The Bethesda System for Reporting Thyroid Cytopathology Explained for Practitioners: Frequently Asked Questions

Bongiovanni, Massimo; Papadakis, Georgios E; Rouiller, Nathalie; Marino, Laura; Lamine, Faïza; Bisig, Bettina; Ziadi, Sonia; Sykiotis, Gerasimos P.

doi:10.1089/thy.2017.0685

Cited by 17 publications

(19 citation statements)

References 33 publications

(36 reference statements)

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“…Our laboratory reported an AUS:malignancy ratio of 2.94, suggesting the appropriate use of the AUS category. In comparison, our literature review of AUS/FLUS use rates demonstrated rates of use of 2.1% to 26%, with a respective ROM of 13% to 43% (Table ) when not considering NIFTP in the ROM, which the findings of the current study are consistent with. The reason for this increased rate can be due to the heterogeneity of the AUS/FLUS category, selection bias for surgery, and known general overuse of this category .…”

Section: Discussionsupporting

confidence: 86%

“…NIFTP previously was known as noninvasive encapsulated follicular variant of PTC, and has been recognized by the World Health Organization as a tumor with a low potential for malignancy in comparison with conventional PTC . Subsequently, when calculating the ROM, the ranges were found to have a tendency to decrease from a ROM of 10% to 30% to a ROM of 6% to 18% when changes consistent with NIFTP were found on surgical histopathology in TBSRTC II (Table ) …”

Section: Introductionmentioning

confidence: 99%

“…Guideline changes in TBSRTC II included management of thyroid nodules, recommendations for molecular testing, and reclassification of the noninvasive follicular variant of papillary thyroid carcinoma (PTC) as noninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP) . NIFTP previously was known as noninvasive encapsulated follicular variant of PTC, and has been recognized by the World Health Organization as a tumor with a low potential for malignancy in comparison with conventional PTC . Subsequently, when calculating the ROM, the ranges were found to have a tendency to decrease from a ROM of 10% to 30% to a ROM of 6% to 18% when changes consistent with NIFTP were found on surgical histopathology in TBSRTC II (Table ) …”

Section: Introductionmentioning

confidence: 99%

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Malignancy rate of atypia of undetermined significance/follicular lesion of undetermined significance in thyroid nodules undergoing FNA in a suburban endocrinology practice: A retrospective cohort analysis

Seagrove-Guffey

Hatic

Peng

et al. 2018

Cancer Cytopathology

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BACKGROUND:The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was created to establish a standard terminology regarding thyroid nodules that can be shared between endocrinologists, pathologists, radiologists, and surgeons. Since its inception and use in 2009, multiple large hospitals and academic institutions have performed retrospective studies to compare their classification rates, specifically those of atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS), with the recommended rates created by the National Cancer Institute. The current study compared AUS/FLUS rates at a private suburban endocrine practice with those of previous publications from large institutions and the rates established by the National Cancer Institute. METHODS: Charts from 893 patients with fine-needle aspiration (FNA) performed in 2015 were reviewed. Data specific to thyroid aspirates classified as AUS/FLUS were organized into whether patients underwent surgery, underwent subsequent repeat FNA, or required continued observation. These results then were calculated to reveal the rate of malignancy in the AUS/FLUS category with surgical pathology in the study institution. RESULTS: A total of 893 patients underwent FNA, with 43 patients (4.82%) shown to have AUS/FLUS. A total of 21 patients proceeded to undergo thyroidectomy or lobectomy, with 7 patients (33.3%) found to have papillary or follicular thyroid carcinoma. CONCLUSIONS: The rate of use of the AUS/FLUS category for thyroid nodules examined at the study institution was found to be within the recommended range set forth by TBSRTC. However, the malignancy rates on histopathology in the study institution were found to be higher than the new proposed malignancy rates from TBSRTC published in 2017.This finding is comparable to those of multiple other community and academic institutions performed prior to and after institution of the new guidelines. Cancer Cytopathol 2018;126:881-888.We thank Richard Delgado, MD, who assisted with the review of surgical pathology slides from patients with a surgical diagnosis of papillary thyroid cancer to confirm the absence or presence of features consistent with noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Shu Xian Lee, MBBS, is credited with the inception and creation of the figure used.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Malignancy rate of atypia of undetermined significance/follicular lesion of undetermined significance in thyroid nodules undergoing FNA in a suburban endocrinology practice: A retrospective cohort analysis

Seagrove-Guffey

Hatic

Peng

et al. 2018

Cancer Cytopathology

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“…It is important to note that among the false-positive cases, 5 cases were suspicious for PTC, and one case was diagnosed as PTC based on the frozen section analysis. Massimo et al [64] explained that there are two main limitations for frozen section analysis. First, the quality of the specimen obtained for a frozen section is lower than that obtained during routine histopathological examination.…”

Section: Intraoperative Frozen Examination In Misdiagnosed Casesmentioning

confidence: 99%

Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review

Zhu

Song

et al. 2020

Diagn Pathol

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Objective: FNA is a simple, safe, cost-effective and accurate diagnostic tool for the initial screening of patients with thyroid nodules. The aims of this study were to determine the diagnostic utility of FNAC performed in our institution, assess the cytomorphologic features that contribute to diagnostic errors and propose improvement measures.Methods: A total of 2781 FNACs were included in the study, and 1122 cases were compared with their histological diagnoses. We retrospectively reexamined our discordant (both false-negative and false-positive) cases and performed a systematic review of previous studies on causes of misdiagnoses.Results: When DC V and DC VI were both considered cytologic-positive, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 98.3, 30.9, 94.9, 58.3 and 93.5%, respectively. If DC VI was considered cytologic-positive, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC were 98.0, 84.0, 99.4, 58.3, and 97.5% respectively. The main cause of false-negative diagnoses was sampling error (13/15, 86.7%), while interpretation error led to the majority of the false-positive diagnoses (38/47, 80.9%). Overlapping cytological features in adenomatous hyperplasia, thyroiditis and cystic lesions were the major factors contributing to interpretation errors, while the size and number of nodules may have led to false-negative diagnoses because of heterogeneity and unsampled areas. Conclusions:The sensitivity and PPV of thyroid FNAC in our institution were higher than those in the published data, while the specificity and NPV were lower. Regarding the FNA category DC V, a frozen section analysis during diagnostic lobectomy is necessary. Multiple passes should be performed in various parts of a large nodule or from different nodules to reduce the risk of false-negative findings. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis and cystic lesions to avoid false-positive diagnoses. NIFTP has little effect on diagnostic accuracy and the distribution of diagnostic errors.

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“…Furthermore, the validation and clinical implementation of these assays require collaborative efforts by the cytopathologist community. Finally, Dr. Massimo Bongiovanni (Vaudois University Medical Center, Lausanne, Switzerland) chaired an interactive “frequently asked questions” session regarding TBSRTC to increase the clinicians’ awareness of the diagnostic criteria behind the categories, ROM, and patient management …”

Section: Introductionmentioning

confidence: 99%

Bird’s eye view of modern cytopathology: Report from the seventh international Molecular Cytopathology Meeting in Naples, Italy, 2018

Pisapia

Bellevicine

Malapelle

et al. 2019

Cancer Cytopathology

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In the era of personalized medicine, cytopathology reports must be standardized to provide clinicians with clear information regarding relevant diagnostic, prognostic, and predictive tumor features. Since 2010, the international Molecular Cytopathology Meeting has been held annually in Naples, Italy, to disseminate recent breakthroughs and ongoing investigations in the field of modern cytopathology. In particular, the seventh annual meeting, which took place on November 26 through 27, 2018, focused on novel cytological and molecular classifications and novel DNA sequencing techniques, as well as on the possibility of using cytological rather than tissue specimens for lung cancer biomarker testing. The present review aims to update cytopathologists on the more recent achievements in modern cytopathology and to identify key research questions that still remain unanswered.

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The Bethesda System for Reporting Thyroid Cytopathology Explained for Practitioners: Frequently Asked Questions

Abstract: For each frequently asked question, an answer is provided based on the literature, the authors' experience, the new version of TBSRTC, and the new World Health Organization classification of tumors of endocrine organs.

Cited by 17 publications

References 33 publications

Malignancy rate of atypia of undetermined significance/follicular lesion of undetermined significance in thyroid nodules undergoing FNA in a suburban endocrinology practice: A retrospective cohort analysis

Malignancy rate of atypia of undetermined significance/follicular lesion of undetermined significance in thyroid nodules undergoing FNA in a suburban endocrinology practice: A retrospective cohort analysis

Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review

Bird’s eye view of modern cytopathology: Report from the seventh international Molecular Cytopathology Meeting in Naples, Italy, 2018

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