The bethesda system for reporting thyroid cytopathology: interpretation and guidelines in surgical treatment

Abstract

(1) The aim of this study is to assess the efficacy of The Bethesda System for Reporting Thyroid Cytology (TBSRTC) in accurate prediction of thyroid lesions on fine needle aspiration (FNA). (2) To appraise the surgeon with guidelines for adequacy of samples, and interpretation of FNA reports with TBSRTC and hence aiding them in surgical decision making. Five hundred and sixty four FNAs were done on patients with thyroid swellings in the department of Pathology and reported using TBSRTC guidelines. In cases where surgery was done, histopathological report was correlated. Using TBSRTC the commonest cytological diagnosis was benign-Hashimotos thyroiditis followed by benign follicular nodule. TBSTRC reduces inter-observer variability in reporting thyroid FNAs and provides good communication between the surgeon and pathologist. It also implicates guidelines for cancer risk and clinical management to the surgeons, thus avoiding unnecessary surgery.

Keywords: Cytology; Fine-needle aspiration; Terminology; Thyroid.

Fig. 1

TBSRTC category I (ND/UNS) cyst fluid with macrophages (H&E ×400)

Fig. 2

TBSRTC category II Benign—Hashimotos thyroiditis—Hurthle cells with abundant pink cytoplasm and lymphocytes (H&E ×400)

Fig. 3

TBSRTC category III (AUS/FLUS) thyroid follicular cells with architectural and cytological atypia (H&E ×400)

Fig. 4

a TBSRTC category IV (FN/SFN) follicular cells in micro follicles with abundant colloid (H&E ×400). b Hurthle cell neoplasm showing only Hurthle cells (H&E ×400)

Fig. 5

TBSRTC category V suspicious for papillary carcinoma-focal nuclear grooving (H&E ×400)

Fig. 6

a TBSRTC category VI Papillary carcinoma-follicular cells in papillae with nuclear grooving and intranuclear inclusions (H&E ×400). b Anaplastic carcinoma with multinucleated tumor giant cells, neutrophilic infiltration of cytoplasm and mitotic activity (H&E ×400)