The Bethesda System for Reporting Thyroid Cytopathology: Proposed Modifications and Updates for the Second Edition from an International Panel

Abstract

The Bethesda System for Reporting Thyroid Cytology (TBSRTC) was proposed in 2007 at the National Cancer Institute Thyroid Fine Needle Aspiration State of the Art and Science Conference held in Bethesda, Maryland. The aim was to address the inconsistent and sometimes confusing reporting terminologies used for thyroid FNA throughout the world. The TBSRTC consists of 6 diagnostic categories, each associated with an implied risk of malignancy that translates directly into a clinical management algorithm. Since the publication of the TBSRTC cytology Atlas in January 2010, considerable experience has been gained regarding its application in cytology practice, clinical impact, and limitations. In conjunction with the International Academy of Cytology (IAC), an international panel composed of sixteen cytopathologists and an endocrinologist with special interest in thyroid cytology, including several co-authors of the 2010 TBSRTC Atlas, was created to: (1) analyze the current worldwide impact of TBSRTC, (2) report on the current state of TBSRTC based upon a review of the published literature, and (3) provide possible recommendations for a future update of TBSRTC. Herein, we summarize the panel's deliberations and key recommendations that our panel hopes will be useful during the preparation of the second edition of TBSRTC.

Comparison of risk of malignancy in a subgroup with atypia of undetermined significance/follicular lesion of undetermined significance: A meta‐analysis

“…The risk ratio computed by this meta‐analysis demonstrates that the cytologic atypia group should be considered separately from the other nodules with architectural atypia based on the risk of malignancy. The need of further subgrouping in AUS/FLUS has been discussed in previous reports or suggested for inclusion in the second edition of the Bethesda System for Reporting Thyroid Cytopathology . However, the conservative manner in the diagnosis of suspicions for malignancy or malignancy will make the risk of malignancy in the cytologic atypia group higher because many suspicious cases will be categorized as AUS/FLUS.…”

The Bethesda System for Reporting Thyroid Cytopathology II

“…The key findings by the group were presented at the ICC symposium to a large audience. The salient points and recommendations of the symposium have been summarized as a ‘Special Commentary' in the current issue of Acta Cytologica [7 ]as well as appearing simultaneously in the Journal of the American Society of Cytopathology (JASC) [8 ]in its September-October issue. This published article by Pusztaszeri et al [7,8] provides a useful reference guide and proposals for potential modifications to the authors of chapters in the forthcoming TBSRTC II.…”

“…The salient points and recommendations of the symposium have been summarized as a ‘Special Commentary' in the current issue of Acta Cytologica [7 ]as well as appearing simultaneously in the Journal of the American Society of Cytopathology (JASC) [8 ]in its September-October issue. This published article by Pusztaszeri et al [7,8] provides a useful reference guide and proposals for potential modifications to the authors of chapters in the forthcoming TBSRTC II. We owe a debt of gratitude to the International Academy of Cytology (IAC) and to Dr. Philippe Vielh (the immediate past president) for their help in arranging the special symposium in Yokohama, and to all the presenters of the seminar and authors of the special commentary on the Bethesda update.…”

Cytomorphologic, Imaging, Molecular Findings, and Outcome in Thyroid Follicular Lesion of Undetermined Significance/Atypical Cell of Undetermined Significance (AUS/FLUS): A Mini-Review

“…However, even in the USA, FNA was not routinely used for the diagnosis of thyroid nodules before the 1970s due to its low success rate and fear of complications [5]. …”

“…In the second edition, the subclassification of AUS/FLUS has been encouraged, which will be discussed in this review [5]. …”