Reporting thyroid FNA before and after implementation of the Bethesda system—one institution's experience

Abstract

The AUS category has a PPV approaching 50% in our lab. This creates uncertainty regarding the appropriate management for this category and may cause unnecessary overuse of molecular testing for cases in the AUS category.

Comparison of thyroid fine needle aspiration biopsy results before and after implementation of Bethesda classification

“…In a study by Sullivan et al, frequencies of benign, suspicious for malignancy and malignant categories did not differ significantly, whereas the non‐diagnostic category demonstrated a decrease in reporting frequency from 19% to 10% after the use of the Bethesda system. Alternatively, an increase in the non‐diagnostic/non‐diagnostic‐cyst category from 13% to 21.8% with the system Bethesda was shown in another study, including a total of 3559 aspirations . However, in contrast to the present study, these were cytological studies.…”

Thyroid Nodules: Nondiagnostic Cytologic Results according to Thyroid Imaging Reporting and Data System before and after Application of the Bethesda System

“…As with the many terms used in describing this cytologic category, the criteria used to determine specimen adequacy vary among cytopathologists and institutions, and the meaning of nondiagnostic cytologic results may be used broadly to describe specimens showing scanty follicular cells or aspirates that are suboptimally suggestive of malignancy. Accordingly, the reported incidence of nondiagnostic cytologic results varies from 3% to 22% (2,(4)(5)(6)(7)(8) and shows a broad range of malignancy rates from 4% to 33%. Thus, this creates confusion in the treatment of patients, with approximately 10%-30% of patients undergoing diagnostic lobectomy for a benign diagnosis (4,9).…”

“…(14) proposed the Thyroid Imaging Reporting and Data System (TIRADS), which is a well-structured reporting system that involves the use of US of the thyroid for risk stratification (15). Although authors of several studies have evaluated the efficacy of the Bethesda System for reporting thyroid FNA cytology (1,4,5,9,16,17), there have been no studies in which investigators compared the US features of nodules with nondiagnostic cytologic results before and after the application of the Bethesda System. In this study, we compared the malignancy rates and the effectiveness of the TIRADS for risk stratification of nodules with nondiagnostic results classified before and after application of the Bethesda System for Reporting Thyroid Cytopathology.…”

Fine-Needle Aspiration Utilization for Malignant Thyroid Neoplasms in the Community Hospital Setting: A Quality Improvement Study

“…10 Researchers have investigated the diagnostic accuracy of FNA both proceeding and succeeding Bethesda endorsement. 9,[11][12][13] The American Thyroid Association and the National Comprehensive Cancer Network (NCCN) have established clinical practice guidelines for the utilization of FNA in the diagnostic workup of thyroid nodules. 5,14 Despite these recommendations, there is a wide variation of clinical practice patterns in the management of thyroid nodules and thyroid cancer.…”