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. 2019 Sep 9;152(4):502-511.
doi: 10.1093/ajcp/aqz076.

Assessment of The Bethesda System for Reporting Thyroid Cytopathology

Jennifer L Sauter  1   2 , Heidi Lehrke  1 , Xiaotun Zhang  1 , Osamah T Al Badri  1 , Rene Rodriguez-Gutierrez  3   4   5   6 , Danae A Delivanis  3 , Naykky Singh Ospina  3   7 , Diane Donegan  3 , Oksana Hamidi  3   8 , Nicole Iñiguez-Ariza  3   9 , Anu Sharma  3 , Nana Esi N Kittah  3 , Shrikant U Tamhane  3 , Maria D Hurtado Andrade  3 , Anupam Kotwal  3 , Sarah M Jenkins  10 , Grant Spears  10 , Michael Rivera  1 , Diana S Dean  3 , Michael R Henry  1
Affiliations

Assessment of The Bethesda System for Reporting Thyroid Cytopathology

Jennifer L Sauter et al. Am J Clin Pathol. .

Abstract

Objectives: Long-term follow-up is important for determining performance characteristics of thyroid fine-needle aspiration (FNA).

Methods: Histologic or 3 or more years of clinical follow-up was used to calculate performance characteristics of thyroid FNA before and after implementation of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) classification was also investigated.

Results: Follow-up was obtained for 1,277/1,134 and 1,616/1,393 aspirates/patients (median clinical follow-up, 9.9 and 4.4 years, pre- and post-TBSRTC, respectively). Nondiagnostic, suspicious for follicular neoplasm, and suspicious for malignancy (SFM) diagnoses decreased and benign diagnoses increased post-TBSRTC, while atypical rate remained less than 1%. Negative predictive value for benign nodules and positive predictive value (PPV) for SFM increased significantly. Eleven nodules were reclassified as NIFTP, slightly decreasing PPV/risk of malignancy (ROM).

Conclusions: Appropriate ROM for thyroid FNA can be achieved through application of TBSRTC terminology with minimal use of atypical category.

Keywords: Atypia of undetermined significance/follicular lesion of undetermined significance; Bethesda; Cytopathology; FNA; Fine-needle aspiration; Follicular neoplasm/suspicious for follicular neoplasm; Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP); Papillary thyroid carcinoma; Risk of malignancy; Thyroid.

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Figures

Image 1
Image 1
A, Aspirate of a thyroid nodule with rare follicular cells containing atypical features, including nuclear enlargement, micronucleoli, and rare nuclear grooves. Given the scant nature of this specimen, a diagnosis of atypia of undetermined significance (AUS) was rendered (Papanicolaou, ×400 and ×600 [inset]). Follow-up histology showed follicular variant of papillary thyroid carcinoma (not shown). B, Aspirate of a thyroid nodule with sheets of follicular cells with atypical features, including nuclear enlargement, open chromatin, and nuclear grooves (Papanicolaou, ×400 and ×600 [inset]). Follow-up histology showed a benign follicular adenoma in a background of thyroiditis (not shown). C, A hypocellular aspirate of a thyroid nodule with a rare area demonstrating a microfollicular pattern. Due to the scant nature of this aspirate, a diagnosis of AUS was most appropriate Papanicolaou, ×200). Follow-up histology showed a benign follicular adenoma (not shown).
Image 2
Image 2
Thyroid nodule with an initial cytology diagnosis of suspicious for papillary thyroid carcinoma (Papanicolaou, ×400 [A] and ×600 [B]). Original histology diagnosis was follicular variant of papillary thyroid carcinoma. This nodule would currently be classified histologically as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (H&E, ×100 [C] and ×400 [D]).
Image 3
Image 3
Thyroid nodule with initial cytology diagnosis of benign (Papanicolaou, ×200 [A] and ×600 [B]). Original histology diagnosis was follicular variant of papillary thyroid carcinoma. This nodule would currently be classified histologically as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (H&E, ×100 [C] and ×400 [D]).
See this image and copyright information in PMC

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