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Refai FA, Alyazidi AS, Shawli MK, Alotibi FA, Jambi AT, Haider RA, Binhamran KW, Osaylan MT. The sensitivity and specificity of fine needle aspiration cytology in detecting thyroid malignancy according to Bethesda system at a teaching hospital in Saudi Arabia. J Family Med Prim Care 2024; 13:4657-4662. [PMID: 39629396 PMCID: PMC11610800 DOI: 10.4103/jfmpc.jfmpc_432_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/24/2024] [Accepted: 06/07/2024] [Indexed: 12/07/2024] Open
Abstract
Background The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) aims to standardize the terminology and morphologic criteria associated with thyroid fine-needle aspiration cytology (FNAC) results while also providing corresponding risk assessments for malignancy. contributing to more consistent and standardized reporting of thyroid nodules and aiding clinicians in making informed decisions. Since then, it has been undergoing revisions and updates to further improve its utility and accuracy. Materials and Methods This is a retrospective study conducted at a tertiary care center. All patients with a history of thyroid gland swelling who had previously undergone FNA were included. The procedure included cytopathologists performing FNAC for all cases of midline neck swelling. Demographic and histopathology data were correlated with the cytological diagnosis. Results We included 288 cases. Of those, 234 (81.3%) were female and 54 (18.8%) were male. The presentation age range was 18-91 years. The most reported category was benign, which constituted 30.9% of the cases followed by malignancy (27.1%). As for thyroid lesions, papillary carcinoma was the most prevalent (43.6%). The correlation on cyto-histopathology was presented in every diagnostic category, showing high heterogeneity in diagnostic specificity and sensitivity. The overall diagnostic specificity and sensitivity were 56.05% (95% confidence interval [CI]: 47.92-63.95%) and 80.92% (95% CI: 73.13-87.25%), respectively. Positive and negative predictive values were 60.57% and 77.88%, respectively. Conclusion Our data suggests that the TBSRTC system promotes similar sensitivity and specificity to those reported elsewhere. It standardizes reporting and improves communication between cytopathologists and clinicians.
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Affiliation(s)
- Fahd A. Refai
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anas S. Alyazidi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Fahad A. Alotibi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Rayan A. Haider
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Majed T. Osaylan
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Shihabi AN, Hussein M, Toraih EA, Attia AS, Youssef MR, Elnahla A, Omar M, Shama M, Corsetti R, Kandil E. Accuracy of the 'CUT' Score for Assessing Malignancy in Bethesda 3 and 4 Thyroid Nodules in North American population: a retrospective study. Cancer Invest 2022; 40:693-699. [PMID: 35549502 DOI: 10.1080/07357907.2022.2077956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND The CUT score is a thyroid nodule malignancy risk assessment scoring system intended to guide surgeons in treating Bethesda 3 and 4 thyroid nodules. It is based on clinical (C) and ultrasonographic (U) features and a five-tiered (T) representing cytology. PURPOSE Our study aimed to assess the utility of the CUT score in predicting thyroid malignancy in the North American population. The main reason for creating this score is to reduce unnecessary surgeries on these challenging thyroid nodules. MATERIALS AND METHODS A retrospective record review study applied the CUT score to 219 Bethesda 3 and 4 thyroid nodules. A total of 203 Bethesda 3 and 16 Bethesda 4 nodules from patients treated between January 2015 and December 2019 at a single institution were assessed. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the CUT diagnostic test. Binary logistic regression analysis was performed. Iteration of analysis was performed after stratification according to body mass index to assess CUT score accuracy in obese and non-obese patients. RESULTS Of 219 nodules analyzed, 148 were characterized as benign and 71 as malignant. Prevalence rates of malignancy were 29.6% (n = 60) and 68.8% (n = 11) in Bethesda 3 and 4 nodules, respectively. The mean CU (clinical, ultrasonography) score was 5.35 ± 1.38 in benign nodules versus 4.96 ± 1.5 in malignant nodules (p = 0.08). The area under the curve (AUC =0.433) for the association of CUT scores with nodule malignancy was not significant (p = 0.13). The CUT score was insignificant as a diagnostic test for nodule malignancy in obese (AUC =0.45; p = 0.72) and non-obese patients (AUC =0.39; p = 0.08). CONCLUSION The CUT score did not correlate with preoperative malignancy risk estimates in Bethesda 3 thyroid nodules and, therefore, may have limited utility as a predictor of malignancy in these thyroid nodules.
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Affiliation(s)
- Areej N Shihabi
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, 70112, USA
| | - Mohammad Hussein
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, 70112, USA
| | - Eman A Toraih
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, 70112, USA.,Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Abdallah S Attia
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, 70112, USA
| | - Mohanad R Youssef
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, 70112, USA
| | - Ahmed Elnahla
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, 70112, USA
| | - Mahmoud Omar
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, 70112, USA
| | - Mohamed Shama
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, 70112, USA
| | - Ralph Corsetti
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, 70112, USA
| | - Emad Kandil
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, 70112, USA
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Alyousif H, Adam I, Alamin NA, Sid Ahmed MA, Al Saeed A, Hassoni AH, Musa IR. The prevalence and associated predictors for Bethesda III-VI for reporting thyroid cytopathology in Royal Commission Hospital, Kingdom of Saudi Arabia. Ther Adv Endocrinol Metab 2022; 13:20420188221122486. [PMID: 36111207 PMCID: PMC9469765 DOI: 10.1177/20420188221122486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/04/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Thyroid cancer is increasing globally and is currently the most prevalent endocrine malignancy. Recent data show an increase in the incidence of thyroid cancer in the Kingdom of Saudi Arabia (KSA). Thyroid ultrasound and fine-needle aspiration cytology (FNAC) are the cornerstones in managing thyroid nodules. We conducted this study to evaluate the prevalence and the associated predictors for thyroid nodule Bethesda III-VI in eastern KSA. METHODS A retrospective study was conducted between January 2015 and 31 August 2021. The participants were recruited patients who received a thyroid ultrasound and ultrasound-guided thyroid FNAC, using the thyroid imaging reporting and data system (TI-RADS) and the Bethesda Classification, respectively. RESULT Three hundred and ten patients who underwent thyroid FNAC were enrolled in the study. The median (interquartile, IQR) age was 47.0 (20.0) years, and 266 (85.8%) of them were females. The median (IQR) body mass index was 30.2 (7.6) kg/m2. Out of these participants, 64.8% were euthyroid, 27.4% had hypothyroidism and 7.7% had hyperthyroidism. The ACR TI-RADS-3, 4 and 5 were 51.3%, 46.1% and 2.6%, respectively. The Bethesda outcome of thyroid FNAC I-VI was 5.2%, 63.9%, 15.5%, 5.8%, 3.5% and 6.1%, respectively. The risk for malignancy (Bethesda III-VI) was documented in 31.0% and atypia of undetermined significance was most prevalent (15.5%). A higher ACR TI-RADS score was associated with a higher risk of malignancy: ACR TI-RADS-3 (20.8%), ACR TI-RADS-4 (39.2%) and ACR TI-RADS-5 (87.5%). In a multivariate analysis, only the ACR TI-RADS score was significantly associated with the outcome of thyroid FNAC: ACR TI-RADS-4 [OR = 2.59 (95% CI = 1.54-4.36)] and ACR TI-RADS-5 [OR = 29.03 (95% CI = 3.44-245.07)]. CONCLUSION There was a high prevalence of Bethesda III-VI and atypia of undetermined significance was most prevalent. A thyroid ultrasound report for TI-RADS was significantly associated with the outcome of thyroid FNAC and is a reliable tool in the absence of molecular testing for thyroid cancer.
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Affiliation(s)
- Hussain Alyousif
- Royal Commission Hospital at AL Jubail Industrial City, Al Jubail, Kingdom of Saudi Arabia
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | | | - Mona A. Sid Ahmed
- Royal Commission Hospital at AL Jubail Industrial City, Al Jubail, Kingdom of Saudi Arabia
| | - Ayat Al Saeed
- Royal Commission Hospital at AL Jubail Industrial City, Al Jubail, Kingdom of Saudi Arabia
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Al-Salam S, Sharma C, Abu Sa’a MT, Afandi B, Aldahmani KM, Al Dhaheri A, Yahya H, Al Naqbi D, Al Zuraiqi E, Mohamed BK, Almansoori SA, Al Zaabi M, Al Derei A, Al Shamsi A, Kaabi JA. Ultrasound-guided fine needle aspiration cytology and ultrasound examination of thyroid nodules in the UAE: A comparison. PLoS One 2021; 16:e0247807. [PMID: 33826647 PMCID: PMC8026079 DOI: 10.1371/journal.pone.0247807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/12/2021] [Indexed: 01/12/2023] Open
Abstract
Background Thyroid nodules are a common clinical finding and most are benign, however, 5–15% can be malignant. There is limited regional data describing the accuracy of ultrasound-guided fine needle aspiration (FNA) cytological examination compared to ultrasound examination of thyroid in patients who have undergone thyroid surgery. Methods A retrospective analysis of ultrasonographic (US) reports, FNA cytology reports and histopathology reports of 161 thyroid nodules presented at the endocrine center at Tawam hospital in Al Ain city, the United Arab Emirates during the period 2011–2019 was performed. US reports and images with FNA cytopathology reports and slides were reviewed by an independent radiologist and pathologist. Results In total, 40 nodules were reported as benign by US examination, while very low suspicious, low suspicious, intermediate suspicious and highly suspicious categories were reported in 21, 41, 14 and 45 nodules respectively. In addition, 68 nodules were reported as benign (Bethesda category II), while atypical follicular cells of unknown significance (Bethesda category III), follicular neoplasm (Bethesda category IV), suspicious for malignancy (Bethesda category V), and malignant (Bethesda category VI) categories were reported in 33, 9, 24 and 27 nodules respectively. The risk of malignancy for US benign nodules was 5%, while the risks of malignancy in very low suspicious, low suspicious, intermediate suspicious and highly suspicious nodules were 52%, 36%, 100% and 87%, respectively. The risk of malignancy for Bethesda category II was 3%, while the risks of malignancy in category III, IV, V and VI were 58%, 67%, 96% and 100%, respectively. Conclusion Thyroid FNA cytological examination and ultrasonography are key tools in predicting malignancy in thyroid nodules. Thyroid nodules with the diagnosis of Bethesda category III & IV run a high risk of malignancy thus more vigilance is required.
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Affiliation(s)
- Suhail Al-Salam
- Department of Pathology, College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Charu Sharma
- Department of Internal Medicine, College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Bachar Afandi
- Endocrine Division–Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Alia Al Dhaheri
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hayat Yahya
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Duha Al Naqbi
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Esraa Al Zuraiqi
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Baraa Kamal Mohamed
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Shamsa Ahmed Almansoori
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Meera Al Zaabi
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Aysha Al Derei
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Amal Al Shamsi
- Department of Internal Medicine, College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Juma Al Kaabi
- Department of Internal Medicine, College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- * E-mail:
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Madgar O, Avior G, Shochat I, Joshua BZ, Baraf L, Avidor Y, Avi Khafif, Assadi N, Alon EE. Thyroid malignancy rates according to the Bethesda reporting system in Israel - A multicenter study. Eur J Surg Oncol 2021; 47:1370-1375. [PMID: 33745793 DOI: 10.1016/j.ejso.2021.03.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The Bethesda System for Reporting Thyroid Cytopathology was developed in 2007 to facilitate an accurate, reproducible communication of thyroid fine-needle aspiration (FNA) interpretations between clinicians and cytopathologists and to serve as a guide for treatment. Based on large patient series, the system details the risk of malignancy for each category as well as a suggested management for each FNA result. Though this system has been widely adopted, there are only few studies to determine whether results are applicable for Israel. METHODS A multicenter, retrospective analysis of medical charts of all patients who underwent thyroid surgery between January 1st, 2012 and December 31st, 2016 in four medical centers in Israel was performed. Data was analyzed for the overall risk of malignancy for the Bethesda system groups as well as comparison between the different laboratories performing the test. RESULTS Records of 810 thyroidectomies in which preoperative cytological reports and final pathology were available and reviewed. The malignancy rates according to the Bethesda groups' I-VI for our cohort were: 27.8%, 17.6%, 41.4%, 41.4%, 86.9%, and 98.1% respectively. Similar results were seen when results were analyzed according to the different laboratories performing the tests. CONCLUSIONS Post-surgical review of all Bethesda groups had higher malignancy rates than those reported in the original report. These results indicate a difference in the malignancy rates for the different Bethesda system groups in Israel compared to those reported. Physicians are encouraged to use data validated for their own country or patients' community in addition to published values.
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Affiliation(s)
- Ory Madgar
- Department of Otolaryngology, Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Galit Avior
- Otolaryngology - Head and Neck Surgery Unit, The Hillel Yaffe Medical Center, Hadera, Israel; Faculty of Medicine, Technion, Haifa, Israel
| | - Isaac Shochat
- Otolaryngology - Head and Neck Surgery Unit, The Hillel Yaffe Medical Center, Hadera, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology, Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel. Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Baraf
- Endocrinology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yuval Avidor
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avi Khafif
- ARM Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel; Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Niddal Assadi
- ARM Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Eran E Alon
- Department of Otolaryngology, Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
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Fatima S, Qureshi R, Imran S, Idrees R, Ahmad Z, Kayani N, Ahmed A. Thyroid cytology in Pakistan: An institutional audit of the atypia of undetermined significance/follicular lesion of undetermined significance category. Cytopathology 2020; 32:205-210. [PMID: 33098589 DOI: 10.1111/cyt.12929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/19/2020] [Accepted: 10/16/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Fine needle aspiration cytology (FNAC), along with thyroid ultrasound, is an important tool in evaluation of thyroid nodules that helps in further management of these patients in making a decision of surgical intervention vs follow-up. The Bethesda System for Reporting Thyroid Cytopathology category III of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) has risk of malignancy (ROM) ranging from 5% to 15%. The aim of the present study was to describe the frequency of AUS/FLUS in thyroid gland FNACs and the surgical outcomes of these cases. METHODS The integrated laboratory management system retrieved the thyroid FNACs from 2010 to 2018 and subsequent surgical pathology specimens. For the AUS/FLUS cases, data regarding patient demographics, cytology and histological diagnoses were recorded. The results were tabulated as the overall frequency of AUS/FLUS in thyroid FNACs, cytohistological correlation (benign and malignant) and ROM. RESULTS Over a period of 9 years, 256 (10.9%) cases out of 2342 thyroid FNACs were reported as AUS/FLUS at our institution. Mean age was 43.5 years. The majority (70.3%) of patients were female. Seventy-two of 104 resection specimens (69.2%) were reported as benign and 32 cases (30.7%) had malignant diagnosis. Upper-bound ROM was 30.7% (32 cases with malignant diagnosis out of 104 resection specimens). Lower-bound ROM was calculated as 12.5% (32 cases with malignant diagnosis out of 256 total AUS diagnosis). CONCLUSION The AUS/FLUS category of thyroid cytology and associated ROM remain an evolving area. Individual institutions should monitor the frequency and include ROM in the dashboard indicators to remain within the recommended range.
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Affiliation(s)
- Saira Fatima
- Section of Histopathology, Department of Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Rabia Qureshi
- Section of Histopathology, Department of Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Sumbul Imran
- Section of Histopathology, Department of Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Romana Idrees
- Section of Histopathology, Department of Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Zubair Ahmad
- Section of Histopathology, Department of Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Naila Kayani
- Section of Histopathology, Department of Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Arsalan Ahmed
- Section of Histopathology, Department of Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Guleria P, Mani K, Agarwal S. Indian experience of AUS/FLUS diagnosis: is it different from rest of Asia and the West?-A systematic review and meta-analysis. Gland Surg 2020; 9:1797-1812. [PMID: 33224856 DOI: 10.21037/gs-20-392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is the most heterogeneous subcategory of the Bethesda system for thyroid cytopathology with laid down permissible limits of frequency and risk of malignancy (ROM). Due to differences in thyroid clinical practice worldwide, variations have been found in frequency, resection rates (RR) and ROM. Therefore, this systematic review and meta-analysis of AUS/FLUS across different regions was conducted and comparison of data from India was done with the rest of Asia and the West. Methods We searched PubMed and Google search engines from January 2009-Dec 2019 using terms "AUS Thyroid" and "FLUS Thyroid". Meta-analysis was performed using DerSimonian-Laird method and 95% confidence intervals were calculated using random effects model. Independent samples t-test was used to compare frequency, RR, and ROM of AUS/FLUS between India, rest of Asia and the West. Results Out of 15,000 studies on internet, 60 (18 Indian, 12 Asian and 30 Western) were included. Total aspirates were 201,657; 14,279 Indian, 62,448 Asian, 124,930 Western. Pooled estimates were: frequency 7.3% (6.3-8.3%), RR 41.9% (37.4-46.6%), ROM 33.3% (26.8-39.9%). Pooled prevalence of rate did not vary significantly across the three regions. Pooled prevalence of RR was highest in India (52.9%) and lowest in rest of Asia (26.5%); of ROM was highest in Asia (45.9%), lowest in the West (26.3%) (P<0.01). Statistical analysis demonstrated publication bias, limited to Indian and Western studies. Papillary thyroid carcinoma was the most common surgical diagnosis (87.9%; 1,082/1,231). Conclusions This meta-analysis showed differences in thyroid clinical practice followed in India, rest of Asia and the West. Although pooled prevalence of rate of AUS/FLUS was similar across the three, pooled RR and ROM varied. AUS/FLUS nodules were more frequently resected in Indian and Western studies than in rest of Asia. ROM was higher than recommended values in all three areas, being intermediate for India.
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Affiliation(s)
- Prerna Guleria
- Department of Laboratory Sciences and Molecular Medicine, Army Hospital Research and Referral, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Nguyen TPX, Truong VT, Kakudo K, Vuong HG. The diversities in thyroid cytopathology practices among Asian countries using the Bethesda system for reporting thyroid cytopathology. Gland Surg 2020; 9:1735-1746. [PMID: 33224851 DOI: 10.21037/gs-20-404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has been adopted and widely used among Asian countries. This study aims to investigate the application of TBSRTC in thyroid cytology practice among Asian countries. Methods We searched electronic databases including PubMed and Web of Science from 2010 to 2019. Meta-analysis of proportion and their 95% confidence intervals (CIs) were calculated using the random-effect model. Meta-regression and subgroup analysis were used to search for heterogeneity origins. Results We included 42 Asian studies with 84.953 fine-needle aspirations. Among six categories, benign was the most commonly diagnosed category. The resection rate (RR) and risk of malignancy (ROM) were highest in malignant and SM categories, and lowest among benign nodules. Thyroid cytology practice in Asia was characterized by a low RR and high ROM in patients with indeterminate thyroid nodules. There was a significant amount of heterogeneities of TBSRTC outputs (frequency, resection rate, and malignancy risk) among Asian countries. Meta-regression showed that the sources of heterogeneity might stem from the differences in study origin and the application of molecular testing. We highlighted the usefulness of preoperative molecular testing to select patients for surgery. Conclusions Our study provided insight regarding thyroid cytology practice among Asian countries. Active surveillance is commonly used in Asian practice resulting in a low RR and high ROM for indeterminate nodules. There are still variations in general thyroid cytology practice in Asia. Future guidelines and consensus regarding the application of TBSRTC in thyroid cytology practice among Asian countries are required.
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Affiliation(s)
| | - Vien Thanh Truong
- Department of Cardiology, The Christ Hospital Health Network, Cincinnati, OH, USA
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi-city, Japan
| | - Huy Gia Vuong
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA.,Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
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Ooi LY, Nga ME. Atypia of undetermined significance/follicular lesion of undetermined significance: Asian vs. non-Asian practice, and the Singapore experience. Gland Surg 2020; 9:1764-1787. [PMID: 33224854 DOI: 10.21037/gs-20-555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Bethesda System for Reporting Thyroid Cytopathology has paved the way for comparisons of the practice of thyroid cytology in many different regions. However, there have been comparatively few studies documenting differences between Asian and non-Asian practice. Here, we aim to compare a few key parameters between the two regions, focusing on the indeterminate category of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS). We compared its incidence, resection rates (RRs), risk of malignancy (ROM), rate of repeat fine needle aspiration (rFNA), ROMs of cytomorphologic subcategories of nuclear atypia (AUS-N) vs. architectural atypia (AUS-A), and, finally, the incidence of papillary thyroid carcinoma (PTC) vs. follicular neoplasms (FNs) in resected AUS/FLUS cases in Asian and non-Asian regions. Where possible, these metrics were compared with the Singapore experience from a tertiary referral institution. While the incidence of AUS/FLUS was similar in both regions, we found geographical differences in the RRs and ROMs, which may reflect a higher collective threshold for surgery in Asian countries. However, both cohorts showed higher ROMs in the AUS-N subcategory as compared to the AUS-A subcategory, supporting the subclassification of the AUS/FLUS based on the presence of nuclear atypia. We also observed a higher incidence of AUS-N coupled with a higher incidence of PTC in resected AUS/FLUS nodules in Asian cohorts, while AUS-A and follicular-patterned neoplasms featured more prominently in the non-Asian cohorts. These incidences may account for the starkly different molecular approaches that we noted-in Asian (chiefly Korean and Chinese) centers, BRAF mutational analysis was favored, while gene panels and gene expression classifiers were more frequently applied in non-Asian centers (chiefly in the United States of America). Overall, the data from Singapore appears more closely aligned to non-Asian trends, despite its geographical location in Southeast Asia and its predominantly Asian population. We conclude that there is significant heterogeneity in the outcomes of the AUS/FLUS categories between and within regions, which is only partially explained by regional variations, and may also reflect different regional diagnostic and management practices. This highlights the importance of understanding the local context in the interpretation of indeterminate Bethesda categories, rather than adopting a "one-size fits all" approach.
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Affiliation(s)
- Li Yin Ooi
- Department of Pathology, National University Hospital, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore
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Ronen O, Cohen H, Sela E, Abu M. Differences in cytopathologist thyroid nodule malignancy rate. Cytopathology 2020; 31:315-320. [PMID: 32333479 DOI: 10.1111/cyt.12841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/06/2020] [Accepted: 04/18/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The accuracy of a cytological diagnosis obtained by fine needle aspiration is influenced by several factors including the technique used and the experience of both the aspirator as well as the cytologist. In this project we planned to evaluate the interobserver differences of thyroid nodule cytopathology in our medical centre. METHODS The study was conducted using retrospective pathology reports from a single academic centre from August 2013 to September 2017. We compared the sensitivity, specificity, negative and positive predictive values, malignancy rates, and accuracy of two cytopathologists who evaluated thyroid nodules. RESULTS We included 287 fine needle aspirations of thyroid nodules in the study. Approximately one fifth (18.5%) of patients had surgery and the rate of malignancy was 40%. There was a similar frequency of use of all thyroid Bethesda system (TBS) categories with the exception of TBS 3 (8.0% and 21.2%, P = .01). As a consequence, the malignancy rate was different in TBS 3 category (40% vs 17%, P = .545). CONCLUSIONS There are interobserver differences in the evaluation of thyroid nodules. Clinicians should be aware of such differences because they affect the malignancy rate in each TBS category.
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Affiliation(s)
- Ohad Ronen
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
| | - Hector Cohen
- Department of Pathology, Galilee Medical Center, Nahariya, Israel
| | - Eyal Sela
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
| | - Mor Abu
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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11
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Razavi MA, Wong J, Akkera M, Shalaby M, Shalaby H, Sholl A, Haddad A, Behl P, Kandil E, Lee GS. Nuclear morphometry in indeterminate thyroid nodules. Gland Surg 2020; 9:238-244. [PMID: 32420247 DOI: 10.21037/gs.2020.02.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Up to 30% of thyroid nodules undergoing fine needle aspiration (FNA) yield an indeterminate result. Recent research efforts have suggested that nuclear morphometry and morphology may enhance the diagnostic accuracy of FNA as an objective adjunct. We applied nuclear morphometric analysis on a diverse cohort of patients to evaluate the association between nuclear morphometry and malignancy. Methods Forty-five randomly selected patients, who underwent thyroid surgery after an indeterminate FNA result (Bethesda III & IV) between 2012-2015, were reviewed. One hundred representative nuclei per FNA of a thyroid nodule were analyzed using ImageJ. Seven validated morphometric parameters were collected: nuclear area, perimeter, circularity, aspect ratio, roundness, and maximum/minimum Feret's diameter. L/S ratio was subsequently calculated. All 8 nuclear parameters were reported as averages with standard errors of the mean (SEM). A Student's t-test was used to assess the association of nuclear parameters with final surgical pathology. Results The mean age of all patients was 56.31±15.39 years, with female patients comprising 68.9% of the cohort. Twenty-two patients had malignant thyroid nodules. The mean perimeter of nuclei for the cohort was 18.48±0.45 µm, the mean area was 22.19±0.93 µm, and the mean maximum Feret's diameter was 6.67±0.13 µm. No significant differences in the 8 nuclear parameters were observed between the malignant and non-malignant groups. Conclusions In the population examined, our results suggest that nuclear morphometry is not yet a tool of reliable diagnostic value in accessing malignant and non-malignant thyroid nodules. Further investigation is necessary to identify objective parameters that will enhance diagnostic accuracy of indeterminate FNA cytology to minimize the number of diagnostic thyroid surgery.
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Affiliation(s)
- Michael A Razavi
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Johnny Wong
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mounika Akkera
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mahmoud Shalaby
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Hosam Shalaby
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Andrew Sholl
- Department of Pathology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Antione Haddad
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Preeti Behl
- Department of Pathology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Grace S Lee
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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12
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McGill Thyroid Nodule Score in Differentiating Thyroid Nodules in Total Thyroidectomy Cases of Indeterminate Nodules. Indian J Surg Oncol 2020; 11:268-273. [PMID: 32523274 DOI: 10.1007/s13193-020-01053-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022] Open
Abstract
Fine-needle aspiration biopsy (FNAB) is the first-line modality in the evaluation of thyroid nodules. However, the results of indeterminate pathology place the thyroid surgeon in difficult management situations. This study evaluates McGill Thyroid Nodule Score (MTNS) to identify thyroid nodules that harbor malignancy in cases of indeterminate FNABs and to guide surgeon about the need and extent of surgery. We conducted a retrospective chart review of 344 patients who underwent total thyroidectomy between January 2013 and January 2018. Patients with FNAB of indeterminate nodules (Bethesda types III, IV, and V) and calculated MTNS were included in the study. Postoperative histopathology was divided into benign and malignant groups. The median and the mean MTNS, the malignancy rate, and the standard deviations were calculated for each subgroup. Of the 344 patient charts reviewed, 106 (30.8%) had an indeterminate FNA biopsy. Eighty-one (76.4%) patients were females and 25 (23.6%) were males. Final pathology revealed malignancy in 69 patients (65.1%). The mean MTNS of patients with malignant pathology (12.81 ± 3.55) was higher than the mean in the benign group (8.32 ± 2.32). 82.4% of thyroid nodules with median MTNS of less than 8 had a benign pathology, and 91.4% of thyroid nodules with median MTNS equal or more than 11 had a malignant pathology (p = 0.002). The rate of malignancy in our series of indeterminate FNABs was 65.1%. The MTNS can be of value to thyroid surgeons in preoperative decision-making when dealing with an indeterminate thyroid nodule.
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13
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Vuong HG, Ngo HTT, Bychkov A, Jung CK, Vu TH, Lu KB, Kakudo K, Kondo T. Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: A systematic review and meta-analysis. Cancer Cytopathol 2019; 128:238-249. [PMID: 31883438 DOI: 10.1002/cncy.22228] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 12/24/2022]
Abstract
There is increasing evidence showing that clinicians employ different management strategies in their use of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). In this meta-analysis, we investigated the differences in diagnosis frequency, resection rate (RR), and risk of malignancy (ROM) between Western (ie, American and European) and Asian cytopathology practices. We searched PubMed and Web of Science from January 2010 to January 2019. Proportion and 95% CIs were calculated using a random-effect model. We used independent sample t tests to compare frequencies, RR, and ROM between Western and Asian practices. We analyzed a total of 38 studies with 145,066 fine-needle aspirations. Compared with Asian practice, Western series had a significantly lower ROM in most of TBSRTC categories, whereas the RR was not statistically different. Focusing on indeterminate nodules, the RR in Western series was significantly higher (51.3% vs 37.6%; P = .048), whereas the ROM was significantly lower (25.4% vs 41.9%; P = .002) compared with those in Asian series. The addition of Asian cohorts increased ROM for most of diagnostic categories compared with the original TBSRTC. In conclusion, this study demonstrates a difference in Western and Asian thyroid cytology practice, especially regarding the indeterminate categories. Lower RR and higher ROM suggest that Asian clinicians adopt a more conservative approach, whereas immediate diagnostic surgery is favored in Western practice for indeterminate nodules. The addition of Asian series into a meta-analysis of TBSRTC altered ROM for several categories, which should be considered in future revisions of TBSRTC.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology, University of Yamanashi, Chuo, Japan
| | - Hanh Thi Tuyet Ngo
- Department of Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa City, Japan.,Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Trang Huyen Vu
- Department of Pathology, Oncology Hospital, Ho Chi Minh City, Vietnam
| | - Kim Bach Lu
- Department of Pathology, Oncology Hospital, Ho Chi Minh City, Vietnam
| | - Kennichi Kakudo
- Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University Faculty of Medicine, Ikoma, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Chuo, Japan
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14
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Strain Elastography as a Valuable Diagnosis Tool in Intermediate Cytology (Bethesda III) Thyroid Nodules. Diagnostics (Basel) 2019; 9:diagnostics9030119. [PMID: 31540296 PMCID: PMC6787586 DOI: 10.3390/diagnostics9030119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 01/21/2023] Open
Abstract
Fine needle aspiration (FNA) is considered the gold standard in the diagnostic of thyroid nodules. Using the recommended BETHESDA reporting system, up to 20% of results are classified as intermediate cytology. As there is no consensus whether ultrasound evaluation, lobectomy or surgery is the best treatment option, intermediate cytology results are considered a grey zone of the FNA. The main aim of our study was to evaluate the performance of combined advanced ultrasound techniques in the process of diagnosis and evaluation of the intermediate cytology cases after FNA. We evaluated 54 consecutive cases with intermediate cytology on FNA, using conventional B-mode ultrasound (2B), and strain elastography, using a linear multifrequency 6-13 MHz linear probe (Hitachi Prerius Machine, Hitachi Inc, Japan). All nodules were classified with our Thyroid Imaging Report and Data System (TI-RADS) proposed model, considering: vertical appearance, with antero-posterior diameter bigger than the transvers diameter, the so called taller than wide shape, irregular borders, intranodular inhomogeneity, marked hypoecogenicity, micro calcifications, the presence of suspect lymph nodes, and increased stiffness as suspicious for malignancy. The classification outcomes were compared with the pathology results, considered the gold standard diagnosis. The prevalence of cancer was 28.8%, with 13/45 cases having a clear diagnostic of cancer. Six cases were diagnosed with borderline follicular neoplasia, a category with unclear evolution, also considered as malignant in the analysis of the imaging results. In total, 16/19 cancer cases had increased stiffness on elastography. The cancer prevalence increased with TI-RADS category, being 25% in TI-RADS 4b category and 92.8% in TI-RADS 5 category. The AUROC (Area Under Receiver Operating Curve) of elastography alone, in differentiation of malignant thyroid nodules was 74.9%; the combination of elastographic and conventional ultrasound characteristics generated an even better AUROC, of 84.5%. The combined conventional ultrasound and elastography identified thyroid cancer in cases with intermediate cytology with a sensitivity of 89.5% with a specificity of 50%. High risk thyroid nodules, identified by combined high risk conventional ultrasound characteristics and increased stiffness, on strain elastography, are highly predictive for malignancy, in the intermediate cytology cases.
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15
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Ronen O, Cohen H, Abu M. Review of a single institution's fine needle aspiration results for thyroid nodules: Initial observations and lessons for the future. Cytopathology 2019; 30:468-474. [DOI: 10.1111/cyt.12739] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/21/2019] [Accepted: 06/06/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Ohad Ronen
- Departments of Otolaryngology – Head and Neck Surgery Galilee Medical Center Nahariya Israel
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
| | - Hector Cohen
- Department of Pathology Galilee Medical Center Nahariya Israel
| | - Mor Abu
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
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16
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Ke J, Jianyong L, Ying L, Genpeng L, Linlin S, Zhihui L, Jinnan L, Xueying S, Yong J, Jingqiang Z. The use of The Bethesda System for Reporting Thyroid Cytopathology in a Chinese population: An analysis of 13 351 specimens. Diagn Cytopathol 2019; 47:876-880. [PMID: 31074206 DOI: 10.1002/dc.24207] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 03/12/2019] [Accepted: 04/22/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Jiang Ke
- Thyroid and Parathyroid Surgery Center; West China Hospital of Sichuan University; Chengdu China
| | - Lei Jianyong
- Thyroid and Parathyroid Surgery Center; West China Hospital of Sichuan University; Chengdu China
| | - Liu Ying
- Department of Laboratory Medicine; West China Hospital of Sichuan University; Chengdu China
| | - Li Genpeng
- Thyroid and Parathyroid Surgery Center; West China Hospital of Sichuan University; Chengdu China
| | - Song Linlin
- Thyroid and Parathyroid Surgery Center; West China Hospital of Sichuan University; Chengdu China
| | - Li Zhihui
- Thyroid and Parathyroid Surgery Center; West China Hospital of Sichuan University; Chengdu China
| | - Li Jinnan
- Department of Pathology; West China Hospital of Sichuan University; Chengdu China
| | - Su Xueying
- Department of Pathology; West China Hospital of Sichuan University; Chengdu China
| | - Jiang Yong
- Department of Pathology; West China Hospital of Sichuan University; Chengdu China
| | - Zhu Jingqiang
- Thyroid and Parathyroid Surgery Center; West China Hospital of Sichuan University; Chengdu China
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17
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Upadhyaya P, Dhakal S, Adhikari P, Adhikari B, Khadka D, Niraula SR. Histopathological Review of Diagnostic Categories of the Bethesda System for Reporting Thyroid Cytopathology - An Institutional Experience of 5 Years. J Cytol 2019; 36:48-52. [PMID: 30745740 PMCID: PMC6343391 DOI: 10.4103/joc.joc_64_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Context: Fine needle aspiration (FNA) plays a crucial role in the evaluation of patients with thyroid lesions. The Bethesda system for reporting thyroid cytopathology (TBSRTC) was designed with a mission to standardize the process of diagnosis and management of thyroid lesions by FNA cytology (FNAC). Aim: We aim to see the benefits of adopting TBSRTC, seek the cytological pitfalls in the diagnosis of thyroid FNAC, and identify the spectrum of thyroid lesions in our setup. Settings and Design: This is a hospital-based cross-sectional study conducted from June 2009 to June 2014 of all thyroid FNACs with available histopathology reports. Cases were designated a specific diagnostic category according to TBSRTC. Materials and Methods: A total of 109 cases were included in the study. Sixty-eight cases had been reported without using TBSRTC and were reviewed and reclassified according to TBSRTC seeking the common reasons for interpretative errors. Statistical Analysis Used: Data were analyzed using SPSS ver. 11.5. Results: In both pre- and post-TBSRTC era, benign neoplasms constituted the major bulk. After the use of TBSRTC, there was increased ability to look for follicular neoplasms, improvement in making definitive diagnosis of the cases, decline in the suspicious category, and an improvement in diagnostic accuracy, and we were in line with the implied risk outlined by TBSRTC in most of the cases except the nondiagnostic or unsatisfactory category. Conclusion: Application of TBSRTC results in uniformity in reporting among pathologists and better interdisciplinary communication and patient management.
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Affiliation(s)
- Paricha Upadhyaya
- Department of Pathology, BP Koirala Institute of Health Sciences, Karnali Province, Nepal
| | - Sushil Dhakal
- Department of Pathology, BP Koirala Institute of Health Sciences, Karnali Province, Nepal
| | - Purbesh Adhikari
- Department of Pathology, BP Koirala Institute of Health Sciences, Karnali Province, Nepal
| | - Bindu Adhikari
- Department of Pathology, BP Koirala Institute of Health Sciences, Karnali Province, Nepal
| | - Dibika Khadka
- Department of Pathology, Province Hospital, Karnali Province, Nepal
| | - Surya R Niraula
- Department of Community Medicine, BP Koirala Institute of Health Sciences, Karnali Province, Nepal
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18
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Del Rio P, Cozzani F, Corcione L, Viani L, Loderer T, Rossini M. Correlation between cytological and histological findings in patients who underwent thyroidectomy. Predictive value and confounders. MINERVA ENDOCRINOL 2018; 44:357-362. [PMID: 30256073 DOI: 10.23736/s0391-1977.18.02845-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Solitary thyroid nodules are the most common endocrine occurance in general population. With the introduction of Bethesda system for reporting thyroid cytopathology (BSRTC) to fine-needle aspiration (FNA) specimens we found a reliable standard method to evaluate malignancy risk in thyroid neoplasms. This study evaluates the correlation between BSRTC and real results in our center investigating the role of several factors as confounding factors for cytological diagnosis. The study has been designed as a retrospective study conducted on 637 patients that underwent thyroid surgery in a single center (Unit of General Surgery, Parma University Hospital, Italy). METHODS We reviewed 637 files of patients who underwent thyroid surgery with a definitive histological finding from surgical specimen. The collected data include: cytological findings from FNA when performed, histological findings after surgery, sex, age, thyroid hyperfunction and the possible presence of thyroiditis. Cytological findings have been evaluated from our institution's pathologists after FNA performed in collaboration with clinical endocrinologists. Thyroid Hyperfunction has been evaluated through a blood test panel for thyroid functionality including reflex TSH, FT3, FT4 and thyreoglobulin. Blood tests' results and patients have been evaluated by clinical endocrinologists before being addressed to surgery. Thyroiditis have been confirmed as an ultrasound scanning (US) finding or as a corollary from histologic results. All patients have been evaluated by the surgeon and underwent different intervention as total, thyroidectomy, near total thyroidectomy or emithyroidectomy depending on cythology, US findings and symptoms in case of benignancy. Histological findings have been evaluated only by our center pathologists. RESULTS In our experience the percentage of malignancy in Thyr 2 Thyr 3 and Thyr 4 Bethesda's classes seeems to be higher then those predicted by BSRTC. We also found a high rate of false positive considered as patients included in categories of suspected malignancy (Thyr 3-4-5-6) and subsequently resulted with benign pathology. This happens specially in those patients affected by thyroiditis. CONCLUSIONS These findings suggest that we need more studies to evaluate real BSRTC predictive value in single centers. Meanwhile we found out that thyroiditis may be a confounding factor in cytological examination wich would lead to an overstating of thyroid nodules.
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Affiliation(s)
- Paolo Del Rio
- Unit of General Surgery, University Hospital of Parma, Parma, Italy
| | - Federico Cozzani
- Unit of General Surgery, University Hospital of Parma, Parma, Italy -
| | - Luigi Corcione
- Unit of General Surgery, University Hospital of Parma, Parma, Italy
| | - Lorenzo Viani
- Unit of General Surgery, University Hospital of Parma, Parma, Italy
| | - Tommaso Loderer
- Unit of General Surgery, University Hospital of Parma, Parma, Italy
| | - Matteo Rossini
- Unit of General Surgery, University Hospital of Parma, Parma, Italy
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Zarif HA, Ghandurah SE, Al-Garni MA, Binmahfooz SK, Alsaywid BS, Satti MB. Thyroid Nodules Cytopathology Applying the Bethesda System with Histopathological Correlation. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2018; 6:143-148. [PMID: 30787841 PMCID: PMC6196689 DOI: 10.4103/sjmms.sjmms_178_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Fine-needle aspiration cytology remains a valuable screening tool for preoperative management of thyroid nodules. However, the rates of false-negative and false-positive diagnosis remain a challenge for pathologists. Objectives To assess the value of thyroid fine-needle aspiration as a screening tool and its accuracy of diagnoses relative to final histological diagnoses. Patients and Methods A chart review was conducted of all adult patients who underwent fine-needle aspiration of thyroid nodule(s) and were subjected to thyroid surgery at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between January 2007 and June 2014. The fine-needle aspiration results were correlated with final histopathology results. Results Of the 408 aspirates from 373 patients, the Bethesda System for Reporting Thyroid Cytology (BSRTC) diagnostic categories were as follows: nondiagnostic in 26 aspirates (6.4%); benign in 128 (31.4%); atypia/follicular lesion of undetermined significance in 52 (12.7%); follicular neoplasm/suspicion for a follicular neoplasm in 83 (20.3%); suspicious for malignancy in 23 (5.6%) and malignant in 96 (23.5%). The comparative histopathological diagnoses were benign in 192 (47.1%) and malignant in 216 (52.9%) aspirates. The calculated risk of malignancy in the fine-needle aspiration categories was 34.6% in diagnostic category (DC) I, 15.6% in DC II, 50% in DC III, 52% in DC IV, 95.7% in DC V and 100% in DC VI. The sensitivity of fine-needle aspiration with BSRTC was 88.9%, specificity was 75.6%, positive predictive value was 79.7%, negative predictive value was 84.4% and accuracy was 81.5%. Conclusion The results of this retrospective study demonstrated higher risks of malignancy in DC I, DC II, DC III and DC IV than that of the original BSRTC definition, along with a higher specificity and positive predictive value for cancer diagnosis, and a lower sensitivity and negative predictive value.
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Affiliation(s)
- Hawazen A Zarif
- Department of Medicine, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, KSA
| | - Samirah E Ghandurah
- King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, KSA
| | - Mohamed A Al-Garni
- Department of Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, KSA
| | - Sarah K Binmahfooz
- King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, KSA
| | - Basim S Alsaywid
- Department of Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, KSA
| | - Mohamed B Satti
- Department of Pathology, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, KSA
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20
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Reuters KB, Mamone MC, Ikejiri ES, Camacho CP, Nakabashi CC, Janovsky CC, Yang JH, Andreoni DM, Padovani R, Maciel RM, Vanderlei FA, Biscolla RP. Bethesda Classification and Cytohistological Correlation of Thyroid Nodules in a Brazilian Thyroid Disease Center. Eur Thyroid J 2018; 7:133-138. [PMID: 30023345 PMCID: PMC6047492 DOI: 10.1159/000488104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/26/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Bethesda System has been used to classify thyroid cytology in 6 categories besides presenting malignancy rates and respective approaches. Reference centers have validated its use by comparing its proposed malignancy rates with those in in their populations. However, to the best of our knowledge, there has been no corresponding study in Brazil. OBJECTIVES To evaluate the performance of the Bethesda classification in a Brazilian thyroid reference center and correlate the results with cytohistological reports in patients referred to surgery. METHODS Data records from 980 fine-needle aspiration (FNA) results were retrospectively analyzed, and, in patients who underwent surgery, the results were correlated with the cytohistological findings. RESULTS 980 FNAs and 585 patients were evaluated. The incidence of each cytological category was: 11% nondiagnostic (ND), 59.6% benign, 7.1% (atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 8.5% follicular neoplasm or suspicious for follicular neoplasm (FN/SFN), 5.1% suspicious for malignancy (SM), and 8.3% malignant. The surgery rate was 41.8% (245/585). The malignancy rate in each category was: 6% benign, 12% AUS/FLUS, 20.8% FN/SFN, 72.5% SM, and 97.3% malignant. For ND nodules, the malignancy rate was 25.7% (66.6% multifocal and papillary microcarcinomas), a higher rate than in the literature. In this category, surgery was performed in multinodular goiters presenting with another nodule > 3.0 cm and/or with an FN/SFN, SM, or malignant cytological result. CONCLUSION The Bethesda System can be applied to the Brazilian population, since the frequency and malignancy rates of each category were similar to those described by its classification. It is noteworthy that a higher risk of malignancy was observed in the ND cytological category.
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Affiliation(s)
- Kassia B. Reuters
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria C.O.C. Mamone
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Elsa S. Ikejiri
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Cleber P. Camacho
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Claudia C.D. Nakabashi
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carolina C.P.S. Janovsky
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ji H. Yang
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Danielle M. Andreoni
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rosalia Padovani
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Santa Casa de São Paulo, São Paulo, Brazil
| | - Rui M.B. Maciel
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Fleury Medicina e Saúde, São Paulo, Brazil
| | - Felipe A.B. Vanderlei
- Head and Neck Division, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rosa P.M. Biscolla
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Fleury Medicina e Saúde, São Paulo, Brazil
- *Rosa Paula Mello Biscolla, MD, PhD, or Rui M.B. Maciel, MD, PhD, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo, 669, 11th floor, São Paulo, SP 04039-032 (Brazil), E-Mail or
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Alshaikh S, Harb Z, Aljufairi E, Almahari SA. Classification of thyroid fine-needle aspiration cytology into Bethesda categories: An institutional experience and review of the literature. Cytojournal 2018. [PMID: 29531571 PMCID: PMC5841007 DOI: 10.4103/cytojournal.cytojournal_32_17] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Fine-needle aspiration cytology (FNAC) of thyroid is the initial screening test for thyroid nodules. The Bethesda system classifies thyroid FNAC into six categories. Each category is linked to a malignancy risk and has a recommended clinical management. The aim of this study is to analyze the thyroid cytology smears by Bethesda system and to correlate the diagnosis of cytopathology with histopathology, whenever surgery was done. Materials and Methods: 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. Results: Categories were as follows: 10.1% were Category I (nondiagnostic), 68.8% Category II (benign), 12.4% were Category III (atypia of undetermined significance), 2.9% were Category IV (suspicious for follicular neoplasm), 2.6% were Category V (suspicious for malignancy), and 4.1% were Category VI (malignant). Surgery was done on 126 nodules from 119 patients with an overall rate of malignancy of 27.8% (35/126 nodules). Conclusion: The Bethesda System for Reporting Thyroid Cytopathology proved to be an excellent reporting system.
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Affiliation(s)
- Safa Alshaikh
- Address: Department of Pathology, Salmanyia Medical Complex, Manama, Bahrain
| | - Zainab Harb
- Address: Department of Pathology, Salmanyia Medical Complex, Manama, Bahrain
| | - Eman Aljufairi
- Address: Department of Pathology, Salmanyia Medical Complex, Manama, Bahrain
| | - S Ali Almahari
- Address: Department of Pathology, Salmanyia Medical Complex, Manama, Bahrain
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Awasthi P, Goel G, Khurana U, Joshi D, Majumdar K, Kapoor N. Reproducibility of "The Bethesda System for Reporting Thyroid Cytopathology:" A Retrospective Analysis of 107 Patients. J Cytol 2018; 35:33-36. [PMID: 29403167 PMCID: PMC5795725 DOI: 10.4103/joc.joc_215_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objectives: Fine-needle aspiration cytology (FNAC) has emerged as an indispensable tool to discriminate thyroid lesions into benign or malignant for appropriate management. The need for simplicity of communication and standardization of terminology for thyroid FNAC reporting led to introduction of “The Bethesda system for reporting Thyroid Cytopathology” (TBSRTC) in a conference held at the National Cancer Institute in 2007. This study aims at establishing the reproducibility of TBSRTC for diagnosing thyroid lesions. Materials and Methods: The present study comprised thyroid FNAC from 107 patients retrospectively over a period of 1.5 year (June 2013 to December 2014), which were reviewed by two trained cytopathologists and re-categorized according to TBSRTC. The interobserver variation and reproducibility of the reporting system was statistically assessed using Cohen's kappa. Results: The cytopathologists were in agreement in 98 out of 107 cases (91.5%). Maximum concordance was noted in benign category (91 of 96 cases; 92.85%), followed by 2 cases each in nondiagnostic/unsatisfactory (ND/US) and follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) category (2.04% each) and 1 case each in atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), suspicious for malignancy (SUS), and malignant category (1.02% each). The highest diagnostic disagreement was noted among ND/US and benign and benign and FN/SFN categories. Conclusion: The utilization of TBSRTC for reporting thyroid cytology should be promoted in our country because it provides a homogeneous, standardized, and unanimous terminology for cytological diagnosis of thyroid lesions. The present study could substantiate the diagnostic reproducibility of this system.
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Affiliation(s)
- Pragati Awasthi
- Department of Pathology and Laboratory Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Garima Goel
- Department of Pathology and Laboratory Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Ujjawal Khurana
- Department of Pathology, People's Medical College, Bhopal, Madhya Pradesh, India
| | - Deepti Joshi
- Department of Pathology and Laboratory Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Kaushik Majumdar
- Department of Pathology, G B Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Neelkamal Kapoor
- Department of Pathology and Laboratory Medicine, AIIMS, Bhopal, Madhya Pradesh, India
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Mosca L, da Silva LFF, Carneiro PC, Chacon DA, de Araujo-Neto VJF, de Araujo-Filho VJF, Cernea CR. Malignancy rates for Bethesda III subcategories in thyroid fine needle aspiration biopsy (FNAB). Clinics (Sao Paulo) 2018; 73:e370. [PMID: 29846414 PMCID: PMC5960075 DOI: 10.6061/clinics/2018/e370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/20/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Most thyroid diseases are nodular and have been investigated using ultrasound-guided fine needle aspiration biopsy (FNAB), the reports of which are standardized by the Bethesda System. Bethesda category III represents a heterogeneous group in terms of lesion characteristics and the malignancy rates reported in the literature. The objective of the present study was to evaluate the differences in the malignancy rates among Bethesda III subcategories. METHODS Data from 1,479 patients who had thyroid surgery were reviewed. In total, 1,093 patients (89.6% female, mean age 52.7 (13-89) years) were included, and 386 patients were excluded. FNAB results (based on Bethesda Class) and histopathological results (benign or malignant) for coincident areas were collected. Bethesda III patients were subcategorized according to cytopathological characteristics (FLUS: follicular lesion of undetermined significance, Bethesda IIIA; AUS: atypia of undetermined significance, Bethesda IIIB). Data were correlated to obtain the malignancy rates for each Bethesda category and the newly defined subcategory. RESULTS FNAB results for these patients were as follows: Bethesda I: 3.1%; Bethesda II: 18.6%; Bethesda III: 35.0%; Bethesda IV: 22.1%; Bethesda V: 4.1%; and Bethesda VI: 17.1%. The malignancy rates for Bethesda Class IIIB were significantly higher than those for Bethesda Class IIIA (p<0.001) and Bethesda Class IV (p<0.001). Bethesda Class IIIA showed significantly lower malignancy rates than Bethesda Class III overall (p<0.001) CONCLUSIONS: Improvements of the Bethesda System should consider this subcategorization to better reflect different malignancy rates, which may have a significant impact on the decision-making process.
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Affiliation(s)
- Leticia Mosca
- Disciplina de Cirurgia de Cabeca e Pescoco, Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Paulo Campos Carneiro
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Danielle Azevedo Chacon
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | | | - Claudio Roberto Cernea
- Disciplina de Cirurgia de Cabeca e Pescoco, Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Al-Abbadi MA, Shareef SQ, Yousef MM, Almasri NM, Mustafa HE, Aljawad H, Ali JA, Groves A, Alsaihati Y. A follow-up study on thyroid aspirates reported as atypia of undetermined significance/follicular lesion of undetermined significance and follicular neoplasm/suspicious for follicular neoplasm: A multicenter study from the Arabian Gulf region. Diagn Cytopathol 2017; 45:983-988. [DOI: 10.1002/dc.23805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 01/21/2023]
Affiliation(s)
| | | | | | | | - Huda E. Mustafa
- Sheikh Khalifa Medical City; Abu Dhabi United Arab Emirates
- Department of Pathology; Sheikh Khalifa Medical City; Abu Dhabi United Arab Emirates
- Department of Laboratory Medicine and Internal Medicine; Sheikh Khalifa Medical City; Abu Dhabi United Arab Emirates
| | | | | | - Alan Groves
- Sheikh Khalifa Medical City; Abu Dhabi United Arab Emirates
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Kim SD, Han SH, Jeong WJ, Kim H, Ahn SH. Differences in Clinical Features Between Subcategories of "Atypia/Follicular Lesion of Undetermined Significance". Endocr Pathol 2017; 28:247-252. [PMID: 28488195 DOI: 10.1007/s12022-017-9486-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Within the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), category III (atypia or follicular lesion of undetermined significance (AUS/FLUS)) comprises specimens with heterogeneous features and the need for subcategorization has been reported. We compared the clinical features of two subgroups from within the category of AUS/FLUS to determine precise guidelines for clinicians who explain the results of fine-needle aspiration (FNA) to patients. Retrospective review was performed including data from all patients who underwent FNA with results reported as AUS/FLUS at a single tertiary hospital from January 2010 to August 2014. The results of repeated FNA, core needle biopsy, and diagnostic surgery were analyzed. Of the 903 patients with results categorized as AUS/FLUS, 500 were subcategorized as cellular atypia and 160 as architectural atypia. On repeated biopsy, diagnostic results were obtained for 78.9% patients of the cellular atypia group, compared to only 54.3% of the architectural atypia group (p < 0.0001). The rate of neoplasm or malignancy was also significantly higher in the cellular atypia group compared to the architectural atypia group (51.8 vs. 25.2%, p < 0.0001, 48.2 vs. 14.2%, p < 0.0001). Therefore, clinicians can inform patients with architectural atypia that the risk of malignancy is low. However, the high rate of non-diagnostic results on repeated biopsy makes clinical decisions difficult. The data of the present study revealed the necessity of subcategorization of category III of TBSRTC in the future.
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Affiliation(s)
- Seong Dong Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, 463-707, South Korea
| | - Seung Hoon Han
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, 463-707, South Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, 463-707, South Korea
| | - Hyojin Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Soon Hyun Ahn
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, 463-707, South Korea.
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26
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Kim M, Park HJ, Min HS, Kwon HJ, Jung CK, Chae SW, Yoo HJ, Choi YD, Lee MJ, Kwak JJ, Song DE, Kim DH, Lee HK, Kim JY, Hong SH, Sohn JS, Lee HS, Park SY, Hong SW, Shin MK. The Use of the Bethesda System for Reporting Thyroid Cytopathology in Korea: A Nationwide Multicenter Survey by the Korean Society of Endocrine Pathologists. J Pathol Transl Med 2017; 51:410-417. [PMID: 28609825 PMCID: PMC5525040 DOI: 10.4132/jptm.2017.04.05] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 01/21/2023] Open
Abstract
Background The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has standardized the reporting of thyroid cytology specimens. The objective of the current study was to evaluate the nationwide usage of TBSRTC and assess the malignancy rates in each category of TBSRTC in Korea. Methods Questionnaire surveys were used for data collection on the fine needle aspiration (FNA) of thyroid nodules at 74 institutes in 2012. The incidences and follow-up malignancy rates of each category diagnosed from January to December, 2011, in each institute were also collected and analyzed. Results Sixty out of 74 institutes answering the surveys reported the results of thyroid FNA in accordance with TBSRTC. The average malignancy rates for resected cases in 15 institutes were as follows: nondiagnostic, 45.6%; benign, 16.5%; atypical of undetermined significance, 68.8%; suspicious for follicular neoplasm (SFN), 30.2%; suspicious for malignancy, 97.5%; malignancy, 99.7%. Conclusions More than 80% of Korean institutes were using TBSRTC as of 2012. All malignancy rates other than the SFN and malignancy categories were higher than those reported by other countries. Therefore, the guidelines for treating patients with thyroid nodules in Korea should be revisited based on the malignancy rates reported in this study.
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Affiliation(s)
- Mimi Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Hyo Jin Park
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Sook Min
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Hyeong Ju Kwon
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Pathology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seoung Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Ju Yoo
- Department of Pathology, Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Mi Ja Lee
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
| | - Jeong Ja Kwak
- Department of Pathology, Soon Chun Hyang University Hospital, Bucheon, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hoon Kim
- Department of Pathology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hye Kyung Lee
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Ji Yeon Kim
- Department of Pathology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Sook Hee Hong
- Department of Pathology, Seegene Medical Foundation, Busan, Korea
| | - Jang Sihn Sohn
- Department of Pathology, Konyang University Hospital, Daejeon, Korea
| | - Hyun Seung Lee
- Department of Pathology, Yangji General Hospital, Seoul, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soon Won Hong
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Kyung Shin
- Department of Pathology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
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Al Dawish MA, Robert AA, Muna A, Eyad A, Al Ghamdi A, Al Hajeri K, Thabet MA, Braham R. Bethesda System for Reporting Thyroid Cytopathology: A three-year study at a tertiary care referral center in Saudi Arabia. World J Clin Oncol 2017; 8:151-157. [PMID: 28439496 PMCID: PMC5385436 DOI: 10.5306/wjco.v8.i2.151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/01/2016] [Accepted: 12/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To stratify the malignancy risks in thyroid nodules in a tertiary care referral center using the Bethesda system.
METHODS From January, 2012 to December, 2014, a retrospective analysis was performed among 1188 patients (15-90 years) who had 1433 thyroid nodules and fine-needle aspiration at Prince Sultan Military Medical City, Saudi Arabia. All thyroid cyto-pathological slides and ultra sound reports were reviewed and classified according to the Bethesda System for Reporting Thyroid Cytopathology. Age, gender, cytological features and histological types of the thyroid cancer were collected from patients’ medical chart and cytopathology reports.
RESULTS There were 124 total cases of malignancy on resection, giving an overall surgical yield malignancy of 33.6%. Majority of the thyroid cancer nodules (n = 57, 46%) in Bethesda VI category followed by Bethesda IV (n = 25, 20.2%). Almost 40% of the cancer nodules in 31-45 age group in both sex. Papillary thyroid carcinoma (PTC) was the most common form of thyroid cancer among the study population (111, 89.6%) followed by 8.9% of follicular thyroid carcinoma (FTC), 0.8% of medullary carcinoma and 0.8% of anaplastic carcinoma. Among the Bethesda IV category 68% thyroid nodules were PTC and 32% FTC.
CONCLUSION The malignancy values reported in our research were constant and comparable with the results of other published data with respect to the risk of malignancy. Patients with follicular neoplasm/suspicious for follicular neoplasm and suspicious of malignancy categories, total thyroidectomy is indicted because of the substantial risk of malignancy.
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Krauss EA, Mahon M, Fede JM, Zhang L. Application of the Bethesda Classification for Thyroid Fine-Needle Aspiration: Institutional Experience and Meta-analysis. Arch Pathol Lab Med 2016; 140:1121-31. [DOI: 10.5858/arpa.2015-0154-sa] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Elliot A. Krauss
- From the Department of Pathology, University Medical Center of Princeton, Plainsboro, New Jersey (Drs Krauss, Fede, and Zhang); the Department of Pathology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (Drs Krauss, Fede, and Zhang, and Ms Mahon); the Department of Chemical Biology, Rutgers Ernest Mario School of Pharmacy, Piscataway, New Jersey (Dr Zhang); and the Cancer
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Arul P, Akshatha C, Masilamani S. A study of malignancy rates in different diagnostic categories of the Bethesda system for reporting thyroid cytopathology: An institutional experience. Biomed J 2016; 38:517-22. [PMID: 27013451 PMCID: PMC6138258 DOI: 10.1016/j.bj.2015.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/07/2015] [Indexed: 01/21/2023] Open
Abstract
Background The Bethesda system for reporting thyroid cytopathology (TBSRTC) was introduced to standardize the communication of fine-needle aspiration cytology (FNAC) interpretation between clinicians and pathologists. This study was undertaken to evaluate the diagnostic utility of TBSRTC for reporting thyroid FNACs and rate of malignancy in each diagnostic category of TBSRTC. Methods A total of 603 thyroid FNAC results were retrieved retrospectively between July 2012 and January 2015 and reclassified according to TBSRTC. Of these, 392 cases had a histopathological follow-up. The FNACs results were compared to the histopathological diagnoses and the malignancy rates of each diagnostic categories of TBSRTC were calculated. Results Of the 603 FNACs, nondiagnostic were 16 (2.7%), benign were 393 (65.2%), atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) were 60 (10%), follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN) were 64 (10.6%), suspicious for malignancy (SM) were 32 (5.3%), and malignant were 38 (6.3%). In 392 cases, there was follow-up histopathology. The malignancy rate for nondiagnostic, benign, AUS/FLUS, FN/SFN, SM, and malignant categories were 0%, 0.8%, 24.4%, 28.9%, 70.8%, and 100%, respectively. Conclusion Our study validated the efficacy of TBSRTC. In conclusion, the malignancy rate of AUS/FLUS in this study was higher than the risk mentioned in TBSRTC and other published studies. Hence, AUS/FLUS category patients in our setup warrant further workup including ultrasound and/or thyroid scan in addition to immediate repeat FNAC.
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Affiliation(s)
- P Arul
- Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Siruvachur, Perambalur, Tamil Nadu, India.
| | - C Akshatha
- Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Siruvachur, Perambalur, Tamil Nadu, India
| | - Suresh Masilamani
- Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Siruvachur, Perambalur, Tamil Nadu, India
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Garg S, Desai NJ, Mehta D, Vaishnav M. To Establish Bethesda System for Diagnosis of Thyroid Nodules on the Basis of Fnac with Histopathological Correlation. J Clin Diagn Res 2015; 9:EC17-21. [PMID: 26816898 DOI: 10.7860/jcdr/2015/14823.6897] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/10/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION In October 2007, "The National Cancer Institute (NCI), Thyroid Fine Needle Aspiration State of the Science Conference" was held in Bethesda, Maryland hosted by the NCI with the intention of formulating internationally acceptable guidelines for reporting of thyroid cytopathology. This was because, thyroid FNAC have a reporting confusion due to multiplicity of category terminologies. To overcome this, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was introduced for unifying the terminology and morphologic criteria along with the corresponding risk of malignancy. The Bethesda system for reporting thyroid cytopathology represents a major step towards standardization, reproducibility, improved clinical significance, and greater predictive value of thyroid fine needle aspirates (FNAs). AIM The aim of this study was to elucidate the diagnostic utility of the Bethesda system in reporting thyroid FNAs and to assess the effectiveness of FNAC in the evaluation of thyroid nodules by comparing the results with histopathological evaluation. MATERIALS AND METHODS The present study was carried out in our institute during the July 2012 to September 2014. In this study, 100 FNACs done which were classified according to the Bethesda system and out of them, 60 histopathological evaluations obtained from this group were evaluated. The sensitivity, specificity, positive and negative predictive values were evaluated. RESULTS Out of 100 FNACs, 06% were Non-diagnostic, 78% were Benign, 04% were Atypical follicular lesion of undetermined significance (AFLUS), 04% were suspicious for Follicular neoplasm (SFN), 01% were suspicious for Follicular neoplasm Hurthle cell type, 03% were suspicious for malignancy (SM), and 04% malignant. In 60 cases, data of follow-up histopathologic examination (HPE) were available. The sensitivity was 88.89% and specificity was 84.31%. The positive and negative predictive value were 50% and 97.7%, respectively. CONCLUSION The Bethesda system is very useful for a standardized system of reporting thyroid cytopathology, improving communication between cytopathologists and clinicians, and inter-laboratory agreement, leading to more consistent management approaches. An additional point which is in favor of the implementation of this system is that the classification is directly related to the risk of malignancy in each category, which in turn, prompts the recommended clinical management of that category, thus truly embodying the clinico-pathological correlation in its true spirit. The correlation of FNAC with histopathology is necessary before starting treatment.
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Affiliation(s)
- Sameep Garg
- Assistant Professor, Department of Pathology, Gujarat Adani Institude of Medical Science , Bhuj, Gujarat, India
| | - Nandini J Desai
- Professor, Department of Pathology, Shri M.P. Shah Medical College , Jamnagar, Gujarat, India
| | - Dimple Mehta
- Assistant Professor, Department of Pathology, Shri M.P. Shah Medical College , Jamnagar, Gujarat, India
| | - Mitsu Vaishnav
- Assistant Professor, Department of Pathology, Gujarat Adani Institude of Medical Science , Bhuj, Gujarat, India
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Straccia P, Rossi ED, Bizzarro T, Brunelli C, Cianfrini F, Damiani D, Fadda G. A meta-analytic review of the Bethesda System for Reporting Thyroid Cytopathology: Has the rate of malignancy in indeterminate lesions been underestimated? Cancer Cytopathol 2015; 123:713-22. [DOI: 10.1002/cncy.21605] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/23/2015] [Accepted: 07/23/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Tommaso Bizzarro
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Chiara Brunelli
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Federica Cianfrini
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Domenico Damiani
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
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Norlén O, Charlton A, Sarkis LM, Henwood T, Shun A, Gill AJ, Delbridge L. Risk of malignancy for each Bethesda class in pediatric thyroid nodules. J Pediatr Surg 2015; 50:1147-9. [PMID: 25783310 DOI: 10.1016/j.jpedsurg.2014.10.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/01/2014] [Accepted: 10/14/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE The Bethesda classification for cytology is used to classify thyroid nodules into one of six categories, and for each category there is an implied cancer risk and also recommendation for management. Despite lack of data in children, the American thyroid association promotes the use of the same management guidelines as in adults. Our aim was to study the risk of malignancy for each Bethesda class in children with thyroid nodules. METHODOLOGY We included all patients ≤18years of age that had underwent a thyroid fine needle aspiration (FNA) at one of two centers between January 1998 and July 2013. FNA results were reclassified according to the Bethesda criteria. Histological, repeat cytological, radiological and clinical follow-up were recorded. RESULTS Fifty-six patients (66 nodules) underwent FNB. Mean age was 13.6 years. Numbers of nodules reported as BI-BVI were 7, 38, 11, 4, 3 and 3, respectively. Follow-up was achieved for 55 (83%) nodules. Twelve (18%) nodules were malignant by histology and revealed papillary (n=7), follicular (n=3) or insular thyroid cancer (n=2), The proportion of nodules with malignancy for BI-BVI was: 0%, 0%, 18%, 100%, 100% and 100%. CONCLUSION The rate of malignancy in thyroid nodules in children seems to be higher than reported in adults. The Bethesda criteria seem to accurately identify benign nodules, but other categories have a very high rate of malignancy and BIII nodules pose a particular challenge.
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Affiliation(s)
- Olov Norlén
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, Australia; Department of Surgical Sciences, Uppsala University, Sweden
| | - Amanda Charlton
- Department of Histopathology, Children's Westmead Hospital, Australia
| | - Leba M Sarkis
- Department of Anatomical Pathology, Royal North Shore Hospital and University of Sydney, Australia
| | - Tony Henwood
- Department of Histopathology, Children's Westmead Hospital, Australia
| | - Albert Shun
- Department of Surgery, Children's Westmead Hospital, Australia
| | - Anthony J Gill
- Department of Anatomical Pathology, Royal North Shore Hospital and University of Sydney, Australia
| | - Leigh Delbridge
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, Australia
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Salillas AL, Sun FCS, Almocera EG. Review of the Bethesda System for Reporting Thyroid Cytopathology: a local study in Bohol Island, Philippines. Acta Cytol 2015; 59:77-82. [PMID: 25720460 DOI: 10.1159/000371752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/23/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the adaptability and reproducibility of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in a local setting and to determine the risk of malignancy for each category. MATERIALS AND METHODS A retrospective cross-sectional study of 80 thyroid fine-needle aspiration cytology cases using the BSRTC with corresponding histopathology was done between September 2009 and December 2012. Agreement scores were calculated using kappa statistics. RESULTS Consensus among two readers was attained for 73 cases (91.25%). No disagreement was noted for the malignant cases. The strength of agreement was very good, with a kappa statistic of 0.90. The risk of malignancy observed histologically was as follows: benign 3%, atypia of undetermined significance (AUS) 50%, suspicious for follicular/Hürthle cell neoplasm 50%, suspicious for malignancy 78%, and malignant 100%. CONCLUSION In this study, there is an outstanding reproducibility for the classification scheme. The application of the BSRTC as the standardized reporting is readily adaptable and therefore its application in larger medical centers is highly recommended. Our findings of a higher risk of malignancy seen in AUS (50%) and malignant (100%) categories in those who underwent surgical resection corroborated other published studies. Conveying this risk to clinical colleagues is important and will facilitate optimal patient care.
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The Australian experience with the Bethesda classification system for thyroid fine needle aspiration biopsies. Pathology 2014; 46:592-5. [DOI: 10.1097/pat.0000000000000168] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Son JI, Rhee SY, Woo JT, Park WS, Byun JK, Kim YJ, Byun JM, Chin SO, Chon S, Oh S, Kim SW, Kim YS. Insufficient experience in thyroid fine-needle aspiration leads to misdiagnosis of thyroid cancer. Endocrinol Metab (Seoul) 2014; 29:293-9. [PMID: 25309787 PMCID: PMC4192815 DOI: 10.3803/enm.2014.29.3.293] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/07/2014] [Accepted: 02/11/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Fine-needle aspiration (FNA) of the thyroid is a widely accepted confirmatory test for thyroid cancer with high sensitivity and specificity. FNA is a simple procedure that is learned by many clinicians to enable accurate diagnosis of thyroid cancer. However, it is assumed that because the FNA test is a relatively simple procedure, its cytologic results are reliable regardless of the operator's experience. The aim of this study was to evaluate the differences in the diagnostic indices of FNA between operators with different levels of experience. METHODS A total of 694 thyroid FNA specimens from 469 patients were reviewed, and were separated based on the experience of the clinicians who performed the procedure. One hundred and ninety were categorized in the experienced group, and 504 in the inexperienced group. All FNA results were then compared with histological data from surgically resected specimens, and the sample adequacy and diagnostic accuracy of the groups were compared. RESULTS The age, gender, and nodule size and characteristics were similar in both groups. The sample adequacy rate was not significantly different between the experienced and nonexperienced groups (96.3% vs. 95.4%, P=0.682). However, the non-experienced group had a higher false-negative rate than the experienced group (6.4% vs. 17.2%, P=0.038), and the sensitivity of the FNA test also tended to be lower in the nonexperienced group (95.6% vs. 88.9%, P=0.065). CONCLUSION These results suggest that FNA operators who have less experience may miss cases of thyroid cancer by performing the procedure incorrectly. As such, the experience of the FNA operator should be considered when diagnosing thyroid cancer. When clinicians are being trained in FNA, more effort should be made to increase the accuracy of the procedure; therefore, enhanced teaching programs and/or a more detailed feedback system are recommended.
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Affiliation(s)
- Jung Il Son
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jeong-taek Woo
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Won Seo Park
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jong Kyu Byun
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yu-Jin Kim
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ja Min Byun
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Ouk Chin
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seungjoon Oh
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Woon Kim
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Young Seol Kim
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
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Park JH, Yoon SO, Son EJ, Kim HM, Nahm JH, Hong S. Incidence and malignancy rates of diagnoses in the bethesda system for reporting thyroid aspiration cytology: an institutional experience. KOREAN JOURNAL OF PATHOLOGY 2014; 48:133-9. [PMID: 24868226 PMCID: PMC4026804 DOI: 10.4132/koreanjpathol.2014.48.2.133] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 03/29/2014] [Accepted: 03/31/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) uses six diagnostic categories to standardize communication of thyroid fine-needle aspiration (FNA) interpretations between clinicians and cytopathologists. Since several studies have questioned the diagnostic accuracy of this system, we examined its accuracy in our hospital. METHODS We calculated the incidences and malignancy rates of each diagnostic category in the BSRTC for 1,730 FNAs that were interpreted by four cytopathologists in Gangnam Severance Hospital between October 1, 2011, and December 31, 2011. RESULTS The diagnostic incidences of categories I-VI were as follows: 13.3%, 40.6%, 9.1%, 0.4%, 19.3%, and 17.3%, respectively. Similarly, the malignancy rates of these categories were as follows: 35.3%, 5.6%, 69.0%, 50.0%, 98.7%, and 98.9%, respectively. In categories II, V, and VI, there were no statistically significant differences in the ranges of the malignancy rates among the four cytopathologists. However, there were significant differences in the ranges for categories I and III. CONCLUSIONS Our findings suggest that institutions that use the BSRTC should regularly update their diagnostic criteria. We also propose that institutions issue an annual report of incidences and malignancy rates to help other clinicians improve the case management of patients with thyroid nodules.
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Affiliation(s)
- Ji Hye Park
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Och Yoon
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Min Kim
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hae Nahm
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - SoonWon Hong
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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