The Bethesda Thyroid Fine-Needle Aspiration Classification System: Year 1 at an Academic Institution

Theoharis, Constantine; Schofield, Kevin; Hammers, Lynwood; Udelsman, Robert; Chhieng, David C.

doi:10.1089/thy.2009.0155

Cited by 316 publications

(354 citation statements)

References 34 publications

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“…5,6,8,9,[12][13][14] The data from these series are summarized in Table 1. It is interesting to note that the overall rate of AUS was 9.7% with only 2 of 8 series reporting AUS rates below the previously recommended threshold of 7%.…”

Section: Resultsmentioning

confidence: 99%

“…We identified PubMed-indexed, peer-reviewed published laboratory experiences using TBS in which the categorical breakdown of all 6 reporting tiers was identified 5,6,8,9,[12][13][14] and supplemented those data with previously unpublished figures from the Massachusetts General Hospital compiled by one of the authors (W.C.F.) from 2006 to 2008 using TBS (a subset of these cases was included in a prior study 3 ).…”

Section: Methodsmentioning

confidence: 99%

“…The heterogeneity of this low-risk category inevitably means that there will be differences in its utilization with significant variability in AUS rates noted among individual practitioners as well as between laboratories. [2][3][4][5][6][7][8][9][10][11][12][13][14] Indeed, TBS only recommends a broad use range for each diagnostic category. 1 To promote uniform practice among laboratories and cytopathologists and encourage quality improvement, it is desirable to have performance measures associated with TBS, especially with regard to the AUS category.…”

Section: Introductionmentioning

confidence: 99%

“…15 The only such recommendation that accompanied TBS for thyroid cytopathology was that the AUS rate not exceed 7% 1 ; however, this proposal lacked a robust evidentiary basis and has proved to be unrealistic for many laboratories publishing their initial experiences with TBS. [2][3][4][5][6][7][8][9][10][11][12][13][14] In this study, we review the initial published experiences with AUS and TBS in conjunction with our own laboratory experiences, with the goal of identifying evidencebased performance measures that will have usefulness in measuring individual and laboratory practices. In so doing, we hope to provide a basis for quality improvement in the reporting of thyroid aspirates within TBS framework.…”

Section: Introductionmentioning

confidence: 99%

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The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio

Krane

VanderLaan

Faquin

et al. 2011

Cancer Cytopathology

125

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BACKGROUND:The Bethesda System (TBS) for reporting thyroid cytopathology introduced the atypia of undetermined significance/follicular lesion of undetermined significance (AUS) category, but did not provide adequate guidance for the appropriate use of this diagnosis. In the current study, the authors sought to identify an appropriate measure for AUS use based on experience to date with TBS.METHODS:The authors reviewed 8 series, including their own laboratory experiences, with a total of 30,466 thyroid aspirates classified within TBS.RESULTS:The median AUS rate was 9.9% with a range of 3.0% to 18.0%. Use of the individual diagnostic categories within TBS varied up to 12.7‐fold. The ratio of “suspicious for follicular neoplasm” plus “suspicious for malignancy” to “malignant” (M) diagnoses varied the least (1.8‐fold). The AUS:M ratio provided a suitable measure of assessing AUS use, with a median ratio of 2.0 and a range of 0.5 to 4.9.CONCLUSIONS:Based on available studies, an AUS:M ratio of 1.0 to 3.0 is recommended. AUS:M ratios > 3.0 are likely because of overdiagnosis of AUS or underdiagnosis of M. AUS:M ratios < 1.0 are mostly due to low AUS rates, at the likely expense of sensitivity. Cancer (Cancer Cytopathol) 2012;. © 2011 American Cancer Society.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio

Krane

VanderLaan

Faquin

et al. 2011

Cancer Cytopathology

125

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“…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%

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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Thyroid Surgery in Paediatric Patients

2012

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The Bethesda Thyroid Fine-Needle Aspiration Classification System: Year 1 at an Academic Institution

Abstract: These data demonstrate that the recently proposed classification system is excellent for reporting thyroid FNAs. Each diagnostic category conveys specific risks of malignancy, which offers guidance for patient management.

Cited by 316 publications

References 34 publications

The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio

The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio

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

Thyroid Surgery in Paediatric Patients

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