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Overview of Diagnostic Terminology and Reporting

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The Bethesda System for Reporting Thyroid Cytopathology

Abstract

The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) established a uniform, tiered reporting system for thyroid fine needle aspiration (FNA) specimens. TBSRTC recommends that every thyroid FNA report begin with one of six diagnostic categories: (1) nondiagnostic or unsatisfactory, (2) benign, (3) atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS), (4) follicular neoplasm or suspicious for a follicular neoplasm, (5) suspicious for malignancy, and (6) malignant. It offers a choice of two different names for three of the six 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” category, and, in this second edition, the malignancy risks have been revised based on additional (post first edition) data. As a function of these risk associations, each category is linked to evidence-based clinical management guidelines. The recent reclassification of some thyroid neoplasms as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has implications for the risk of malignancy, and this is accounted for in this chapter. For some of the general diagnostic categories, subcategorization can be informative and is often appropriate. Additional descriptive comments (beyond such subcategorization) are optional and left to the discretion of the cytopathologist. Notes and recommendations can be useful, especially due to the introduction of NIFTP.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Founders Pavilion, Philadelphia, PA, 19104, USA

    Zubair W. Baloch

  2. Division of Endocrinology, Diabetes, & Metabolism, The Johns Hopkins Hospital/The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    David S. Cooper

  3. Department of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN, USA

    Hossein Gharib

  4. Department of Endocrinology, Brigham & Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Erik K. Alexander

Authors
  1. Zubair W. Baloch
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  2. David S. Cooper
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  3. Hossein Gharib
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  4. Erik K. Alexander
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Correspondence to Zubair W. Baloch .

Editor information

Editors and Affiliations

  1. Department of Pathology, The Johns Hopkins Hospital/The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Syed Z. Ali

  2. Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA

    Edmund S. Cibas

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Baloch, Z.W., Cooper, D.S., Gharib, H., Alexander, E.K. (2018). Overview of Diagnostic Terminology and Reporting. In: Ali, S., Cibas, E. (eds) The Bethesda System for Reporting Thyroid Cytopathology. Springer, Cham. https://doi.org/10.1007/978-3-319-60570-8_1

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  • DOI: https://doi.org/10.1007/978-3-319-60570-8_1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60569-2

  • Online ISBN: 978-3-319-60570-8

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