The Bethesda Terminology for Reporting Thyroid Cytopathology: From Theory to Practice in Europe

Cochand‐Priollet, Béatrix; Schmitt, Fernando; Tötsch, Martin; Vielh, Philippe

doi:10.1159/000334687

Cited by 58 publications

(44 citation statements)

References 31 publications

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“…8 These terminologies varied from pathologist to pathologist and institution to institution and has led confusion and frustration among treating physicians. Benign thyroid lesions have been given as colloid goiter, adenomatous goiter, hyperplastic nodule and colloid cyst.…”

Section: Discussionmentioning

confidence: 99%

A Cell Pattern Approach for Interpretation of Fine Needle Aspiration Cytology of Thyroid Lesions Using the Bethesda System: A Tertiary Care Centre Study With Literature

Sharma¹,

Kaur²,

Madan³

et al. 2015

jemds

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INTRODUCTION:Fine needle aspiration of thyroid lesions has proven to be an important, simple, safe, cost effective and accurate method for diagnosing the various thyroid lesions. Multiple organizations have proposed diagnostic guidelines for reporting thyroid cytology. National Cancer Institute (NCI) organized the NCI Thyroid Fine Needle Aspiration State of the Science conference in 2007 and proposed the Bethesda System for reporting Thyroid Cytopathology (TBSRTC). The aim of the study is to highlight the application of new nomenclature which can improve inter-laboratory agreement thus leading to more consistent management approach. MATERIALS AND METHODS:The present study was done on 91 random FNAC cases of thyroid lesions in Pathology Department, SGRDIMSAR. The cases were classified according to 6 levels of TBSRTC which are DC-I: Non diagnostic, DC-II: Benign, DC-III: atypia/follicular lesion of undetermined significance (AUS/FLUS), DC-IV: Follicular neoplasm/suspicion for a follicular neoplasm (FN/SFN), DC-V: suspicious for malignancy and DC-VI: Malignant RESULTS: In the present study females outnumbered males with the ratio of 5:1. The age group varied from 13-80 years with maximum number of cases in 3 rd and 4 th decade. Maximum numbers of the cases (48.5%) were benign followed by FN/SFN and malignant category constituting 20.8% and 12.2% respectively. 8.7% were classified under AUS/FLUS category, 6.5% as non-diagnostic and 3.3% as suspicious of malignancy. CONCLUSION: The management of thyroid lesions has been complicated by the lack of universal terminology. TBSTRC is an effective thyroid FNA classification to guide clinical management of patients with thyroid nodules. Its implementation should be encouraged in our country because of its easy understandability and reproducibility. KEYWORDS: Thyroid, Fine needle aspiration, FNA, Bethesda classification. INTRODUCTION:Fine needle aspiration (FNA) of thyroid gland is a widely accepted, simple, safe, cost-effective and accurate method for the evaluation of thyroid lesions. 1 Clinical evaluation, imaging including ultrasound and FNA are mainstay for evaluation of thyroid lesions patients. Among all, highest rate of detection of thyroid neoplasm arising in solitary nodule is achieved by cytological studies thus forming FNAC the most sensitive and specific test. 2 So FNAC provides information that guides the management of the patients with thyroid nodules by identifying the patients who require the surgical intervention. 3 Various cyto morphological features including predominant cell pattern, cell morphology, background and marginal vacuoles are taken into account for diagnosing various lesions. 4 The clinical management of lesions has been complicated by the lack of universal terminology.

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Section: Discussionmentioning

confidence: 99%

A Cell Pattern Approach for Interpretation of Fine Needle Aspiration Cytology of Thyroid Lesions Using the Bethesda System: A Tertiary Care Centre Study With Literature

Sharma¹,

Kaur²,

Madan³

et al. 2015

jemds

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“…It is especially difficult to define demarcations between FLUS and its neighbouring diagnoses (nondiagnostic, benign, SFN and suspicious for malignancy) (15). As a consequence, reproducibility of FLUS diagnoses is as low as 20% (22). There is general consensus that this category should include the cases in which it is impossible to distinguish whether the smear should be classified as BL or SFN.…”

Section: Discussionmentioning

confidence: 99%

Low malignancy risk of thyroid follicular lesion of undetermined significance in patients from post-endemic areas

Słowińska-Klencka¹,

Wozniak²,

Wojtaszek³

et al. 2013

European Journal of Endocrinology

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Objective: New classification of the thyroid fine-needle aspiration biopsy (FNAB) results tries to stratify the risk of malignancy of thyroid follicular lesions using 'follicular lesion of undetermined significance' (FLUS) subcategory. Clinical significance of this category in the endemic (or post-endemic) areas has not been clearly established. Design: The aim of the study was to determine the risk of malignancy for FLUS as well as to evaluate ultrasound (US) malignancy risk features (MRF) in such nodules in comparison with 'suspicious for neoplasm' (SFN) and 'benign lesions' (BL). Methods: The US images and cytological diagnoses of 589 thyroid follicular lesions were analysed from January 2010 to July 2012. Cytological follow-up was assessed in 110 cases and surgical one in 100 cases. Results: FLUS was diagnosed in 340 cases (3.8% of all cytological diagnoses and 57% of thyroid follicular lesions). Altogether, clinical and/or surgical follow-up revealed thyroid cancer in 3.2% patients with FLUS nodules. Repeat FNAB led to more specific diagnosis in 74.4% of FLUS (3.5%, papillary cancers or their suspicion; 2.3%, SFN; 68.6%, BL). The histopathological examination showed thyroid cancer in 6.4% cases of FLUS and 7.0% of SFN and follicular adenoma in 8.5% of FLUS and 11.6% of SFN (NS, FLUS vs SFN). FLUS showed MRF of intermediate values between BL and SFN; SFN more often than FLUS showed at least two MRF (53 vs 30%, P!0.0001). Conclusions: The risk of cancer in FLUS in areas with recently corrected iodine supply is low. In such areas, repeated biopsy leads to more precise cytological diagnosis in about 3/4 cases.

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“…These diagnoses are formulated usually by exclusion of other diagnostic categories and are not a consequence of the presence of specific features in a smear [4][5]19]. Thus, they are more prone to interobserver discrepancies [13,[20][21]. A particularly controversial problem is the degree of nuclear atypia (polymorphism) that allows the categorisation of aspirate as FLUS and not SM.…”

Section: Prace Oryginalnementioning

confidence: 99%

Analiza znaczenia klinicznego niejednoznacznych wyników biopsji tarczycy ze szczególnym uwzględnieniem kategorii ZPBN na podstawie 5 lat stosowania nowej klasyfikacji rozpoznań cytologicznych

Słowińska-Klencka

Wojtaszek-Nowicka

Sporny

et al. 2016

Endokrynologia Polska

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Introduction: The diagnostic category of follicular lesion of undetermined significance (FLUS) was intended to allow selection of cases with low risk of malignancy from all smears with indeterminate, suspicious cytology (ISC), which can potentially take advantage from repeat fine-needle aspiration (rFNA). Aim of the study was a comparison of the risk of malignancy related to FLUS nodules and other nodules with ISC: suspected follicular neoplasm (SFN) and suspected malignancy (SM), as well as analysis of the usefulness of assessing ultrasonographic malignancy risk features (UMRF) in nodules with ISC. Material and methods: We analysed UMRF, rFNA, and results of histopathological examination (H) in 441 FLUS, 135 SFN, and 72 SM nodules. Results: The frequency of exposing cancer in H in FLUS nodules was 5.9%, and when cytological follow up was also included it was 2.9%. rFNAs made the diagnosis more precise in 72.7% of FLUS, and in 5.2% it was diagnosis/suspicion of cancer. The incidence of cancer in SFN nodules was 8.2%, in SM nodules with suspicion of papillary cancer -61.1%, and in nodules with suspicion of other or unspecified malignancy -53.8% (p < 0.0001 FLUS vs. both groups). The presence of calcifications is the only independent UMRF for nodules with ISC (OR 4.7). Features of importance are also microcalcifications (OR 3.8), especially in the SM group, and taller-than-wide-shape (OR 2.2). FLUS and SFN nodules are characterised by particularly low value of assessing suspicious margins; analysis of hypoechogenicity is of low value in SFN nodules, like suspected vascularisation in SFN and SM nodules. Conclusions: The risk of cancer in FLUS and SFN nodules is lower than in SM nodules. rFNAs of FLUS nodules make the diagnosis more precise in more than 70% of cases and are effective in revealing cancers. UMRFs present variable diagnostic value depending on the subcategory of ISC. (Endokrynol Pol 2016; 67 (1): 23-34)

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The Bethesda Terminology for Reporting Thyroid Cytopathology: From Theory to Practice in Europe

Cited by 58 publications

References 31 publications

A Cell Pattern Approach for Interpretation of Fine Needle Aspiration Cytology of Thyroid Lesions Using the Bethesda System: A Tertiary Care Centre Study With Literature

A Cell Pattern Approach for Interpretation of Fine Needle Aspiration Cytology of Thyroid Lesions Using the Bethesda System: A Tertiary Care Centre Study With Literature

Low malignancy risk of thyroid follicular lesion of undetermined significance in patients from post-endemic areas

Analiza znaczenia klinicznego niejednoznacznych wyników biopsji tarczycy ze szczególnym uwzględnieniem kategorii ZPBN na podstawie 5 lat stosowania nowej klasyfikacji rozpoznań cytologicznych

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