Bethesda Made It Clearer: A Review of 542 Patients in a Single Institution

Abstract

Background: It is essential to interpret fine needle aspiration biopsy (FNAB) material correctly to create a common language among pathologists and surgeons, leading to a uniform approach to thyroid nodule management. We aimed to compare FNAB reports of patients at our institution who were treated with total thyroidectomy, before and after the Bethesda classification system. Patients and Methods: Patients who underwent total thyroidectomy for thyroid nodules are reviewed. 226 patients who underwent total thyroidectomy before the Bethesda era (2006-2009) were classified as Group-I, and 316 patients in whom total thyroidectomy was performed after the Bethesda classification system was introduced (2010-2014) were classified as Group-II. Results: Before Bethesda, ‘nondiagnostic' or ‘benign' lesions were reported in 16.4 and 45% of patients, respectively, which then significantly decreased to 4.7 and 32.9% as the Bethesda classification criteria came into use. In Group-II, the actual malignancy rates were 13.3, 2.8, 7.3, 15.5, 85.4, and 96.5% for Bethesda I, II, III, IV, V, and VI, respectively. Conclusion: Our experience confirms that the Bethesda classification system leads to a significant reduction in lesions that used to be reported as ‘benign' without compromising the actual rates of malignancy. It ensures better classification of so-called suspicious lesions, and allows for more accurate predictions of suspicious or malignant lesions.

Thyroid Nodule Management: Thyroid-Stimulating Hormone, Ultrasound, and Cytological Classification System for Predicting Malignancy

“…Some of the tools that could prove effective in predicting malignancy in TN assessment include the assessment of the TN size, thyroid-stimulating hormone (TSH) level at the time of diagnosis, Bethesda System for Reporting Thyroid Cytopathology (BSRTC) and Thyroid Imaging Reporting and Data System (TI-RADS). 11 , 12 Consequently, establishing a concordance between the diagnostic procedures (fine-needle aspiration [FNA] and US) might reduce the health care costs as well as numbers of nonessential procedures in the population at risk could be reduced. Findings from various researches also reported that the FNA biopsy must be interpreted precisely to generate a common language among pathologists and surgeons, to enable them to establish a uniform TN management strategy.…”

“…Findings from various researches also reported that the FNA biopsy must be interpreted precisely to generate a common language among pathologists and surgeons, to enable them to establish a uniform TN management strategy. 12 …”

“…Findings from various researches also reported that the FNA biopsy must be interpreted precisely to generate a common language among pathologists and surgeons, to enable them to establish a uniform TN management strategy. 12 Over the past few eras, thyroid cancer has been considerably rising in frequency, globally, although the mortality rate has gradually decreased, in Saudi Arabia as well. [13][14][15] The decreased mortality in thyroid cancer is an indication of the variations in exposure to the risk factors, as well as to the modifications in the techniques employed in disease diagnosis and treatment, whereas the spike in the incidence is possibly a reflection of the increased rate of detection of this neoplasm over the past few decades.…”

Malignancy rates and risk factors in Bethesda category IV thyroid nodules: Is lobectomy enough in an endemic region?

“…As Acar et al suggested in their paper, the Bethesda system allows for more accurate predictions for suspicious and malignant lesions (11). Although this is true, the rates of malignancy of indeterminate lesions vary, and the factors that can predict the risks of malignancy of indeterminate nodules to avoid unnecessary thyroidectomies are being investigated (12,13).…”

The Application of the Bethesda System for Reporting Cervical Cytology to Oral Cytology: An Institutional Study

“…Hence, there is a need to establish a uniform classification system that would provide clear-cut thresholds for management and reduce inter-observer variability. This study attempts to compare the Pap classification system [15] with the Bethesda 2014 system [20] as well as to determine the accuracy of the Bethesda system in predicting the oral potentially malignant disorders (OPMD) and malignant cases so as to allow us to establish its clinical applicability.…”