Skip to main content

Advertisement

SpringerLink
Log in

The Bethesda System for Reporting Thyroid Cytopathology: A Single-Center Experience over 5 Years

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) was developed to refine fine-needle aspiration (FNA) cytology definitions and improve clinical management. This study evaluates the impact of the BSRTC 5 years after its adoption at a single institution.

Methods

A total of 1,625 patients undergoing thyroidectomy in the pre-BSRTC (Group 1: July 2007–January 2009) and post-BSRTC (Group 2: February 2009–September 2013) periods were reviewed. Cytologic diagnoses in Group 1 included non-diagnostic, benign, follicular neoplasm, suspicious for malignancy and malignant. Atypia/follicular lesion of undetermined significance (AUS/FLUS) was included in Group 2. The proportions of each FNA category and malignancy rate per cytologic diagnosis were compared.

Results

Fifty-four percent (187/347) of Group 1 patients had a preoperative FNA versus 61 % (777/1278) in Group 2 (p = 0.02). Group 1 FNA results included 3 % non-diagnostic, 48 % benign, 17 % follicular, 13 % suspicious for cancer, and 19 % cancer. Group 2 results included 3 % non-diagnostic, 36 % benign, 9 % follicular, 8 % suspicious for malignancy, 18 % malignant and 26 % AUS/FLUS. In Group 2, the proportions of benign, follicular and suspicious for malignancy FNAs decreased significantly (p < 0.05). In Group 2, there were more indeterminate FNA diagnoses overall (30 vs. 43 %; p < 0.001). The rate of cancer in suspicious for cancer FNA lesions increased from 44 to 65 % (p = 0.07). The AUS/FLUS malignancy rate was 15 %.

Conclusions

Since the adoption of the BSRTC at our institution, the proportion of indeterminate FNAs has increased; however, the diagnostic accuracy of the suspicious for cancer category improved. We recommend periodic review of the utilization and malignancy rates per cytologic category at each institution to help tailor clinical management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2009;19(11):1159–65.

    Article  PubMed  Google Scholar 

  2. Broome JT, Cate F, Solorzano CC. Utilization and impact of repeat biopsy for follicular lesion/atypia of undetermined significance. World J Surg. 2014; 38(3):628–33.

    Article  PubMed  CAS  Google Scholar 

  3. Miller B, Burkey S, Lindberg G, Snyder WH 3rd, Nwariaku FE. Prevalence of malignancy within cytologically indeterminate thyroid nodules. Am J Surg. 2004;188(5):459–62.

    Article  PubMed  Google Scholar 

  4. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–214.

    Article  PubMed  Google Scholar 

  5. Layfield LJ, Morton MJ, Cramer HM, Hirschowitz S. Implications of the proposed thyroid fine-needle aspiration category of “follicular lesion of undetermined significance”: a five-year multi-institutional analysis. Diagn Cytopathol. 2009;37(10):710–4.

    Article  PubMed  Google Scholar 

  6. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer. 2007;111(5):306–15.

    Article  PubMed  Google Scholar 

  7. Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111(6):508–16.

    Article  PubMed  Google Scholar 

  8. Ohori NP, Nikiforova MN, Schoedel KE, LeBeau SO, Hodak SP, Seethala RR, et al. Contribution of molecular testing to thyroid fine-needle aspiration cytology of “follicular lesion of undetermined significance/atypia of undetermined significance”. Cancer Cytopathol. 2010;118(1):17–23.

    Article  PubMed  CAS  Google Scholar 

  9. Broome JT, Solorzano CC. The impact of atypia/follicular lesion of undetermined significance on the rate of malignancy in thyroid fine-needle aspiration: evaluation of the Bethesda System for Reporting Thyroid Cytopathology. Surgery. 2011;150(6):1234–41.

    Article  PubMed  Google Scholar 

  10. Sosa JA, Hanna JW, Robinson KA, Lanman RB. Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States. Surgery. 2013;154(6):1420–6.

    Article  PubMed  Google Scholar 

  11. Faquin WC, Baloch ZW. Fine-needle aspiration of follicular patterned lesions of the thyroid: diagnosis, management, and follow-up according to National Cancer Institute (NCI) recommendations. Diagn Cytopathol. 2010;38(10):731–9.

    PubMed  Google Scholar 

  12. Rabaglia JL, Kabbani W, Wallace L, Holt S, Watumull L, Pruitt J, et al. Effect of the Bethesda system for reporting thyroid cytopathology on thyroidectomy rates and malignancy risk in cytologically indeterminate lesions. Surgery. 2010;148(6):1267–72.

    Article  PubMed  Google Scholar 

  13. Harvey AM, Mody DR, Amrikachi M. Thyroid fine-needle aspiration reporting rates and outcomes before and after Bethesda implementation within a combined academic and community hospital system. Arch Pathol Lab Med. 2013;137(11):1664–8.

    Article  PubMed  Google Scholar 

  14. Cibas ES, Baloch ZW, Fellegara G, LiVolsi VA, Raab SS, Rosai J, et al. A prospective assessment defining the limitations of thyroid nodule pathologic evaluation. Ann Intern Med. 2013;159(5):325–32.

    Article  PubMed  Google Scholar 

  15. Cross PA, Poller D. The Bethesda thyroid terminology and progress towards international agreement on thyroid FNA cytology reporting. Cytopathology. 2010;21(2):71–4.

    Article  PubMed  CAS  Google Scholar 

  16. Cuhaci N, Arpaci D, Ucler R, Yazgan AK, Kiyak G, Yalcin S, et al. Malignancy rate of thyroid nodules defined as follicular lesion of undetermined significance and atypia of undetermined significance in thyroid cytopathology and its relation with ultrasonographic features. Endocr Pathol. 2014.doi:10.1007/s12022-014-9298-7.

    PubMed  Google Scholar 

  17. Jeong SH, Hong HS, Lee EH, Cha JG, Park JS, Kwak JJ. Outcome of thyroid nodules characterized as atypia of undetermined significance or follicular lesion of undetermined significance and correlation with ultrasound features and BRAF(V600E) mutation analysis. AJR Am J Roentgenol. 2013;201(6):W854–60.

    Article  PubMed  Google Scholar 

  18. Yoo WS, Choi HS, Cho SW, Moon JH, Kim KW, Park HJ, et al. The role of ultrasound findings in the management of thyroid nodules with atypia or follicular lesions of undetermined significance. Clin Endocrinol (Oxf). 2013;80(5):735–42.

    Article  Google Scholar 

  19. Walts AE, Mirocha J, Bose S. Follicular lesion of undetermined significance in thyroid FNA revisited. Diagn Cytopathol. 2014;42(1):18–22.

    Article  PubMed  Google Scholar 

  20. Mehta RS, Carty SE, Ohori NP, Hodak SP, Coyne C, LeBeau SO, et al. Nodule size is an independent predictor of malignancy in mutation-negative nodules with follicular lesion of undetermined significance cytology. Surgery. 2013;154(4):730–7.

    Article  PubMed  Google Scholar 

Download references

Financial disclosures

None.

Author information

Authors and Affiliations

  1. Department of General Surgery, Vanderbilt University, Nashville, TN, USA

    Colleen M. Kiernan MD

  2. Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University, Nashville, TN, USA

    J. T. Broome & C. C. Solórzano

Authors
  1. Colleen M. Kiernan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. T. Broome
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. C. Solórzano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Colleen M. Kiernan MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kiernan, C.M., Broome, J.T. & Solórzano, C.C. The Bethesda System for Reporting Thyroid Cytopathology: A Single-Center Experience over 5 Years. Ann Surg Oncol 21, 3522–3527 (2014). https://doi.org/10.1245/s10434-014-3743-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3743-1

Keywords

Search

Navigation