Fine Needle Aspiration of Thyroid Nodules Using the Bethesda System for Reporting Thyroid Cytopathology: An Institutional Experience in a Rural Setting

Guo, Aili; Kaminoh, Yuuki; Forward, Terra R.; Schwartz, Frank; Jenkinson, Scott

doi:10.1155/2017/9601735

Cited by 18 publications

(25 citation statements)

References 25 publications

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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.…”

Section: Discussionsupporting

confidence: 89%

“…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.…”

Section: Discussionsupporting

confidence: 88%

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2019

MIJOPAT

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Background: The Bethesda system for reporting Thyroid cytopathology (TBSRTC) is a standardized system, providing pathologists the opportunity to report thyroid fine needle aspiration cytologies (FNACs) using uniform nomenclature, thereby facilitating the clinical care of the patients. Aim: The aim of this study was to analyze thyroid FNACs reported by the Bethesda system, and correlating with histopathology, whenever surgical resections were done. Materials and Methods: We retrospectively studied thyroid cytology cases received between January 2018 to December 2018. In cases that underwent surgical resection, histopathological correlation was done. Results: Out of the total 141 cases, 126 cases were females (89.3 %) and 15 cases were males (10.6 %). The mean age of the patients at presentation was 41.2 years. Out of the total 141 cases, 7 cases(4.9%) were Unsatisfactory/Nondiagnostic , 118 cases (83.68%) were Benign lesions, 6 cases (4.2%) were Atypia of undetermined significance/Follicular lesion of undetermined significance, 3 cases(2.1%) were Follicular neoplasm/Suspicious for follicular neoplasm, 1 case (0.7%) was suspicious for malignancy, and 6 cases (4.2%) were malignant. All the nine cases which were diagnosed as benign on cytology, were confirmed as benign on histopathology. Single case of malignancy was available for histopathological correlation, which showed Medullary carcinoma on both cytology and histopathology. Conclusions: In our study, FNAC reporting using TBSRTC system was evaluated, which was correlated with histopathological diagnosis where-ever possible. The study highlighted the importance of FNAC as an investigation of choice in evaluation of thyroid nodules.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 88%

Untitled

2019

MIJOPAT

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“…In our study, thyroid nodules with relatively TI-RADS high scores received FNA, so total ROM of Bethesda system III/IV was 54.2%, which was significantly higher than those from Western practice, 29,[32][33][34] demonstrating that TI-RADS reduces the number of unnecessary thyroid nodule FNAs. 35 Second, as we know differentiated thyroid carcinoma (DTC) accounts for more than 90% of all thyroid cancers and DTC is an indolent carcinoma, our practice of triaging patients with Bethesda system III/IV nodules is as follows:…”

Section: Discussionmentioning

confidence: 52%

“…In our study, thyroid nodules with relatively TI‐RADS high scores received FNA, so total ROM of Bethesda system III/IV was 54.2%, which was significantly higher than those from Western practice, demonstrating that TI‐RADS reduces the number of unnecessary thyroid nodule FNAs . Second, as we know differentiated thyroid carcinoma (DTC) accounts for more than 90% of all thyroid cancers and DTC is an indolent carcinoma, our practice of triaging patients with Bethesda system III/IV nodules is as follows: ≥TI‐RADS 4c with Bethesda system III/IV nodules were referred to surgery; ≤TI‐RADS 4a with Bethesda system III/IV nodules were referred for routine observation, with the exception of benign thyroid nodules, which were referred to surgery; for TI‐RADS 4b with Bethesda system III/IV nodules needing further discussion with the patients, possible advice included repeat FNA diagnostic surgery, routine observation, use of other imaging modalities, and so on based on patient preference …”

Section: Resultsmentioning

confidence: 75%

Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Pan

et al. 2019

Diagnostic Cytopathology

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Background This study was designed to explore whether ultrasound of thyroid nodules facilitates the interpretation of the malignant risk of Bethesda III/IV thyroid nodules to inform further therapies. Methods We reviewed patient records in which the results of ultrasound‐guided fine‐needle aspiration (US‐FNA) were classified by the Bethesda III/IV in our institution between January 2016 and June 2018. Studies were retrieved from PubMed, Cochrane Central Register of Controlled Trials, ISI Web of Science, Science Direct, Wiley Online Library, EMBASE, China National Knowledge Infrastructure, WanFang, and Chinese VIP. The odds ratio (OR) was used to measure associations between risk factors and thyroid nodule malignancy. Results Fifty‐nine cases of Bethesda III/IV with corresponding surgeries were included, and the malignancy risk was 54.2%. Meta‐analysis revealed irregular borders, solitary nodules, hypoechogenicity, microcalcifications, and being taller than wide, all of which increased the malignancy risk of thyroid nodules. Combined ORs for these factors were 4.08 (95% CI: 2.34‐7.14, P < .001), 2.18 (95% CI: 1.39‐3.42, P = .001), 2.02 (95% CI: 1.35‐3.01, P = .001), 3.21 (95% CI: 2.26‐4.56, P < .001), and 4.35 (95% CI: 3.07‐6.15, P < .001), respectively. Conclusion As the risk of malignancy for papillary thyroid carcinoma (PTC) is high, when any one of the five ultrasound features of malignancy were confirmed, repeated FNA is recommended to confirm PTC‐type malignancy, even though nodules were Bethesda III/IV classification. However, repeated FNA should be avoided when none of these ultrasound features are identified because repeated FNA does not contribute to identifying non‐PTC type malignancies, such as follicular thyroid carcinoma and poorly differentiated thyroid carcinoma.

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“…We excluded a further 233 studies and finally selected 38 studies, which included 145,066 thyroid nodules, for meta‐analysis (Fig. ) . Among the included studies, 4 were prospective and 34 were retrospective.…”

Section: Resultsmentioning

confidence: 99%

Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: A systematic review and meta‐analysis

Vuong

Ngo

Bychkov

et al. 2019

Cancer Cytopathology

101

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There is increasing evidence showing that clinicians employ different management strategies in their use of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). In this meta-analysis, we investigated the differences in diagnosis frequency, resection rate (RR), and risk of malignancy (ROM) between Western (ie, American and European) and Asian cytopathology practices. We searched PubMed . Proportion and 95% CIs were calculated using a random-effect model. We used independent sample t tests to compare frequencies, RR, and ROM between Western and Asian practices. We analyzed a total of 38 studies with 145,066 fine-needle aspirations. Compared with Asian practice, Western series had a significantly lower ROM in most of TBSRTC categories, whereas the RR was not statistically different. Focusing on indeterminate nodules, the RR in Western series was significantly higher (51.3% vs 37.6%; P = .048), whereas the ROM was significantly lower (25.4% vs 41.9%; P = .002) compared with those in Asian series. The addition of Asian cohorts increased ROM for most of diagnostic categories compared with the original TBSRTC. In conclusion, this study demonstrates a difference in Western and Asian thyroid cytology practice, especially regarding the indeterminate categories. Lower RR and higher ROM suggest that Asian clinicians adopt a more conservative approach, whereas immediate diagnostic surgery is favored in Western practice for indeterminate nodules. The addition of Asian series into a meta-analysis of TBSRTC altered ROM for several categories, which should be considered in future revisions of TBSRTC.

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Fine Needle Aspiration of Thyroid Nodules Using the Bethesda System for Reporting Thyroid Cytopathology: An Institutional Experience in a Rural Setting

Cited by 18 publications

References 25 publications

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Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: A systematic review and meta‐analysis

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