancy for each category. The same fact has been emphasized on by the 2015 American Thyroid Association Management Guidelines, which reported 1%â10% risk of malignancy associated with benign cytological category. Risk of malignancy: 1 - 4%. While it is easy to diagnose most benign and straightforward malignant lesions, diagnostic challenges arise when aspirates are quantitatively or qualitatively inadequate to exclude a neoplastic process. The Bethesda system used six categories for thyroid cytology reporting, and each category is supplemented by a list of criteria. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a significant step to standardize the reporting of Of the 126 nodules with histopathology follow-up, carcinoma was identified in 35 cases yielding an overall rate of malignancy of 27.8% (35/126 nodules and 34/119 patients). In addition, they differ in the clinical management, where patients with AUS/FLUS should be followed up with repeated FNA or observation, and patients with SFN should undergo at least thyroid lobectomy to determine the type of the follicular lesion and rule out follicular carcinoma. Background. All of our cytopathologists were aware of TBSRTC, and adhered to its criteria and terminologies. The Bethesda system suggests a six category classification system to report thyroid FNAB results: 1. A total of 632 patients underwent 681 FNAs during the study period. OBJECTIVE: The Bethesda classification was introduced in 2008 to provide standardisation in the evaluation of thyroid fine needle aspiration cytology (FNAC). Of the 60 nodules diagnosed as Bethesda II (benign) on preoperative FNAC, nine nodules found to be malignant, yielding a malignancy rate of 15% (9/60) for those undergoing surgery, which represented around 2% of the total number of Category II nodules. With regard to the possibility of malignancy for a given classification, the data corroborate the results anticipated when the classification was set up (1). The system led to standardization of FNA reports based In patients with benign FNA or inadequate specimens who undergo surgery, it is likely that clinical factors, such as a family history of thyroid cancer, the size of the nodule, compressive symptoms, or suspicious findings on ultrasonography are the basis for the decision to perform surgery. (C) Professor, Department of Pathology McGill University Director, Cytopathology Laboratory The Bethesda System for Reporting Thyroid Cytopathology categorizes thyroid cytology findings into six groups, with each group assigned a putative malignancy risk. In addition, clinicians should always be aware of the malignancy rate in the Bethesda categories in their respective hospitals to improve the management decisions taken regarding patients with thyroid nodules. [311171819] That tells us that there is no much of difference between how pathologists in the Middle East use TBSRTC compared to their peers in more developed countries, i.e., the United States. Briefly, 69 (10.1%) were Category I/Bethesda I (nondiagnostic), 469 (68.8%) were Category II/Bethesda II (benign), 85 (12.4%) were Category III/Bethesda III (AUS), 20 (2.9%) were Category IV/Bethesda IV (SFN, 18 (2.6%) were Category V/Bethesda V (suspicious for malignancy), and 28 (4.1%) were Category VI/Bethesda VI (malignant). Bethesda Classification and Cytohistological Correlation of Thyroid Nodules in a Brazilian Thyroid Disease Center 27 April 2018 | European Thyroid Journal, Vol.
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