The National Cancer Institute Thyroid FNA State of the Science Conference: “Wrapped up”

Abati, Andrea

doi:10.1002/dc.20850

Cited by 24 publications

(14 citation statements)

References 13 publications

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“…Despite a long history of clinical application of FNA in the diagnosis of thyroid nodules and attempts by several professional organizations to clarify appropriate utilization, terminology, diagnostic criteria, post-FNA follow-up, and therapeutic options, until relatively recently no universally accepted guidelines for reporting or recommendations for management existed. In the past few years, clinical practice guidelines and recommendations have been developed by many, including the Papanicolaou Society, the American Thyroid Association of Clinical Endocrinologists, the Italian Association for Medical Endocrinology, and the BTA/RCPath [15]. In October 2007, the NCI sponsored a conference to review the state of the science for the use of FNA in the management of thyroid nodules.…”

Section: Discussionmentioning

confidence: 99%

“…In October 2007, the NCI sponsored a conference to review the state of the science for the use of FNA in the management of thyroid nodules. This conference included an interdisciplinary program with a permanent website and a 2-day meeting at Bethesda in an attempt to establish a standardized diagnostic terminology/classification system and morphological criteria for reporting thyroid FNA [15,16,17,18,19,20,21]. One of the recommendations endorsed by the conference and published in 2010 is the establishment of a six-tiered diagnostic classification system based on a probabilistic approach [22].…”

Section: Discussionmentioning

confidence: 99%

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The UK Royal College of Pathologists Thyroid Fine-Needle Aspiration Diagnostic Classification Is a Robust Tool for the Clinical Management of Abnormal Thyroid Nodules

Lobo

McQueen²,

Beale³

et al. 2011

Acta Cytologica

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Objective: To compare the outcomes and evaluate the relative risk of thyroid cancer by using the UK thyroid fine-needle aspiration (FNA) cytological diagnostic categories, with the main objective being the clarity of patient management. Study Design: Results of thyroid FNA reported as Thy3a, Thy3f, Thy4, and Thy5 were correlated with histological outcomes. The specificity and positive predictive value (PPV; risk of malignancy) for each reporting category was assessed. Results: Of a total of 873 thyroid FNAs, 237 (27%) were reported as ‘abnormal’: 40 (4.6%) as Thy3a, 119 (13.6%) as Thy3f, 20 (2.2%) as Thy4, and 58 (6.6%) as Thy 5. The final outcomes were available in 136 (57%) cases which underwent surgical resection (25, 60, 55, and 74% of Thy3a, Thy3f, Thy4, and Thy5, respectively). The known outcomes of the Thy3a category were too low to be statistically significant. The specificity and PPV of the Thy3f, Thy4, and Thy5 (equivalent to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) IV, V, and VI) categories were 50, 50, and 100% and 28, 64, and 100%, respectively. The PPV of Thy3f for diagnosis of ‘neoplasms’ (benign and malignant) was 63%. Conclusion: The current thyroid FNA classification system used in the UK, which is comparable to TBSRTC, offers a sound basis for clear communication on which the management of patients with abnormal thyroid FNA findings can be based. Categories Thy3f, Thy4, and Thy5 carry a progressively rising risk of malignancy, justifying their continuing use. Diagnostic category Thy5 ‘malignant’ is robust and can be used as a sure indication of a definitive surgical management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The UK Royal College of Pathologists Thyroid Fine-Needle Aspiration Diagnostic Classification Is a Robust Tool for the Clinical Management of Abnormal Thyroid Nodules

Lobo

McQueen²,

Beale³

et al. 2011

Acta Cytologica

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“…12, 13 On January 1, 2008, our institution adopted this six-tiered diagnostic approach in reporting thyroid FNA with minor modifications. In this study, we evaluated the impact on the frequency distribution of various diagnostic categories and the diagnostic accuracy rate of thyroid FNA before and after the implementation of The Bethesda system (TBS) for reporting thyroid FNA.…”

mentioning

confidence: 99%

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

Theoharis¹,

Adeniran²,

Roman³

et al. 2013

Diagnostic Cytopathology

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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.

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“…23 Past and present thyroid FNA classification schemes were reviewed and present practice summarized. 24 A tiered classification scheme was discussed and a category designated ''follicular lesion of undetermined significance'' (FLUS) or ''atypia of undetermined significance'' was proposed.…”

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confidence: 99%

Implications of the proposed thyroid fine‐needle aspiration category of “follicular lesion of undetermined significance”: A five‐year multi‐institutional analysis

Layfield

Morton

Cramer

et al. 2009

Diagnostic Cytopathology

154

138

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National Cancer Institute State of the Science Conference on thyroid fine-needle aspiration (FNA) summarized diagnostic terminology. Six diagnostic categories were proposed including "follicular lesion of undetermined significance" (FLUS). FLUS was defined as findings neither convincingly benign nor sufficiently atypical for a diagnosis of "follicular neoplasm" or "suspicious for malignancy." It was proposed that this category represent less than 7% of thyroid FNAs. A search of the cytology records at three University Hospitals was performed for the term FLUS or older equivalent terms. Usage of FLUS was compared between institutions and among pathologists. Surgical pathology outcome for FLUS cases was determined. Twenty-eight pathologists evaluated 6,872 cases at the three institutions. Use of FLUS varied among pathologists (2.5 to 28.6%). Frequency of use of FLUS among institutions varied from 3.3 to 14.9%. FLUS cases [127 of 673 (18.9%)] underwent surgical exploration with malignancy identified in 36 cases (28.3%) undergoing resection. Use of FLUS varied substantially among pathologists and institutions. FLUS category requires more rigorously defined morphologic criteria for it to become a useful guide in clinical management.

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The National Cancer Institute Thyroid FNA State of the Science Conference: “Wrapped up”

Cited by 24 publications

References 13 publications

The UK Royal College of Pathologists Thyroid Fine-Needle Aspiration Diagnostic Classification Is a Robust Tool for the Clinical Management of Abnormal Thyroid Nodules

The UK Royal College of Pathologists Thyroid Fine-Needle Aspiration Diagnostic Classification Is a Robust Tool for the Clinical Management of Abnormal Thyroid Nodules

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

Implications of the proposed thyroid fine‐needle aspiration category of “follicular lesion of undetermined significance”: A five‐year multi‐institutional analysis

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