To Establish Bethesda System for Diagnosis of Thyroid Nodules on the Basis of F NAC with Histopathological Correlation

Abstract

Original Article IntrOductIOnThyroid nodules are common, varieties of benign and malignant lesions of thyroid present as nodules. At our tertiary care centre, we do not have provision for IHC and other higher investigation. Also, the majorities of patients are from lower socio economic class and can't afford higher investigation in private laboratories. As a result of which our study is based on cytological diagnosis of thyroid lesions according to Bethesda system and it's histopathological correlation. The Bethesda system of thyroid lesion on FNAC reporting, aims at standardization of reports. It bridges the communication gap between clinicians and pathologists and thus helps the surgeons to take appropriate therapeutic interventions [1]. AImTo elucidate the diagnostic utility of the Bethesda system in reporting thyroid FNAs and to assess the effectiveness of FNAC in the evaluation of thyroid nodules by comparing the results with histopathological evaluation. mAterIAls And methOdsThe present study was carried out in our institute during the July 2012 to September 2014 (Prospective study). The study comprised of 100 patients who presented with the history of swelling of thyroid which were referred from the Departments of Surgery, Medicine & ENT. Patients were explained about the procedure and written consent was taken.Inclusion criteria: Patient of both gender, age 10 to 80 years, presenting with thyroid swelling in any lobe of thyroid selected by clinical palpation (multinodular, solitary nodules, diffuse goiter, etc) and patients with recurrent thyroid swellings after a previous thyroid surgery.FNAc was performed in all cases of midline neck swelling by cytopathologist. Proper consent was taken. The patient asked to lie in supine position with their neck stretched up. A 23-24 gauge needle is used to perform the fine needle aspiration. The cytological diagnosis was given according to the Bethesda system. The Keywords: Fine needle aspiration cytology, Predictive value, Sensitivity, Specificity Aim:The aim of this study was to elucidate the diagnostic utility of the Bethesda system in reporting thyroid FNAs and to assess the effectiveness of FNAC in the evaluation of thyroid nodules by comparing the results with histopathological evaluation. materials and methods:The present study was carried out in our institute during the July 2012 to September 2014. In this study, 100 FNACs done which were classified according to the Bethesda system and out of them, 60 histopathological evaluations obtained from this group were evaluated. The sensitivity, specificity, positive and negative predictive values were evaluated.results: Out of 100 FNACs, 06% were Non-diagnostic, 78% were Benign, 04% were Atypical follicular lesion of undetermined significance (AFLUS), 04% were suspicious for Follicular neoplasm (SFN), 01% were suspicious for Follicular neoplasm Hurthle cell type, 03% were suspicious for malignancy (SM), and 04% malignant. In 60 cases, data of follow-up histopathologic examination (HPE) were available. The sensitivi...

Thyroid Cytology in India: Contemporary Review and Meta-analysis

“… Forest plot of meta-analysis on the risk of malignancy for Bethesda category IV (follicular neoplasm/suspicious for a follicular neopla sm)[ 14 - 17 , 21 , 23 , 30 - 35 , 37 , 38 , 42 , 44 , 45 ,; 46 , 49 , 50 , 52 - 54 , 56 , 60 , 61 , 63 ]. ES, effect size ; CI, confidence interval.…”

Concordance between the TIRADS ultrasound criteria and the BETHESDA cytology criteria on the nontoxic thyroid nodule

“…Nevertheless, the implementation of this reporting system has shown significant diagnostic variability, both inter and intra pathologists, particularly when read as “atypical cells of undetermined significance, follicular lesion of undetermined significance, or follicular neoplasm” (also termed as Bethesda Category III, comprising a heterogeneous population of low-risk lesions that contain follicular cells exhibiting either architectural abnormalities or nuclear atypia that do not fit into other definitive cytological categories). A recent meta-analysis evaluated the validity of the Bethesda reporting system and found 97% sensitivity, 50.7% specificity and 68.8% diagnostic accuracy; the negative and positive predictive values were 96.3 and 55.9%, respectively [ 7 , 8 ]. Notwithstanding the fact that both US and FNA biopsy are widely recommended procedures to study patients with thyroid nodules, the value of the existing concordance between the two methods has not been established.…”

The Bethesda system for reporting thyroid cytology: a prospective study in a tertiary care institute along with review of literature

“…50.7%, 64.6%, 84.3% and 89.5% respectively. 9,28,29,31 It was slightly lower in study conducted by Kujur et al i.e., 91.9%. 32 Positive predictive value in our study was 100%, comparable with Arul et al i.e.…”

“…[7][8][9]24,26,27 The sensitivity of TBSRTC in our study was 90.4% which was comparable to the study conducted by Muratli et al and Garg et al i.e., 87.1% and 88.9% respectively. 28,29 It was higher in studies conducted by Bongiovanni et al and Arul et al i.e. 97% and 94.4% while it was lower in studies conducted by Mehrotra et al and Kujur et al constituting 69.2% and 80% respectively.…”