Bethesda System for Reporting Thyroid Cytopathology: A three-year study at a tertiary care referral center in Saudi Arabia

Dawish, Mohamed Abdulaziz Al; Robert, Asirvatham Alwin; Muna, Aljuboury; Alkharashi, Eyad; Ghamdi, Abdullah Al; Hajeri, Khalid Al; Thabet, Mohammed A; Braham, Rafik

doi:10.5306/wjco.v8.i2.151

Cited by 19 publications

(17 citation statements)

References 31 publications

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“…With regard to the risk of malignancy associated with each Bethesda system category on follow-up, higher risks of malignancy in Category I, II, and III have been noted in studies with low number of follow-up cases including our study. [ 2 5 16 17 ] Surprisingly, our study shows the highest risk of malignancy in the benign category compared to the other studies. Some of these studies show even a higher risk of malignancy in Category III compared to Category IV, which is not consistent with TBSRTC proposal of a sequentially increasing implied risk of malignancy.…”

Section: Discussioncontrasting

confidence: 86%

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Classification of thyroid fine-needle aspiration cytology into Bethesda categories: An institutional experience and review of the literature

et al. 2018

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Background:Fine-needle aspiration cytology (FNAC) of thyroid is the initial screening test for thyroid nodules. The Bethesda system classifies thyroid FNAC into six categories. Each category is linked to a malignancy risk and has a recommended clinical management. The aim of this study is to analyze the thyroid cytology smears by Bethesda system and to correlate the diagnosis of cytopathology with histopathology, whenever surgery was done.Materials and Methods:This study presents our experience with the Bethesda system in 681 thyroid FNAs from 632 patients in the period between January 2013 and December 2016.Results:Categories were as follows: 10.1% were Category I (nondiagnostic), 68.8% Category II (benign), 12.4% were Category III (atypia of undetermined significance), 2.9% were Category IV (suspicious for follicular neoplasm), 2.6% were Category V (suspicious for malignancy), and 4.1% were Category VI (malignant). Surgery was done on 126 nodules from 119 patients with an overall rate of malignancy of 27.8% (35/126 nodules).Conclusion:The Bethesda System for Reporting Thyroid Cytopathology proved to be an excellent reporting system.

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Section: Discussioncontrasting

confidence: 86%

“…[ 15 ] Regarding Category III, although the incidence of malignancy is slightly high, it is still within the range reported in the literature which is 6%–50%. [ 12 13 16 17 ]…”

Section: Discussionmentioning

confidence: 99%

Classification of thyroid fine-needle aspiration cytology into Bethesda categories: An institutional experience and review of the literature

et al. 2018

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“…We excluded a further 233 studies and finally selected 38 studies, which included 145,066 thyroid nodules, for meta‐analysis (Fig. ) . Among the included studies, 4 were prospective and 34 were retrospective.…”

Section: Resultsmentioning

confidence: 99%

Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: A systematic review and meta‐analysis

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Ngo

Bychkov

et al. 2019

Cancer Cytopathology

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There is increasing evidence showing that clinicians employ different management strategies in their use of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). In this meta-analysis, we investigated the differences in diagnosis frequency, resection rate (RR), and risk of malignancy (ROM) between Western (ie, American and European) and Asian cytopathology practices. We searched PubMed . Proportion and 95% CIs were calculated using a random-effect model. We used independent sample t tests to compare frequencies, RR, and ROM between Western and Asian practices. We analyzed a total of 38 studies with 145,066 fine-needle aspirations. Compared with Asian practice, Western series had a significantly lower ROM in most of TBSRTC categories, whereas the RR was not statistically different. Focusing on indeterminate nodules, the RR in Western series was significantly higher (51.3% vs 37.6%; P = .048), whereas the ROM was significantly lower (25.4% vs 41.9%; P = .002) compared with those in Asian series. The addition of Asian cohorts increased ROM for most of diagnostic categories compared with the original TBSRTC. In conclusion, this study demonstrates a difference in Western and Asian thyroid cytology practice, especially regarding the indeterminate categories. Lower RR and higher ROM suggest that Asian clinicians adopt a more conservative approach, whereas immediate diagnostic surgery is favored in Western practice for indeterminate nodules. The addition of Asian series into a meta-analysis of TBSRTC altered ROM for several categories, which should be considered in future revisions of TBSRTC.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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Background/objectives:Thyroid nodule (TN) is a common thyroid disorder globally, and the incidence has been increasing in recent decades. The objective of this study was to determine the contribution of thyroid-stimulating hormone (TSH), ultrasound (US), and cytological classification system for predicting malignancy among the surgically excised nodules.Design and methods:A retrospective analysis was performed between January 2012 and December 2014, using data drawn from 1188 patients (15-90 years), who had 1433 TN and fine-needle aspiration in Prince Sultan Military Medical City, Saudi Arabia. After reviewing all the thyroid cytopathological slides and US reports, classification was done based on the Bethesda System for Reporting Thyroid Cytology and the Thyroid Imaging Reporting and Data System (TI-RADS).Results:A total of 1188 patients’ medical records were reviewed for this study, among them 311 patients had undergone surgical intervention (253 patients had single nodule and 58 had 2 nodules), with a total of 369 nodules. However, as 54 nodules on the US were either unavailable or unclear, the 315 remaining nodules were analyzed, revealing 30.2% (n = 95) malignancy overall. Patients with TSH values of >4.5 mIU/L (38.2%), TN <1 cm (48.8%), TI-RADS category 5 (75.6%), and Bethesda category VI (88.9%) revealed a higher percentage of malignancy. From the univariate analysis using the χ2 test, significant relationship between the TSH, nodule size, TI-RADS, and the Bethesda category between the malignant and benign nodules emerged. The regression analysis showed that patients with a TSH value of 0.5 to 4.5 mIU/L (odds ratio [OR]: 2.96), TSH >4.5 mIU/L (OR: 6.54) had higher risk for malignancy than those with a TSH value of ≤0.4 mIU/L. Thyroid nodules with sizes of 1 to 1.9 cm (OR: 1.12), 2 to 2.9 cm (OR: 0.74), 3-3.9 cm (OR: 1.21), and ≥4 cm (OR: 0.52) were found to have no association with the risk of malignancy. Compared with TI-RADS 2 patients, those with categories 4B (OR: 1.35) and 5 (OR: 2.3) were found to be at higher risk of malignancy. Similarly, Bethesda IV (OR: 2.72), V (OR: 8.47), and VI (OR: 20; P < .02) category patients had a higher risk for malignancy than those in Bethesda class I. Among the study population, the papillary thyroid carcinoma was the most common type of thyroid cancer (86, 90.5%) followed by 7.4% (n = 7) of follicular thyroid carcinoma, 1.05% (n = 1) of anaplastic carcinoma, and 1.05% (n = 1) of medullary thyroid carcinoma.Conclusions:A predictive model for risk of malignancy using a combining characteristic of the TSH, US, and cytological classification systems could assist the clinicians in minimizing exposing the patients with TNs to nonessential invasive procedures.

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Bethesda System for Reporting Thyroid Cytopathology: A three-year study at a tertiary care referral center in Saudi Arabia

Cited by 19 publications

References 31 publications

Classification of thyroid fine-needle aspiration cytology into Bethesda categories: An institutional experience and review of the literature

Classification of thyroid fine-needle aspiration cytology into Bethesda categories: An institutional experience and review of the literature

Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: A systematic review and meta‐analysis

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

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