Bethesda Categorization of Thyroid Nodule Cytology and Prediction of Thyroid Cancer Type and Prognosis

Liu, Xiaoyun; Medici, Marco; Kwong, Norra; Angell, Trevor E.; Marqusee, Ellen; Kim, Matthew I.; Larsen, P. Reed; Cho, Nancy L.; Nehs, Matthew A.; Ruan, Daniel T.; Gawande, Atul A.; Moore, Francis D.; Barletta, Justine A.; Krane, Jeffrey F.; Cibas, Edmund S.; Yang, Tao; Alexander, Erik K.

doi:10.1089/thy.2015.0376

Cited by 74 publications

(66 citation statements)

References 26 publications

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“…Our findings are consistent with those reported by Lastra et al who found that of the malignant tumors resected at their institution with a suspicious Afirma result and a preceding AUS/FLUS or SFN diagnosis, 73% were FVPTCs (the FVPTCs were not further subclassified in this study), 14% were classical PTCs, and 14% were FTCs (24). Moreover, the finding that many of the carcinomas detected by the GEC are NFVPTCs is a direct reflection of the fact that the Bethesda categorization of a nodule is associated with tumor type, stage, and prognosis (22,25). In other words, carcinomas resected in the setting of an AUS/FLUS or SFN FNA diagnosis are usually FVPTCs without associated extrathyroidal extension or lymph node metastases (22,25).…”

Section: Discussionmentioning

confidence: 79%

“…Moreover, the finding that many of the carcinomas detected by the GEC are NFVPTCs is a direct reflection of the fact that the Bethesda categorization of a nodule is associated with tumor type, stage, and prognosis (22,25). In other words, carcinomas resected in the setting of an AUS/FLUS or SFN FNA diagnosis are usually FVPTCs without associated extrathyroidal extension or lymph node metastases (22,25). Specifically, Vanderlaan et al found that FVPTCs accounted for 85% and 73% of the PTCs associated with an AUS/FLUS and SFN FNA diagnosis, respectively (22), and Liu et al showed AUS, SUS, and malignant FNA diagnoses were progressively associated with an increasing risk of extrathyroidal extension ( p < 0.001) and local lymph node metastases ( p < 0.001) (25).…”

Section: Discussionmentioning

confidence: 99%

“…In other words, carcinomas resected in the setting of an AUS/FLUS or SFN FNA diagnosis are usually FVPTCs without associated extrathyroidal extension or lymph node metastases (22,25). Specifically, Vanderlaan et al found that FVPTCs accounted for 85% and 73% of the PTCs associated with an AUS/FLUS and SFN FNA diagnosis, respectively (22), and Liu et al showed AUS, SUS, and malignant FNA diagnoses were progressively associated with an increasing risk of extrathyroidal extension ( p < 0.001) and local lymph node metastases ( p < 0.001) (25). Thus, it is not surprising that most of the carcinomas resected on the basis of a suspicious Afirma result are indolent FVPTCs, since Afirma testing is being performed on nodules associated with an AUS/FLUS or SFN diagnosis on FNA.…”

Section: Discussionmentioning

confidence: 99%

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Noninvasive Follicular Variant of Papillary Thyroid Carcinoma and the Afirma Gene-Expression Classifier

Wong

Angell

Strickland

et al. 2016

Thyroid

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Background: It is now recognized that noninvasive follicular variant of papillary thyroid carcinoma (NFVPTC) is a distinct subset of FVPTC with an exceedingly indolent clinical course. The Afirma gene-expression classifier (GEC) helps guide clinicians in the management of thyroid nodules with indeterminate fine-needle aspiration (FNA) results. Thyroid surgery is recommended for nodules with a suspicious Afirma result, whereas observation is deemed reasonable for most nodules with a benign result. The aim of this study was to confirm that the Afirma test detects NFVPTCs and to determine how many carcinomas detected by the Afirma GEC represent NFVPTCs. Methods: From a database of 249 FNAs sent for Afirma testing between January 2012 and October 2014, a search was conducted for cases with a preceding FNA diagnosis of atypia/follicular lesion of undetermined significance (AUS/FLUS) or suspicious for a follicular neoplasm (SFN), a suspicious Afirma result, and a corresponding resection specimen reviewed at Brigham and Women's Hospital. The diagnoses of the prior FNAs and subsequent resection specimens were recorded. Slides for all resection specimens with a diagnosis of FVPTC were reviewed to identify NFVPTCs. Results: Sixty-three cases met the inclusion criteria. The preceding FNA diagnosis was AUS/FLUS in 34 (54%) cases and SFN in 29 (46%) cases. The surgical resection specimen demonstrated 16 (25%) FVPTCs, five (8%) follicular thyroid carcinomas, one (2%) classical type PTC, and 41 (65%) benign tumors/nodules. Of the 16 FVPTCs, 14 (88%) were NFVPTCs. Thus, NFVPTCs accounted for 64% of the carcinomas in the cohort. Conclusion: These results indicate that the Afirma GEC detects NFVPTCs and that many of the carcinomas detected by Afirma are NFVPTCs. While all care should be individualized and include clinical and sonographic assessment, these results suggest lobectomy as opposed to total thyroidectomy should be considered for nodules with a preceding AUS/FLUS or SFN on cytology and a suspicious Afirma result.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Noninvasive Follicular Variant of Papillary Thyroid Carcinoma and the Afirma Gene-Expression Classifier

Wong

Angell

Strickland

et al. 2016

Thyroid

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“…Atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm or suspicious for follicular neoplasm (FN/SFN), and suspicious of malignancy (SM) categories in the Bethesda classification may be considered indeterminate cytologies. These groups are representative of morphologically abnormal findings that are related to an increased risk of malignancy, though not enough to confirm a malignant lesion (5). Majority of the nodules with indeterminate cytology are surgically excised due to their malignancy potential, which confronts the patients with risks of morbidity and complications related to unnecessary surgeries (6).…”

Section: Introductionmentioning

confidence: 99%

Ratio of Thyrotropin to Thyroglobulin as a Novel Marker for Differentiating Between Benign and Malignant Thyroid Nodules within Different Bethesda Categories

Tam¹,

Özdemır²,

Aydın³

et al. 2018

Turk J Endocrinol Metab

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Objective: We aimed to determine whether the ratio of thyrotropin (TSH) to thyroglobulin (Tg) (TSH/Tg) would be able to assist in predicting malignancy in thyroid nodules. Material and Methods: Euthyroid patients operated between the year 2007 and 2014 were retrospectively reviewed. Patients who previously had thyroid disease or surgery and those with increased levels of anti-thyroglobulin antibodies were excluded from this study. Clinicopathological features, as well as serum TSH, Tg, and TSH/Tg were compared between histopathologically benign and malignant groups. Results: Data related to 370 (60.3%) benign and 244 (39.7%) malignant patients were analyzed. The malignant patients exhibited significantly higher TSH, TSH/Tg, and total thyroid volume, and a lower Tg compared to the benign patients (p<0.001 for each). There were 924 (74.2%) benign and 321 (25.8%) malignant nodules. Cytological distribution of the nodules was observed to be as follows: 343 (27.6%) nondiagnostic, 637 (51.2%) benign, 121 (9.7%) atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 39 (3.1%) follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 64 (5.1%) suspicious for malignancy (SM), and 41 (3.3%) malignant. TSH, Tg, and TSH/Tg were significantly different in different Bethesda categories (p<0.001 for each). Median TSH/Tg was the lowest in benign (0.013), and highest in SM (0.054) and malignant (0.086) cytologies. TSH/Tg was significantly higher in the malignant nodules compared to benign nodules, in AUS/FLUS, FN/SFN, and SM categories (p=0.001, p<0.001, and p=0.003, respectively). In the regression analysis, TSH/Tg demonstrated higher diagnostic performance compared to TSH and Tg (p<0.001). Discussion: Preoperative TSH/Tg could be used as a novel marker for differentiating between benign and malignant thyroid nodules. It could also assist in the prediction of risk of malignancy and management decisions when the cytology is indeterminate. Keywords

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“…It is well documented that FVPTC does not express the conventional nuclear features of PTC and may localize the cytological diagnosis in subcategories. This may be one of the causes resulting the higher malignancy rates in histology as reported in several reports (12,13).…”

Section: Discussionmentioning

confidence: 87%

Malignancy Rates in Bethesda Category AUS/FLUS: Single Center Experience

Can¹,

Ayturk²,

Tastekin³

et al. 2016

Acta Oncol Tur.

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ÖZETAmaç: Tiroid nodüllerinin prevelansı yüksek olmasına rağmen, bu nodüller için malignite oranları düşüktür. Bu nedenle, cerrahi yaklaşım gerektiren malign nodülleri, benign nodüllerden ayırmak çok önemlidir. Ultrasonografi, ultrasonografi eşliğinde ince iğne aspirasyonu ve ayrıca Tiroid Sitopatolojisi için Bethesda Raporlama Sistemi tiroid nodüllerinin değerlendirilmesinde fayda sağlamaktadır. Ancak, bu sistem 'Önemi Belirsiz Atipi/ Önemi Belirsiz Foliküler Lezyon (ÖBA/ÖBFL)' olarak adlandırılan problemli bir kategori içermektedir. Bu kategori için son zamanlarda bildirilen malignite yüzdeleri %5 ile %96,7 arasında değişmektedir. Bu çalışmada merkezimizde incelenen ilk ince iğne aspirasyon tanısı ÖBA/ÖBFL olan tiroid nodüllerindeki malignite oranlarının sunulması amaçlanmaktadır. Yöntem: Yedi yıl süresince, Trakya Üniversitesi Tıp Fakültesi Patoloji Anabilimdalı'nda (Edirne, Türkiye) incelenen hastaların tanıları (ince iğne aspirasyon ve tiroidektomi) geriye dönük olarak değerlendirildi. Bulgular: İnce iğne aspirasyon sitolojisinde ÖBA/ÖBFL tanısı alan 153 hastadan 68'inde (%44,4) histopatolojik tanı papiller tiroid karsinomu, 1'inde (%7) foliküler karsinom ve 1'inde (%7) de medüller karsinom idi. Tartışma ve Sonuç: Tiroid Sitopatolojisi için Bethesda Raporlama Sistemi bazı tanı kategorilerinde standardizasyon sağlamışsa da, ÖBA/ÖBFL kategorisi hala subjektif sitolojik kriterleri barındırmakta ve farklı çalışmalarda oldukça değişken histolojik malignite oranları bildirilmektedir. Bu nedenle, immünositokimya ve özellikle moleküler testler gibi yardımcı yöntemlerin kullanılması tiroid nodüllerinin preoperatif tanısında faydalı olabilir. Anahtar Kelimeler: Tiroid Karsinomu, Sitoloji, Önemi Belirsiz Atipi/ Önemi Belirsiz Foliküler Lezyon ABSTRACT Introduction: Although the prevelance of thyroid nodules is high, the rate of malignancy in these nodules is low. Thus, the distinction between the malignant nodules requiring surgical approach and the benign ones is very important. Ultrasound, ultrasound guided fine needle aspiration and also The Bethesda Reporting System for Thyroid Cytopathology are useful tools for interpretation of thyroid nodules. However, this system includes a problematic category titled as 'Atypia of Undetermined Significance/ Follicular Lesion of Undetermined Significance (AUS/FLUS)'. The reported percentages of malignancy in these nodules range between 5-96,7%, recently. We aimed to present the rate of malignancy in thyroid nodules with initial fine needle aspiration diagnosis as AUS/FLUS. Methods: The final diagnosis (fine needle aspiration and thyroidectomy) of patients who presented at the Department of Pathology of the Trakya University Medical Faculty (Edirne, Turkey) were reviewed for seven years. Results: Histological diagnosis was papillary thyroid carcinoma in 68 (44,4%), follicular carcinoma in 1 (0.7%) and medullary carcinoma in 1 (0.7%) of the 153 patients with prior fine needle aspiration diagnosis as AUS/FLUS. Discussion and Conclusion: Although, The Bethesda Reporting System for...

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Bethesda Categorization of Thyroid Nodule Cytology and Prediction of Thyroid Cancer Type and Prognosis

Abstract: In addition to predicting cancer prevalence, the TBS also imparts important prognostic information about cancer type, variant, and risk of recurrence. These data extend the utility of TBS classification by fostering an improved understanding of the risk posed by any confirmed malignancy.

Cited by 74 publications

References 26 publications

Noninvasive Follicular Variant of Papillary Thyroid Carcinoma and the Afirma Gene-Expression Classifier

Noninvasive Follicular Variant of Papillary Thyroid Carcinoma and the Afirma Gene-Expression Classifier

Ratio of Thyrotropin to Thyroglobulin as a Novel Marker for Differentiating Between Benign and Malignant Thyroid Nodules within Different Bethesda Categories

Malignancy Rates in Bethesda Category AUS/FLUS: Single Center Experience

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