Evaluation of Bethesda system for reporting thyroid cytology with histopathological correlation

Abstract

Background: The Bethesda system of reporting thyroid cytopathology is a standardised system, improving communication between cytopathologists and clinicians, leading to more consistent management approaches. The aim of the research work was to study the utility of Bethesda system in reporting thyroid cytology with histopathological correlation of all the cases undergoing surgical resection.Methods: We studied all the thyroid cytology cases received between November 2012 to April 2014, and classified them according to the Bethesda system. Histopathological correlation was done for all the cases which underwent surgical resection with evaluation of cyto-histological discrepancies.Results: Out of 484 cases studied, 432(89.2%) were benign lesions, 20(4.1%) were malignant,18 (3.7%) were Unsatisfactory/Nondiagnostic, 10(2%) were Follicular neoplasm/Suspicious for neoplasm, 3 (0.6%) were suspicious for malignancy, and 1(0.002%) case was reported as Atypia of undetermined significance. Out of the 54 cases available for histopathological follow-up, cyto-histological discrepancies were noted in 5 cases (9.2%). Statistical analysis of the present study showed that cytological analysis of thyroid lesions by Bethesda system has got high sensitivity (72.72%), high specificity (95.3%) with a positive predictive value of 80% and negative predictive value of 93.1% and a high accuracy (90.7%).Conclusions: Reviewing the thyroid FNAs (fine needle aspirates) using Bethesda system allowed a more specific cytological diagnosis with better interlaboratory agreement. As evidenced by its high sensitivity and specificity, Bethesda system has proven to be a very effective guide for the clinical management of thyroid nodules.

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“…In the present study, female patients outnumbered the male patients, similar to other studies. [3][4][5][6][7] The mean age of the patients at presentation was 41.2 years in our study, similar to study by Yang et al 4 Most of our patients belonged to the 31-40 years age bracket, similar to the study by Arul et al 5 , who also had majority of their cases clustered in the third decade. We compared the findings of our study with that of various other studies as shown in TABLE 5.…”

“…In the present study, ND/UNS cases were 4.9 %, similar to the study by Arul et al 5 The smears which were predominantly haemorrhagic, or contained cyst fluid only were reported under this category. The percentage of cases in the benign category was 83.68% in our study, comparable to other studies by Reddy et al, 3 Mehra et al, 8 Mondal et al, 9 and Guo et al 6 Studies by Yang et al, 4 Arul et al, 5 Jo et al 10 had comparatively lesser benign cases. The high incidence of benign cases in our study can be attributed to the fact that our hospital caters to the general population in the area where it is located.…”

“…Such cases are then categorized as Suspicious for malignancy. 2 In the present study, 0.7 % (single case) was categorized as suspicious for malignancy, similar to the 0.6 % incidence of the study by Reddy et al 3 The category malignant is used whenever the cytomorphologic features are conclusive for malignancy. 2 In the present study, we had 4.2 % of cases categorized as malignant, similar to the studies by Reddy et al 3…”

“…Out of the six cases diagnosed as Malignant on cytology, specimen of a single case was available for study, which was diagnosed as Medullary carcinoma, both on cytology and histopathology. [3] (%) Mehra et al [8] (%) Yang et al [4] (%) Arul et al [5] (%)…”

“…Mondal et al 9 In our study, the histopathological specimens received in the study period was 8.5% , which is close to the 11.2% surgical follow up by Reddy at al. 3 Many unnecessary surgeries are avoided by virtue of FNACs. In the benign category, all the nine cases which were diagnosed as benign on cytology, were confirmed as benign on histopathology, in the present study.…”