Correlation of Bethesda cytopathology classification with Ti Rads: When surgery is necessary?

Abstract

Teaching Points (1) A brief review of Bethesda system;(2) A review of Ti-Rads system;(3) To confront the two systems for recommending surgery. Table of Contents/Outline Bethesda and Ti-Rads improves communication among cytopathologists, radiologists, surgerons and physicians. Bethesda has 6 categories for thyroid FNA. The categories stratify the risk of malignancy and recomend clinical management. The Bethesda classification: I- Nondiagnostic, II- Benign, III- Atypia of Undetermined Significance (not able to be classify as benign, suspicious, or malignant), IV- Follicular Neoplasm (cytologic do not allow diagnosis of carcinoma or adenoma), V- Suspicious for Malignancy (incomplete cellular malign architectural) and VI- malignant. Ti-Rads has 5 categories. 1- normal, 2-certainly benign (simple cyst, septated cyst or isolated macrocalcification), 3- very probably benign (oval shape, regular borders, iso or hyperechoic), 4A– suspicous nodules but low risk of malignancy (oval shape, regular borders and mildly hypoechoic), 4B- suspicious nodules with high risk of malignancy, 1 or 2 high suspicious features (taller-than-wide, spiculated, markdely hypoechoic and microcalcifications), 5-certainly malignant (3 or 5 suspicious features and/or presence of metastatic node). Whenever you have Bethesda III, IV and V with Ti-Rads 4B- and 5, patient should undergo surgery.