Thyroid Fine-Needle Aspiration Reporting Rates and Outcomes Before and After Bethesda Implementation Within a Combined Academic and Community Hospital System

Abstract

Context.-The current study compares data from our hospital system before and after the 2008 implementation of the Bethesda System for Reporting Thyroid Cytology (BSRTC).Objective.-To show the effects the BSRTC has had on the reporting rates and outcomes for thyroid lesions.Design.-A search for thyroid fine-needle aspiration biopsies (FNABs) was performed for 2002-2005 (before BSRTC) and -2011. Diagnostic outcomes were reviewed for cases with available follow-up.Results. -For 2002-For -2005, cytology reports for 3302 thyroid FNABs were reviewed, and 309 (9.4%) were classified as suspicious. For 2009-2011, cytology reports for 3432 thyroid FNABs were reviewed; 72 (2.1%) were classified as ''atypia of undetermined significance or follicular lesion of undetermined significance'' (AUS/ FLUS), and 142 (4.1%) were classified as suspicious. Follow-up material was available for 31 AUS/FLUS cases (43.0%), and 6 of these cases (19%) were malignant. Follow-up material was available for 60 cases (42.3%) classified as suspicious, and 23 of these cases (38%) were malignant.Conclusions.-The AUS/FLUS rate of 2.1% at our institution is at the lower range of the ,7% recommended by the BSRTC, and our rate of 19% for risk of malignancy for AUS/FLUS is slightly above the BSRTC recommendation of 5% to 15%. Implementation of the BSRTC did not significantly affect our institution's reporting rates, most likely because an essentially similar classification system was employed before implementation of the BSRTC.

Kliniczne znaczenie rozpoznania zmiany pęcherzykowej bliżej nieokreślonej (grupa III wg Systemu Bethesda) w biopsji aspiracyjnej cienkoigłowej (BAC)

“…The authors of one of the large studies base the initial diagnostics on the work of screeners. However, the published data do not differ from other analyses [8].…”

“…The expected risk of malignancy in this class ranges between 5 and 15% [2,7]. The creation of this category reduces the malignancy risk and the number of unnecessary surgical interventions in favour of repeat FNA and correlations of cytological, clinical, and ultrasonographic presentation [7,8].…”

“…Ho et al in the analysis of 541 DC III diagnoses reported surgical removal in 350/541 (64.7%) cases [7]. Harvey et al showed 25% (18/72) of excisions [8].…”

Podejrzenie nowotworu pęcherzykowego czy nowotwór pęcherzykowy? Dylemat patologa i chirurga

“…Harvey et al compared the results of FNA before and after the implementation of BSRTC on groups of similar size (3302 and 3432), obtaining 309 and 79 of DC IV, respectively. 70% from the 1st and 33% from the 2nd group were histopathologically verified, receiving the diagnoses of malignancy in 26% and 7%, respectively [14]. Moreover, they submitted an analysis of 11 studies comparing the number of surgical resections in DC IV category.…”

“…These studies often come from different medical centres, and the stains vary because of the need to collect a sufficiently large cohort. An overwhelming majority of researchers use Papanicolau stain [5,6,10,14,18,[20][21][22][23][24][25][26][27][28].…”