Abstract
The Italian SIAPEC-AIT 2014 classification, the 2017 Bethesda System for Reporting Thyroid Cytology (TBSRTC), the 2016 UK Royal College of Pathologists (RCPath) thyroid reporting system, and the 2019 Japanese reporting system for thyroid aspiration cytology (JRSTAC2019) represent the most widely used reporting systems among clinicians and pathologists for the purpose of cytologically diagnosing, estimating the potential risk of malignancy (ROM), and defining the most appropriate treatment for a patient with a thyroid nodule. Although all the systems use overlapping diagnostic categories and morphologic criteria, they differ on the basis of the criteria for inclusion in the cytologic categories, which may, in turn, affect the ROM of a given category and the clinical management of the patient, particularly with regard to the “indeterminate” categories. The aim of this review is to analyze the main differences that emerge between the systems and to propose possible solutions for a comprehensive reporting system that integrates and harmonizes all the criteria of the Italian classification and the Bethesda system, also taking into account the impact that the new tumor entity NIFTP (non-invasive follicular tumor with papillary-like nuclear features) that has, in many instances, replaced the non-invasive form of the follicular variant of papillary carcinoma, has had on the modification of malignancy risks.
Highlights
The diagnosis of thyroid nodules represents an important problem for clinicians and pathologists, especially regarding the diagnostic framing and the choice of the most appropriate treatment
In order to distinguish nodules to be sent for surgical treatment from those to be observed over time with clinical and ultrasonographic examinations, classifications based on cytological criteria have been drawn up
The purpose of this review is to discuss these differences in order to propose a common reporting system that can be used for all patients with thyroid nodules
Summary
The diagnosis of thyroid nodules represents an important problem for clinicians and pathologists, especially regarding the diagnostic framing and the choice of the most appropriate treatment. In addition to clinical and ultrasonographic examination, the study of thyroid nodules is performed by fine needle aspiration (FNA) or needle aspiration, a rapid, effective, safe, and cost-effective procedure. This technique allows, through fine needle aspiration under ultrasound guidance, to prepare cytological preparations and study the morphology of the cells of the lesion [4]. In order to distinguish nodules to be sent for surgical treatment from those to be observed over time with clinical and ultrasonographic examinations, classifications (or reporting systems) based on cytological criteria have been drawn up. The purpose of this review is to discuss these differences in order to propose a common reporting system that can be used for all patients with thyroid nodules
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