The 2017 Bethesda System for Reporting Thyroid Cytopathology.

Published on Nov 1, 2017in Thyroid6.568
· DOI :10.1089/THY.2017.0500
Edmund S. Cibas64
Estimated H-index: 64
(Brigham and Women's Hospital),
Syed Z. Ali43
Estimated H-index: 43
(Johns Hopkins University)
Sources
Abstract
The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) established a standardized, category-based reporting system for thyroid fine-needle aspiration (FNA) specimens. The 2017 revision reaffirms that every thyroid FNA report should begin with one of six diagnostic categories, the names of which remain unchanged since they were first introduced: (i) nondiagnostic or unsatisfactory; (ii) benign; (iii) atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS); (iv) follicular neoplasm or suspicious for a follicular neoplasm; (v) suspicious for malignancy; and (vi) malignant. There is a choice of two different names for some of the categories. A laboratory should choose the one it prefers and use it exclusively for that category. Synonymous terms (e.g., AUS and FLUS) should not be used to denote two distinct interpretations. Each category has an implied cancer risk that ranges from 0% to 3% for the “benign” category to virtually 100% for the “malignant” categ...
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References20
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#1Marina Vivero (Brigham and Women's Hospital)H-Index: 17
#2Andrew A. Renshaw (Baptist Memorial Hospital-Memphis)H-Index: 62
Last. Jeffrey F. Krane (Brigham and Women's Hospital)H-Index: 57
view all 3 authors...
Adequacy criteria for thyroid fine-needle aspiration (FNA) recommended by The Bethesda System for Reporting Thyroid Cytopathology (TBS) were developed with smears, but they are commonly applied to ThinPreps (TPs). This study evaluated adequacy in TPs at different diagnostic thresholds.All FNA procedures performed between 2010 and 2015 with matched surgical specimens were analyzed. Cell counts and cytological features were evaluated in all initially nondiagnostic (ND) cases. ND cases were reclass...
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#1Jeffrey F. Krane (Brigham and Women's Hospital)H-Index: 57
#2Erik K. Alexander (Brigham and Women's Hospital)H-Index: 52
Last. Justine A. Barletta (Brigham and Women's Hospital)H-Index: 41
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#1Yuri E. Nikiforov (University of Pittsburgh)H-Index: 92
#2Raja R. Seethala (University of Pittsburgh)H-Index: 72
Last. Ronald Ghossein (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 82
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Importance Although growing evidence points to highly indolent behavior of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), most patients with EFVPTC are treated as having conventional thyroid cancer. Objective To evaluate clinical outcomes, refine diagnostic criteria, and develop a nomenclature that appropriately reflects the biological and clinical characteristics of EFVPTC. Design, Setting, and Participants International, multidisciplinary, retrospective study of patie...
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#1William C. Faquin (Harvard University)H-Index: 68
#2Lawrence Q. Wong (HUP: Hospital of the University of Pennsylvania)H-Index: 6
Last. Zubair W. Baloch (HUP: Hospital of the University of Pennsylvania)H-Index: 70
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BACKGROUND Recent discussions have focused on redefining noninvasive follicular variant of papillary thyroid carcinoma (NI-FVPTC) as a neoplasm rather than a carcinoma. This study assesses the potential impact of such a reclassification on the implied risk of malignancy (ROM) for the diagnostic categories of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). METHODS The study consisted of consecutive fine-needle aspiration biopsy (FNAB) cases collected between January 1, 2013 and ...
Source
#1Kyle C. Strickland (Brigham and Women's Hospital)H-Index: 16
#2Brooke E. Howitt (Brigham and Women's Hospital)H-Index: 36
Last. Justine A. Barletta (Brigham and Women's Hospital)H-Index: 41
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Background: Increased recognition of the indolent nature of noninvasive follicular variant of papillary thyroid carcinoma (NFVPTC) along with greater insight into the molecular alterations of these tumors has prompted endocrine pathologists to question whether these tumors warrant a diagnosis of carcinoma. However, a change in terminology would affect the rates of malignancy of fine-needle aspiration (FNA) diagnostic categories. Therefore, the aim of this study was to determine the percentage de...
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#1Mazen E. Iskandar (Mount Sinai Health System)H-Index: 7
#2Giovanni Bonomo (Mount Sinai Health System)H-Index: 1
Last. Jennifer L. Marti (Mount Sinai Health System)H-Index: 13
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Background Several recent analyses of indeterminate thyroid nodules classified as Bethesda III (follicular lesion of undetermined significance) have reported considerably greater rates of malignancy than those initially reported by the Bethesda System for Reporting Cytopathology (BSRTC). These values, however, may be overestimates owing to several sources of bias, such as referral, selection, and publication biases. Our aim was to analyze the prevalence of malignancy in Bethesda III and IV thyro...
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#1Ha Young Lee (Inha University)H-Index: 14
#2Jung Hwan Baek (UOU: University of Ulsan)H-Index: 61
Last. Jae Yol LimH-Index: 19
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Objective: The purpose of this study was to determine whether the recommended waiting period of 3 months is necessary for repeat fine-needle aspiration biopsy (FNAB). Study Design: A retrospective review of 128 nodules from 126 patients with initial nondiagnostic (ND) results was performed for the period between January 2009 and December 2012. Demographic and clinical factors were recorded including age, sex, time interval between FNABs, and ultrasound (US) factors, i.e. nodule size, location, c...
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#1Andrew A. Renshaw (Baptist Hospital of Miami)H-Index: 62
There is limited histologic follow-up for adequacy criteria in thyroid fine needle aspirations. We correlated the number of benign follicular cells in nondiagnostic aspirates (excluding atypical and Hurthle cells) and the results of histologic follow-up. A total of 170 cases with only benign follicular cells were reviewed. The sensitivity and specificity for 60 benign follicular cells was 97% and 42%. If the threshold for adequacy was lowered to 10 cells, the specificity of a benign diagnosis in...
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#1Remmi S. Singh (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 2
#2Helen H. WangH-Index: 57
Objective: The Bethesda System for reporting thyroid fine-needle aspirations (FNAs) recommends repeat aspirations be done at least 3 months following the initial aspiration to prevent false-positive misinterpretations due to reactive/reparative changes. Because limited data exists, we reviewed our own data to ascertain the recommendation. Study Design: We retrospectively reviewed thyroid FNAs accessioned in the Cytology Laboratory at Beth Israel Deaconess Medical Center in Boston, Mass., USA, fr...
Source
#1Syed Z. AliH-Index: 43
#2Edmund S. CibasH-Index: 64
Overview of Diagnostic Terminology and Reporting.- Nondiagnostic/Unsatisfactory.- Benign.- Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance.- Follicular Neoplasm/Suspicious for a Follicular Neoplasm.- Follicular Neoplasm, Hurthle Cell Type/Suspicious for a Follicular Neoplasm, Hurthle Cell Type.- Suspicious for Malignancy.- Papillary Thyroid Carcinoma and Variants.- Medullary Thyroid Carcinoma.- Poorly Differentiated Thyroid Carcinoma.- Undifferentiated (Anaplas...
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#1Nguyen Thanh DucH-Index: 3
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Abstract null null Accurately cytopathological diagnosis of Papillary Thyroid Carcinoma (PTC) is of importance for reducing costs and increasing efficiency of treatments. In this paper, we pursue that goal by introducing artificial intelligence (AI) for automatic classification of malignant PTC cell clusters from Fine Needle Aspiration Cytology (FNAC) processed by ThinPrep. High-resolution cytological images obtained with a 40 × objective lens digital camera attached to an Olympus microscope wer...
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Rationale and Objectives This study aims to evaluate the diagnostic accuracy, inter-reader, and intra-reader variability of the ACR Thyroid Imaging Reporting and Data System (TI-RADS) for risk-stratification of indeterminate thyroid nodules using next generation genetic sequencing and tissue histology as a reference standard. Materials and Methods Retrospective chart review was performed on all patients who underwent thyroid ultrasound for a nodule with subsequent fine-needle aspiration ± surgic...
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#1William H. Scola (UM: University of Miami)
#2Samantha M. Linhares (UM: University of Miami)H-Index: 3
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BACKGROUND The Bethesda System for Reporting Thyroid Cytopathology has 6 diagnostic categories, each with an implied cancer risk of malignancy (ROM). Bethesda III, defined as atypia or follicular lesions of undetermined significance (AUS/FLUS) on fine needle aspiration (FNA), has an indeterminate ROM. This study investigates the utility of Afirma Gene Expression Classifier (GEC) and Thyroid Sequencing (ThyroSeq) molecular testing to predict malignancy in AUS/FLUS thyroid nodules. METHODS A retro...
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#1Keely O Reidelberger (UNMC: University of Nebraska Medical Center)H-Index: 1
#2Abbey L. Fingeret (UNMC: University of Nebraska Medical Center)H-Index: 7
Incidental findings are common in the evaluation of surgical patients. Understanding the appropriate assessment and management of these frequent occurrences is important for the provision of comprehensive quality care. This review details the epidemiology, considerations, and recommendations for management of common incidental manifestations in surgical patients, including Meckel diverticulum, adrenal incidentaloma, thyroid nodule, solitary pulmonary nodule, small bowel intussusception, gallston...
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Fine-needle aspiration cytology of an intrathyroidal nodule diagnosed as squamous cell carcinoma: A case report
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#2Kai Qian (SJTU: Shanghai Jiao Tong University)H-Index: 2
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Background: Papillary thyroid carcinoma (PTC) is a rare malignancy in children and young adults (CAYA). It often presents with aggressive disease patterns and advanced stages, which are clinically ...
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#1Francesca Perticone (UniSR: Vita-Salute San Raffaele University)H-Index: 1
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Introduction null Hurthle cells are modified follicular thyroid cells, whose development and proliferation have been related to different stimuli inducing cellular stress. Most thyroid aspirates containing Hurthle cells are classified as indeterminate, although the specific risk of malignancy for this subtype of atypia remains unclear. The aim of our study was to assess if the presence of Hurthle cells in indeterminate thyroid nodules correlates with the risk of malignancy. We further evaluated ...
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Background: Various Thyroid Imaging and Reporting data systems (TIRADS) are used worldwide for risk stratification of thyroid nodules. Their sensitivity is high, while the specificity is suboptimal. The aim of the study was to compare several TIRADS systems and evaluate the effect of hypoechogenicity as a sign of risk of malignancy on the overall assessment of diagnostic accuracy. Methods: The prospective study includes 274 patients with 289 thyroid nodules to whom US and risk of malignancy were...
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#2Shengliang Zhou (Sichuan University)H-Index: 1
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#1Joyce Zhi'en Tang (SGH: Singapore General Hospital)
#2Jasmine Ming Er Chua (SGH: Singapore General Hospital)H-Index: 2
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BACKGROUND The management of thyroid nodules ≥ 4 cm is controversial due to conflicting evidence on the prevalence of malignancy and diagnostic accuracy of fine-needle aspiration cytology (FNAC). Some literature recommends routine excision of large thyroid nodules due to high cytology false negative rates (FNR). We aim to investigate the diagnostic accuracy of FNAC, prevalence of malignancy in large (≥ 4 cm) thyroid nodules compared to nodules < 4 cm, and the clinical and ultrasound characterist...
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