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Correlating the Bethesda System for Reporting Thyroid Cytopathology with Histology and Extent of Surgery: A Review of 21,746 Patients from Four Endocrine Surgery Registries Across Two Continents

  • William B. InabnetIIIEmail author
  • Fausto Palazzo
  • Julie Ann Sosa
  • Joshua Kriger
  • Sebastian Aspinall
  • Marcin Barczynski
  • Gerard Doherty
  • Maurizio Iacobone
  • Erik Nordenstrom
  • David Scott-Coombes
  • Goran Wallin
  • Lauren Williams
  • Rachel Bray
  • Anders Bergenfelz
Original Scientific Report
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Abstract

Background

The Bethesda system for cytopathology (TBSRTC) is a 6-tier diagnostic framework developed to standardize thyroid cytopathology reporting. The aim of this study was to determine the risk of malignancy (ROM) for each Bethesda category.

Methods

Thyroidectomy-related data from 314 facilities in 22 countries were entered into the following outcome registries: CESQIP (North America), Eurocrine (Europe), SQRTPA (Sweden) and UKRETS (UK). Demographic, cytological, pathologic and extent of surgery data were mapped into one dataset and analyzed.

Results

Out of 41,294 thyroidectomy patient entries from January 1, 2015, to June 30, 2017, 21,746 patients underwent both thyroid FNA and surgery. A comparison of cytology and surgical pathology data demonstrated a ROM for Bethesda categories 1 to 6 of 19.2%, 12.7%, 31.9%, 31.4%, 77.8% and 96.0%, respectively. Male patients had a higher rate of malignancy for every Bethesda category. Secondary analysis demonstrated a high ROM in male patients with Bethesda 3 category aged 31–35 years (52.1%, 95% confidence interval (CI) 37.9–66.2%), aged 36–40 years (55.9%, 95% CI 39.2–72.6%) and aged 41–45 years (46.9%, 95% CI 33–60.9%). Patients with Bethesda 5 and 6 scores were more likely to undergo total thyroidectomy (65.9% and 84.6%); for patients with Bethesda scores 2 and 3, a higher percentage of females underwent total thyroidectomy compared to males in spite of a higher ROM for males.

Conclusions

These data demonstrate that Bethesda categories 1–4 are associated with a higher ROM compared to the first edition of TBSRTC, especially in male patients, and validate findings from the second edition of TBSRTC.

Notes

Acknowledgements

The investigators would like to acknowledge and thank Bruce Levin for his expert assistance with the statistical analysis of the data. CESQIP and the hospitals participating in CESQIP are the source of the CESQIP data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. The conclusions, findings and opinions expressed by the authors do not necessarily reflect the official position of the American Association of Endocrine Surgeons or CESQIP. Use of CESQIP data does not imply endorsement by any of the groups named above.

Compliance with ethical standards

Conflict of interest

None of the authors declare any conflict of interest except Dr. Sosa who declares the following disclosures: She is a member of the Data Monitoring Committee of the Medullary Thyroid Cancer Consortium Registry supported by GlaxoSmithKline, Novo Nordisk, Astra Zeneca, and Eli Lilly.

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • William B. InabnetIII
    • 1
    Email author
  • Fausto Palazzo
    • 2
  • Julie Ann Sosa
    • 3
  • Joshua Kriger
    • 4
  • Sebastian Aspinall
    • 5
  • Marcin Barczynski
    • 6
  • Gerard Doherty
    • 7
  • Maurizio Iacobone
    • 8
  • Erik Nordenstrom
    • 9
  • David Scott-Coombes
    • 10
  • Goran Wallin
    • 11
  • Lauren Williams
    • 4
  • Rachel Bray
    • 4
  • Anders Bergenfelz
    • 9
  1. 1.Department of SurgeryUniversity of Kentucky College of MedicineLexingtonUSA
  2. 2.Hammersmith Hospital and Imperial CollegeLondonUK
  3. 3.University of CaliforniaSan FranciscoUSA
  4. 4.Columbia University Mailman School of Public HealthNew YorkUSA
  5. 5.Aberdeen Royal InfirmaryAberdeenUK
  6. 6.Department of Endocrine Surgery, Third Chair of General SurgeryJagiellonian University Medical CollegeKrakowPoland
  7. 7.Brigham and Women’s HospitalBostonUSA
  8. 8.University of PaduaPaduaItaly
  9. 9.Lund UniversityLundSweden
  10. 10.University Hospital of WalesCardiffUK
  11. 11.Örebro UniversityÖrebroSweden

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