The Bethesda System for Reporting Thyroid Cytopathology: A Meta-Analysis

Bongiovanni, Massimo; Spitale, Alessandra; Faquin, William C.; Mazzucchelli, Luca; Baloch, Zubair W.

doi:10.1159/000339959

Cited by 868 publications

(999 citation statements)

References 62 publications

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“…However, most of these studies are at high risk of selection bias. Some of them estimate the risk of malignancy based only on results of patients who undergo surgery (10,15). In a meta-analysis to assess the risk of malignancy of thyroid nodules classified according to the Bethesda categories based on histology follow-up, only 16% of patients with a nondiagnostic FNA had histological follow-up to assess malignancy risk (10).…”

Section: Discussionmentioning

confidence: 99%

“…Some of them estimate the risk of malignancy based only on results of patients who undergo surgery (10,15). In a meta-analysis to assess the risk of malignancy of thyroid nodules classified according to the Bethesda categories based on histology follow-up, only 16% of patients with a nondiagnostic FNA had histological follow-up to assess malignancy risk (10). Other studies estimate the malignancy risk based on patients with a repeat diagnostic FNA or histology (13,14).…”

Section: Discussionmentioning

confidence: 99%

“…Fine-needle aspirates of thyroid nodules were classified as diagnostic (including all Bethesda categories except nondiagnostic) or non-diagnostic (10). At the Mayo Clinic, an FNA is considered non-diagnostic when there are fewer than the required six cell groups with ‡15 cells/group.…”

Section: Methodsmentioning

confidence: 99%

“…The non-diagnostic rate for ultrasound (US)-guided FNAs varies widely among studies, with rates as high as 47% and as low as 0.6% in studies with on-site cytology (5-7). More commonly, however, the non-diagnostic rate usually ranges between 8% and 20% (8)(9)(10). The risk of malignancy for non-diagnostic thyroid nodules is not clearly defined and varies among studies between 2% and 15% (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

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Risk of Malignancy in Thyroid Nodules with Non-Diagnostic Fine-Needle Aspiration: A Retrospective Cohort Study

Ycaza

Lowe

Dean

et al. 2016

Thyroid

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Background: Fine-needle aspiration (FNA) of thyroid nodules is commonly performed, and despite the use of ultrasound (US) guidance, the rate of non-diagnostic FNAs is still significant. The risk of malignancy of thyroid nodules with a non-diagnostic FNA is not clearly defined. However, most studies exclude the majority of patients without a repeat biopsy or surgery, thus increasing the likelihood of selection bias. The aims of this study were to determine the malignancy risk in nodules with an initial non-diagnostic FNA, and to identify the factors associated with malignancy. Methods: This was a retrospective cohort study of patients with thyroid nodules who underwent US-guided FNA between 2004 and 2010 and had a non-diagnostic result. Patients were followed until confirmatory diagnosis of the nature of the nodule was made. The outcome of malignant or benign disease was based on one of the following: (i) final surgical pathology following thyroidectomy; (ii) repeat biopsy; (iii) clinically, based on repeat ultrasound performed at least three years following biopsy; or (iv) report of thyroid status for patients without follow-up visits contacted by mail. Results: There were 699 nodules from 665 patients included. The mean age was 59 -15 years, and 71.7% were women. There was complete follow-up of 495 nodules. After a median follow-up of 2.7 years, thyroid cancer was found in 15 nodules. The prevalence of malignancy was 3% (15/495). The presence of nodular calcifications was the strongest predictor of thyroid malignancy (odds ratio 5.03 [confidence interval 1.8-14.7]). Initial nodule size was inversely associated with malignancy (odds ratio 0.55 [confidence interval 0.28-0.93]). However, the 193 patients without follow-up had smaller nodules compared with those included in the analysis. None of the patients with repeatedly non-diagnostic results were diagnosed with thyroid cancer at follow-up. Conclusion: The prevalence of thyroid cancer in nodules with non-diagnostic results is lower than the malignancy rate in thyroid nodules in general, but not negligible. They should be followed as per guidelines with heightened suspicion for nodules containing calcifications. Nodules with repeatedly non-diagnostic FNA results especially in the absence of calcifications have a low risk of malignancy and may be observed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of Malignancy in Thyroid Nodules with Non-Diagnostic Fine-Needle Aspiration: A Retrospective Cohort Study

Ycaza

Lowe

Dean

et al. 2016

Thyroid

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“…The results can confirm that a nodule is benign, triage patients requiring diagnostic surgery or confirm a diagnosis of malignancy enabling one-step therapeutic surgery (Perros et al 2014, Pitoia & Miyauchi 2015. In the UK, cytology results are reported using the THY classification (The Royal College of Pathologists 2009), whereas in the US, the Bethesda scoring system (Bongiovanni et al 2012) is used. Despite accuracy of diagnosis in the majority of thyroid nodules, FNAC has drawbacks including the sometimes high rate of insufficient/inadequate samples, the inability to distinguish between benign and malignant follicular lesions and difficulties in detecting follicular variant papillary carcinomas (Sangalli et al 2006, Rago et al 2007.…”

Section: Current Diagnostic Approaches and Limitationsmentioning

confidence: 98%

WOMEN IN CANCER THEMATIC REVIEW: Thyroid-stimulating hormone in thyroid cancer: does it matter?

Nieto¹,

Boelaert²

2016

Endocrine-Related Cancer

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Differentiated thyroid cancer is the most common endocrine malignancy and the incidence is increasing rapidly worldwide. Appropriate diagnosis and post-treatment monitoring of patients with thyroid tumours are critical. Fine needle aspiration cytology remains the gold standard for diagnosing thyroid cancer, and although there have been significant refinements to this technique, diagnostic surgery is often required for patients suspected to have malignancy. Serum thyroid-stimulating hormone (TSH) is higher in patients with malignant thyroid nodules than in those with benign disease, and TSH is proportionally increased in more aggressive tumours. Importantly, we have shown that the pre-operative serum TSH concentration independently predicts the presence of malignancy in subjects presenting with thyroid nodules. Establishing the use of TSH measurements in algorithms identifying high-risk thyroid nodules in routine clinical practice represents an exciting, cost-efficient and non-invasive approach to optimise thyroid cancer diagnosis. Binding of TSH to receptors on thyrocytes stimulates a number of growth promoting pathways both in normal and malignant thyroid cells, and TSH suppression with high doses of levothyroxine is routinely used after thyroidectomy to prevent cancer recurrence, especially in high-risk tumours. This review examines the relationship between serum TSH and thyroid cancer and reflects on the clinical potential of TSH measurements in diagnosis and disease monitoring.

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