Thyroid nodules cytopathology applying the Bethesda system with histopathological correlation

Zarif, Hawazen; Ghandurah, Samirah; Al-Garni, Mohamed A; Binmahfooz, Sarah; Alsaywid, Basim; Satti, Mohamed B.

doi:10.4103/sjmms.sjmms_178_17

Cited by 15 publications

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“…Of those 23 were reported malignant by histopathological examination giving a 96% risk of malignancy. This is similar to what has been reported by Zarif et al (95.6%) [ 12 ], and higher than was reported by the BSRTC report [ 16 , 17 ]. The higher rate of Bethesda category V reported in the current study may be related to sampling issues and variable experience of aspiration techniques as well as differences in interpretation of findings.…”

Section: Discussionsupporting

confidence: 92%

“…This high rate was also reported by Lee et al study 79% [ 18 ]. A lower rate was also seen in Mufti et al 20% [ 11 ], and 52% in Zarin et al study [ 12 ]. A lower rate (25–40%) has also been reported according to the BSRTC definition [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 60%

“…Many studies have considered FNA cytology as the gold standard in analyzing thyroid nodules as well as outlining the future management of patients with thyroid nodules [ 6 – 12 ]. However, indeterminate cytopathological diagnoses, Bethesda category III and IV, creates a problem in determining the appropriate method of management of patients with thyroid nodules.…”

Section: Discussionmentioning

confidence: 99%

“…Of these 18 (54.5%) were reported malignant on histopathological examination and were either microcarcinoma or follicular variant PTC, or follicular carcinoma or classic PTC pT1b (>1cm<2cm) ( Table 6 ). Interestingly, the reported malignancy rates for this category vary widely, from 50% [ 11 , 12 ] to 69% [ 13 ] and 79% [ 18 ], while rates were much lower (10–30%) in the BSRTC definition [ 16 , 17 ]. The lower rate of malignancy in category III according to the BSRTC definition report was probably due to the high number of cases included in their study as compared with the current study.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided fine needle aspiration cytology and ultrasound examination of thyroid nodules in the UAE: A comparison

et al. 2021

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Background Thyroid nodules are a common clinical finding and most are benign, however, 5–15% can be malignant. There is limited regional data describing the accuracy of ultrasound-guided fine needle aspiration (FNA) cytological examination compared to ultrasound examination of thyroid in patients who have undergone thyroid surgery. Methods A retrospective analysis of ultrasonographic (US) reports, FNA cytology reports and histopathology reports of 161 thyroid nodules presented at the endocrine center at Tawam hospital in Al Ain city, the United Arab Emirates during the period 2011–2019 was performed. US reports and images with FNA cytopathology reports and slides were reviewed by an independent radiologist and pathologist. Results In total, 40 nodules were reported as benign by US examination, while very low suspicious, low suspicious, intermediate suspicious and highly suspicious categories were reported in 21, 41, 14 and 45 nodules respectively. In addition, 68 nodules were reported as benign (Bethesda category II), while atypical follicular cells of unknown significance (Bethesda category III), follicular neoplasm (Bethesda category IV), suspicious for malignancy (Bethesda category V), and malignant (Bethesda category VI) categories were reported in 33, 9, 24 and 27 nodules respectively. The risk of malignancy for US benign nodules was 5%, while the risks of malignancy in very low suspicious, low suspicious, intermediate suspicious and highly suspicious nodules were 52%, 36%, 100% and 87%, respectively. The risk of malignancy for Bethesda category II was 3%, while the risks of malignancy in category III, IV, V and VI were 58%, 67%, 96% and 100%, respectively. Conclusion Thyroid FNA cytological examination and ultrasonography are key tools in predicting malignancy in thyroid nodules. Thyroid nodules with the diagnosis of Bethesda category III & IV run a high risk of malignancy thus more vigilance is required.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided fine needle aspiration cytology and ultrasound examination of thyroid nodules in the UAE: A comparison

et al. 2021

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“…This rate is reported as 99%-97% in the Bethesda system. In the study of Zarif et al [ 20 ], 100% of the cases diagnosed with malignant cytology were diagnosed as malignant.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Thyroid Fine Needle Aspiration Biopsy With Histopathological Results

Durgun¹

2023

Cureus

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Introduction Fine needle aspiration biopsy (FNAB) is an effective method used in the differential diagnosis of thyroid nodules. The Bethesda system has contributed to the determination of clinical approaches by bringing standardization to cytopathology reporting. However, the rate of cytological-histological incompatibility varies between 10% and 30%. Results differ according to clinics in the literature. These results create a need to reevaluate the efficacy and safety of fine needle aspiration biopsy. In this study, we aimed to evaluate the diagnostic accuracy of FNAB of thyroid nodules by correlating the cytopathology results of FNAB with the results of postoperative histopathology. Methods In this retrospective study, thyroid FNAB results and postoperative histopathology results of patients who underwent thyroidectomy operations in our clinic between January 2018 and December 2021 were compared. Accuracy, sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), false positive rate (FPR), and false negative rate (FNR) were calculated. Cases with nondiagnostic FNAB results were excluded from the calculations. FNAB results with a follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN) and suspicious for malignancy were included in the malignant group. Results A total of 304 patients were included in the study. The male/female ratio was 1:3.3. As a result of the study, malignancy was detected histopathologically in 47 (15.46%) patients. The commonest malignancy detected was papillary carcinoma. According to the Bethesda system, the results were evaluated in six categories. The incidence of malignancy in the Bethesda categories were 0%, 4%, 40%, 69.2%, 100%, and 100%, respectively. Accordingly, the specificity and sensitivity of FNAB for detecting malignancy were 98.7% and 66.6%, respectively. The accuracy was 93.5%. The false positive rate, false negative rate, positive predictive value, and negative predictive value were 1.20%, 33.3%, 91.4%, and 93.8%, respectively. Conclusion Thyroid FNAB is an effective method used with satisfactory reliability in the differential diagnosis of malignancies of thyroid nodules. Still, it has some limitations. This article demonstrates higher rates of malignancy in Bethesda categories III and IV. Therefore, clinical approaches are gaining importance in these categories.

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Diagnostic Accuracy of Fine-Needle Biopsy in the Detection of Thyroid Malignancy

et al. 2022

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ImportanceFine-needle biopsy (FNB) became a critical part of thyroid nodule evaluation in the 1970s. It is not clear how diagnostic accuracy of FNB has changed over time.ObjectiveTo conduct a systematic review and meta-analysis estimating the accuracy of thyroid FNB for diagnosis of malignancy in adults with a newly diagnosed thyroid nodule and to characterize changes in accuracy over time.Data SourcesPubMed, SCOPUS, and Cochrane Central Register of Controlled Trials were searched from 1975 to 2020 using search terms related to FNB accuracy in the thyroid.Study SelectionEnglish-language reports of cohort studies or randomized trials of adult patients undergoing thyroid FNB with sample size of 20 or greater and using a reference standard of surgical histopathology or clinical follow-up were included. Articles that examined only patients with known thyroid disease or focused on accuracy of novel adjuncts, such as molecular tests, were excluded. Two investigators screened each article and resolved conflicts by consensus. A total of 36 of 1023 studies met selection criteria.Data Extraction and SynthesisThe MOOSE guidelines were used for data abstraction and assessing data quality and validity. Two investigators abstracted data using a standard form. Studies were grouped into epochs by median data collection year (1975 to 1990, 1990 to 2000, 2000 to 2010, and 2010 to 2020). Data were pooled using a bivariate mixed-effects model.Main Outcomes and MeasuresThe primary outcome was accuracy of FNB for diagnosis of malignancy. Accuracy was hypothesized to increase in later time periods, a hypothesis formulated prior to data collection.ResultsOf 16 597 included patients, 12 974 (79.2%) were female, and the mean (SD) age was 47.3 (12.9) years. The sensitivity of FNB was 85.6% (95% CI, 79.9-89.5), the specificity was 71.4% (95% CI, 61.1-79.8), the positive likelihood ratio was 3.0 (95% CI, 2.3-4.1), and the negative likelihood ratio was 0.2 (95% CI, 0.2-0.3). The area under the receiver operating characteristic curve was 86.1%. Epoch was not significantly associated with accuracy. None of the available covariates could explain observed heterogeneity.Conclusions and RelevanceAccuracy of thyroid FNB has not significantly changed over time. Important developments in technique, preparation, and interpretation may have occurred too heterogeneously to capture a consistent uptrend over time. FNB remains a reliable test for thyroid cancer diagnosis.

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Thyroid nodules cytopathology applying the Bethesda system with histopathological correlation

Cited by 15 publications

References 12 publications

Ultrasound-guided fine needle aspiration cytology and ultrasound examination of thyroid nodules in the UAE: A comparison

Ultrasound-guided fine needle aspiration cytology and ultrasound examination of thyroid nodules in the UAE: A comparison

Correlation of Thyroid Fine Needle Aspiration Biopsy With Histopathological Results

Diagnostic Accuracy of Fine-Needle Biopsy in the Detection of Thyroid Malignancy

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