The impact of implementation of the Bethesda System for Reporting Thyroid Cytopathology on the quality of reporting, “risk” of malignancy, surgical rate, and rate of frozen sections requested for thyroid lesions

Abstract

BACKGROUND: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has been anticipated to improve communication between pathologists and clinicians and thereby patient outcomes. In the current study, the impact of TBSRTC on various quality and outcome measures was assessed. METHODS: The current study included all patients who underwent fine‐needle aspiration (FNA) of the thyroid between April 2006 and April 2009. Before implementation, the authors used generic diagnostic categories; after implementation, TBSRTC was used. Quality of reporting, diagnostic categories, rate of surgery, rates of frozen section, the “risk” of malignancy after a cytologic diagnosis, and errors before and after implementation of TBSRTC were compared using the chi‐square and Fisher exact tests. Multilevel likelihood ratios and the receiver operating characteristic were used to compare the accuracy of FNA before and after implementation. RESULTS: A total of 1671 FNAs (957 obtained before and 714 obtained after implementation of TBSRTC) were obtained from 1339 patients. Of these, 301 patients (191 before and 110 after implementation) underwent subsequent surgical resection. Before implementation, the reports were more ambiguous (3.7% vs 0.5%; P < .05) and implicit (5.1% vs 2.7%; P < .05) than after implementation. The overall rate of surgery decreased after implementation of TBSRTC (24.5% vs 19.6%; P < .05). The overall risk of malignancy did not appear to be affected by implementation of TBSRTC, but it decreased significantly after a benign FNA diagnosis compared with a diagnosis of an atypical lesion or follicular neoplasm. The rate of frozen section remained unchanged. The diagnostic accuracy was not found to be significantly different before compared with after implementation of TBSRTC. CONCLUSIONS: Implementation of TBSRTC appears to improve the quality of reporting by lowering the number of ambiguous and implicit diagnoses and decreases the overall surgery rates, particularly for benign lesions, but it does not appear to have any effect on the accuracy of FNA of the thyroid, false‐positive rates, or the frequency of intraoperative consultations. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society.

Bethesda System in the evaluation of thyroid nodules: Review

“…On the basis of these results, Hershman found that TBSRTC is an effective classification system of FNA for the treatment of patients with thyroid nodules. 21 Crowe et al claim 22 TBSRTC affects the quality of reporting. By comparing the cases of thyroid FNA assessed by TBSRTC and the previous system, the authors proved that TBSRTC has reduced the number of subsequent surgical resection and reduced the number of ambiguous diagnoses.…”

“…However, the diagnostic accuracy has not changed significantly following the introduction of TBSRTC. 22 According to Olson et al 23 the introduction of TBSRTC coincided with a reduction in the number of cases of "suspicious for papillary thyroid carcinoma" (SPTC) and at the same time caused an increase in the indicator of malignancy for that category, called in the Bethesda System, "suspicious for malignancy" (SM).…”

Nowa klasyfikacja wyników biopsji tarczycy — 3-letnia obserwacja jednego ośrodka

“…Crowe et al observed that the application of the newC reduces the incidence of ambiguous diagnoses and frequency of surgical interventions, particularly with regard to benign lesions, but it does not affect the accuracy of cytology and the percentage of false positive outcomes [8]. In turn, Rabaglia et al showed no impact of the introduction of the newC system on the number of surgeries performed, but noted the reduced risk of malignancy in respect to ambiguous results of FNAB (corresponding to the FLUS category in the newC system) [9].…”

Accuracy of Fnac in Diagnosing Thyroid Nodules: A Single Institution Experience

“…Taking in to consideration the need for standardization, the Bethesda System for Reporting Thyroid Cyto pathology (TBSRTC) was proposed and has been accepted worldwide [4,5]. This study was carried out with the aim of identifying the accuracy of FNAC in diagnosing thyroid nodules by comparing the final histopathology report of patients who had undergone thyroidectomy with their pre-operative FNAC.…”