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. 2020 Apr 16:2020:8095378.
doi: 10.1155/2020/8095378. eCollection 2020.

The Bethesda System for Reporting Thyroid Cytopathology: A Cytohistological Study

Bakiarathana Anand  1 , Anita Ramdas  1 , Marie Moses Ambroise  1 , Nirmal P Kumar  2
Affiliations

The Bethesda System for Reporting Thyroid Cytopathology: A Cytohistological Study

Bakiarathana Anand et al. J Thyroid Res. .

Abstract

Introduction: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a significant step to standardize the reporting of thyroid fine needle aspiration (FNA). It has high predictive value, reproducibility, and improved clinical significance.

Aim: The study was aimed to evaluate the diagnostic utility and reproducibility of "TBSRTC" at our institute. Methods and Material. The study included 646 thyroid FNAs which were reviewed by three pathologists and classified according to TBSRTC. Cytohistological correlation was done for 100 cases with surgical follow-up and the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and risk of malignancy (ROM) were calculated. The interobserver variation among three pathologists was also assessed.

Results: The distribution of cases in various TBSRTC categories is as follows: I-nondiagnostic 13.8%, II-benign 75.9%, III-atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) 1.2%, IV-follicular neoplasm (FN)/suspicious for follicular neoplasm (SFN) 3.7%, V-suspicious for malignancy (SM) 2.6%, and VI-malignant 2.8%. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy are 72.4%, 94.3%, 84%, 89.2%, and 87.9%, respectively. The ROM of various TBSRTC categories were II-8.5%; III-66.7%; IV-63.6%; and V and VI-100%. Cohen's Weighted Kappa score was 0.99 which indicates almost perfect agreement among the three pathologists.

Conclusions: Our study substantiates greater reproducibility among pathologists using TBSRTC to arrive at a precise diagnosis with an added advantage of predicting the risk of malignancy which enables the clinician to plan for follow-up or surgery and also the extent of surgery.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Atypia of undetermined significance (Bethesda category III). Smear shows clotting artefact with crowding of follicular cells hindering the interpretation (MGG stain ×400).
Figure 2
Figure 2
Follicular neoplasm/suspicious for follicular neoplasm (Bethesda category IV). (a) Highly cellular smear with cells arranged predominantly in microfollicular pattern (MGG ×100). Histopathology of the same showed follicular carcinoma with capsular invasion (b) and vascular invasion (c) (H&E ×100).
Figure 3
Figure 3
Suspicious for papillary carcinoma (Bethesda category V). (a) One of the follicular cells show nuclear groove (arrow) (H&E ×400). (b) Intranuclear cytoplasmic inclusion (arrow) seen in occasional follicular cell (H&E ×400). (c) Smear shows focal papillaroid structure (H&E ×400). (d) Histopathology of the same showed papillary microcarcinoma (H&E ×100).
See this image and copyright information in PMC

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