The Use of the Bethesda System for Reporting Thyroid Cytopathology in Korea: A Nationwide Multicenter Survey by the Korean Society of Endocrine Pathologists

Kim, Mi Mi; Park, Hyojin; Min, Hye Sook; Kwon, Hyeong Ju; Jung, Chan Kwon; Chae, Seoung Wan; Yoo, Hyun Ju; Choi, Yoo Duk; Lee, Mi Ja; Kwak, Jeong Ja; Song, Dong Eun; Kim, Dong Hoon; Lee, Hye Kyung; Kim, Ji Yeon; Hong, Sook Hee; Sohn, Jang Sihn; Lee, Hyun Seung; Park, So Yeon; Hong, Soon Won; Shin, Mi Kyung

doi:10.4132/jptm.2017.04.05

Cited by 31 publications

(33 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Proportions (average and range) of FNA samples in Korean practice were slightly high for AUS/FLUS at 9.7% (3.8%‐19.8%) and very low for FN/SFN at 0.9% (0%‐2.1%), which were reported in several previous studies from Korea . Average RRs of the six Bethesda categories were 14.3% (non‐diagnostic), 2.4% (benign), 20.2% (AUS/FLUS), 43.7% (FN/SFN), 59.9% (SM) and 69.2% (malignant), respectively . The average ROMs for the six Bethesda categories were 46.5% (non‐diagnostic), 16.5% (benign), 68.7% (AUS/FLUS), 30.2% (FN/SFN), 97.5% (SM) and 99.7% (malignant), respectively .…”

Section: Review Of Reports By Members Of the Working Group Of Asian Tsupporting

confidence: 60%

“…They found that 60 (81%) out of 74 pathology laboratories in Korea used the Bethesda system as of 2012, which was a higher rate than in US practice reported in 2013 by the College of American Pathologists and 94% (34/36) in 2016 . Proportions (average and range) of FNA samples in Korean practice were slightly high for AUS/FLUS at 9.7% (3.8%‐19.8%) and very low for FN/SFN at 0.9% (0%‐2.1%), which were reported in several previous studies from Korea . Average RRs of the six Bethesda categories were 14.3% (non‐diagnostic), 2.4% (benign), 20.2% (AUS/FLUS), 43.7% (FN/SFN), 59.9% (SM) and 69.2% (malignant), respectively .…”

Section: Review Of Reports By Members Of the Working Group Of Asian Tmentioning

confidence: 96%

“…Average RRs of the six Bethesda categories were 14.3% (non‐diagnostic), 2.4% (benign), 20.2% (AUS/FLUS), 43.7% (FN/SFN), 59.9% (SM) and 69.2% (malignant), respectively . The average ROMs for the six Bethesda categories were 46.5% (non‐diagnostic), 16.5% (benign), 68.7% (AUS/FLUS), 30.2% (FN/SFN), 97.5% (SM) and 99.7% (malignant), respectively . Hong and Jung provided data from their practices (K. Kakudo, personal communication), as shown in Table .…”

Section: Review Of Reports By Members Of the Working Group Of Asian Tmentioning

confidence: 99%

“…The Endocrine Pathology Study Group of the Korean Society of Pathologists conducted a nationwide survey on thyroid FNAC in Korea and published their results describing Korean practices for thyroid nodules and thyroid FNAC in 2017 . They found that 60 (81%) out of 74 pathology laboratories in Korea used the Bethesda system as of 2012, which was a higher rate than in US practice reported in 2013 by the College of American Pathologists and 94% (34/36) in 2016 .…”

Section: Review Of Reports By Members Of the Working Group Of Asian Tmentioning

confidence: 99%

“…In this opinion paper, the authors introduce Asian practices for patients with thyroid nodules and describe Asian clinical practice (active surveillance for indeterminate thyroid nodules and low‐risk thyroid carcinomas), as reliable and valid means for reducing overdiagnosis and overtreatment of borderline thyroid tumours and low‐risk thyroid carcinomas . In addition, there are reports of significant variations in ROM in cytological‐histological correlation studies even when the ATA thyroid cancer management guidelines and the Bethesda system were employed . This article presents high quality data provided by members of the Working Group of Asian Thyroid FNA Cytology, which confirms high ROMs in the indeterminate FNA categories and low rates of non‐invasive follicular neoplasm with papillary‐like nuclear features (NIFTP) in most Asian thyroid FNA practice .…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Thyroid FNA cytology in Asian practice—Active surveillance for indeterminate thyroid nodules reduces overtreatment of thyroid carcinomas

et al. 2017

View full text Add to dashboard Cite

Although Asian thyroid practices have implemented the American Thyroid Association guidelines, significant deviations in actual risk of malignancy (ROM) have been reported. With review of the literature from Asia, the authors examine the underlining reasons for actual ROMs reported in Asia being so different from western practice based on the author's perspective. Although the most popular diagnostic system for thyroid cytology used in Asian countries is the Bethesda system, the Japan Thyroid Association published clinical guidelines, including a national reporting system for thyroid cytology, to adapt conservative clinical management (active surveillance and strict triage patients for surgery) for low-risk thyroid carcinomas. As less aggressive clinical management is favoured in Asian societies, strict triage of patients with indeterminate thyroid nodules for surgery is usually applied, which ultimately reduces overtreatment of indolent thyroid tumours. As a result, low resection rates and high ROMs for indeterminate nodules were achieved in Asian practices using the same Bethesda system. Recently, borderline thyroid tumours were introduced in the thyroid tumour classification and significant decreases in ROMs have been reported in the indeterminate categories in western practice.However, ROM of indeterminate nodules remained high in Asian practice even after borderline tumours were deemed benign. These results suggested that the diagnostic threshold of papillary thyroid carcinoma-type nuclear features varied among practices (stricter in Asia than in western practice), and diagnostic surgery was not performed for a significant number of indeterminate nodules with benign clinical features in Asian practice, resulting in low rates of borderline tumours in surgicallytreated patients. K E Y W O R D SAsia, borderline tumour, indeterminate cytology, resection rate, risk of malignancy, thyroid FNAC

show abstract

Section: Review Of Reports By Members Of the Working Group Of Asian Tsupporting

confidence: 60%

Section: Review Of Reports By Members Of the Working Group Of Asian Tmentioning

confidence: 96%

Section: Review Of Reports By Members Of the Working Group Of Asian Tmentioning

confidence: 99%

Section: Review Of Reports By Members Of the Working Group Of Asian Tmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Thyroid FNA cytology in Asian practice—Active surveillance for indeterminate thyroid nodules reduces overtreatment of thyroid carcinomas

et al. 2017

View full text Add to dashboard Cite

show abstract

Risk stratification of indeterminate thyroid nodules by novel multigene testing: a study of Asians with a high risk of malignancy

Jing

Chang

et al. 2022

Molecular Oncology

View full text Add to dashboard Cite

Molecular testing of indeterminate thyroid nodules informs about the presence of point mutations, insertions/deletions, copy number variants, RNA fusions, transcript alterations and miRNA expression. American Thyroid Association (ATA) guidelines suggest molecular testing of indeterminate thyroid nodules may be considered to supplement risk of malignancy (ROM). Although these recommendations have been incorporated in clinical practices in the United States, molecular testing of indeterminate thyroid nodules is not common practice in Asia. Here, we performed molecular testing of 140 indeterminate nodules from Chinese patients using a novel molecular platform composed of RNA and DNA‐RNA classifiers, which is similar to Afirma GEC and ThyroSeq v3. Compared with reports from North America, the new RNA and DNA‐RNA classifiers had a higher positive predictive value (p1 = 0.000 and p2 = 0.020) but a lower negative predictive value (p1 = 0.004 and p2 = 0.098), with no significant differences in sensitivity (p1 = 0.625 and p2 = 0.179) or specificity (p1 = 0.391 and p2 = 0.264). Out of 58 resected nodules, 10 were borderline and 33 malignant, indicating a 74.1% ROM, which was higher than reports in North America (10–40% ROM). Our findings emphasize molecular testing with the newly reported RNA and DNA‐RNA classifiers can be used as a ‘rule‐in’ test when ROM is high.

show abstract

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

Vuong

Ngo

Bychkov

et al. 2019

Cancer Cytopathology

Self Cite

104

View full text Add to dashboard Cite

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.

show abstract

The Use of the Bethesda System for Reporting Thyroid Cytopathology in Korea: A Nationwide Multicenter Survey by the Korean Society of Endocrine Pathologists

Cited by 31 publications

References 26 publications

Thyroid FNA cytology in Asian practice—Active surveillance for indeterminate thyroid nodules reduces overtreatment of thyroid carcinomas

Thyroid FNA cytology in Asian practice—Active surveillance for indeterminate thyroid nodules reduces overtreatment of thyroid carcinomas

Risk stratification of indeterminate thyroid nodules by novel multigene testing: a study of Asians with a high risk of malignancy

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

Contact Info

Product

Resources

About