The impact of implementing the bethesda system for reporting of thyroid FNA at an academic center

Abstract

Recently, a six-tiered diagnostic risk classification system was created based on the recommendations of the National Cancer Institute (NCI) sponsored NCI Thyroid Needle Aspiration State of the Science Conference at Bethesda, MD in October 2007. The objective of the current study was to compare the frequency distribution of the various diagnostic categories to evaluate its diagnostic performance before and after implementation of The Bethesda System (TBS). A total of 5,897 thyroid Fine needle aspirations (FNAs) were reviewed; 3,207 were from 2008 after TBS implementation, and 2,690 were from 2007 immediately before TBS implementation. Follow-up consisted of reviewing corresponding histologic results. The rates of "Nondiagnostic" specimens and cases with a diagnosis of "Follicular Neoplasm" decreased from 13.1 to 11.1% and 8.6 to 5.5%, respectively, after implementation of TBS, while the rate of negative specimens increased from 68.2 to 73.8%. The other categories remained relatively stable. In addition, there also was a significant decrease in the use of noncommittal descriptive diagnoses. The diagnostic performance of thyroid FNA in identifying a neoplastic process as measured by area under the receiver operating characteristic curve increased from 0.88 to 0.89; the difference was statistically significant (P=0.03). Implementation of TBS showed a significant reduction of: nondiagnostic thyroid FNAs, of FNAs with a diagnosis of "Follicular Neoplasm," as well as cases with descriptive noncommittal diagnoses. TBS results in improved diagnostic performance and therefore more consistent and uniform reporting of thyroid FNA.

Kliniczne znaczenie rozpoznania zmiany pęcherzykowej bliżej nieokreślonej (grupa III wg Systemu Bethesda) w biopsji aspiracyjnej cienkoigłowej (BAC)

“…In 180 cases repeat FNA was performed, from which the diagnosis of DC I or DC II was established 109 times (60.5%); 41 (22.7%) patients again obtained DC III (36 were put under observation after that, five had another [third] FNA). The remaining 30 patients had DC IV, DC V, or diagnoses in six groups allowed improvement in the communication and specifying of the right clinical management [1][2][3][4][5][6].…”

“…The possibility of consultation between the competent pathologists regarding aspirates examination is essential. Most of the shown analyses concern the work of cytopathologists or pathologists that deal with cytological diagnostics of the thyroid on a daily basis [1,4,10,11]. The authors of one of the large studies base the initial diagnostics on the work of screeners.…”

Podejrzenie nowotworu pęcherzykowego czy nowotwór pęcherzykowy? Dylemat patologa i chirurga

“…The risk of neoplasia, and especially the risk of malignancy, presented by the researchers is greatly varied [2,17,18]. These major discrepancies may result from the number of analysed cases, from 97 FNAs [13] to more than 16 thousand (16,656 in our study).…”

“…Theoharis et al based their analysis on a group of 5897 FNA; most of the material was stained with Papanicolau stain; part of the analysed cases were outside consultations stained with Papanicolau and HE [18]. Ho et al [1] verified aspirates stained with Papanicolau and Giemsa, and Topeoglu studied specimens stained with Giemsa and HE, performing from 4 to 20 smears [8].…”

“…These studies often come from different medical centres, and the stains vary because of the need to collect a sufficiently large cohort. An overwhelming majority of researchers use Papanicolau stain [5,6,10,14,18,[20][21][22][23][24][25][26][27][28].…”