The Use of the Bethesda Terminology in Thyroid Fine-Needle Aspiration Results in a Lower Rate of Surgery for Nonmalignant Nodules: A Report From a Reference Center in Turkey


Ozluk Y. , Pehlivan E., Gulluoglu M. , Poyanli A., Salmaslioglu A. , Colak N., ...More

INTERNATIONAL JOURNAL OF SURGICAL PATHOLOGY, vol.19, no.6, pp.761-771, 2011 (Peer-Reviewed Journal) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 19 Issue: 6
  • Publication Date: 2011
  • Doi Number: 10.1177/1066896911415667
  • Journal Name: INTERNATIONAL JOURNAL OF SURGICAL PATHOLOGY
  • Journal Indexes: Science Citation Index Expanded, Scopus
  • Page Numbers: pp.761-771
  • Keywords: thyroid, fine-needle aspiration, cytopathology, Bethesda system, reporting, FOLLICULAR PATTERNED LESIONS, PAPILLARY CARCINOMA, SCIENCE CONFERENCE, UNDETERMINED SIGNIFICANCE, DIAGNOSTIC TERMINOLOGY, CANCER, MALIGNANCY, FEATURES, BIOPSY, STATE

Abstract

The Bethesda system (BS) for reporting thyroid fine-needle aspiration (FNA), which classifies nodules as nondiagnostic (ND), benign (B), atypia/follicular lesion of undetermined significance (AUS/FLUS), suspicious for follicular neoplasm (SFN/FN), suspicious for malignancy (SFM), or malignant (M), uses clinically valuable management guidelines. The authors employed a similar in-house classification system (IS) for thyroid FNAs, using the categories of ND, B, suspicious follicular cells (SFC), follicular lesion/neoplasm (FL/FN), SFM, and M. The authors compared IS and BS, and assessed the utility of BS in clinical practice. A total of 581 nodules with cytological/histological follow-up were examined and indeterminate lesions by BS were reclassified. The sensitivity and specificity for malignancy using IS were similar to that of BS (77% vs 99%). However, when SFN/FN and SFM were both considered positive, the results for IS and BS were as follows: sensitivity, 85% versus 85%; specificity, 87% versus 94%; and diagnostic accuracy, 86% versus 90%, respectively. Discrepancies between cytological and histological data were evident in 35 cases among all categories of BS except AUS/FLUS. The rate of surgery for nonmalignant nodules was lesser (20% vs 9%) by BS. Among 34 AUS/FLUS cases with follow-up data, hypocellularity was the case in 11 (46%) nonneoplastic and 10 (100%) neoplastic nodules. The use of BS results in a lower rate of surgery for nonmalignant nodules even though patients with borderline cytopathologic features are still encountered. AUS/FLUS category can be separated into subgroups according to the factors causing difficulties in the interpretation. There is a need of accumulation of AUS/FLUS cases to do further evaluations and studies.