The sydpath post-bethesda experience: an audit of thyroid fine-needle aspiration biopsy reports from 2008–2013

Abstract

Aim This study is an evaluation of thyroid fine-needle aspiration (FNA) diagnostic reports from 2008 to 2013, during which there was continual implementation of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Methods Thyroid FNA reports from 2008 to 2013 (inclusive) were reviewed by the author and categorised 1 to 6 according to TBSRTC. Reports interpreted as ‘unclear’ or ‘equivocal’ as to the category were retrospectively coded by the original reporting cytopathologist. FNA reports were counted, tabulated and analysed. Results A total of 2956 FNA reports were reviewed. From 2008 to 2013, there was an overall increase in FNAs reported; concurrently there was a decrease in Categories 1 (e.g. ‘nondiagnostic’ and ‘insufficient’ FNAs) and 3 [e.g. follicular lesion of uncertain significance (FLUS) and atypia of indeterminate significance (AUS)]. Discussion The aggregate mean data correlates well with TBSRTC recommendations for distribution of categories. The continual adoption of TBSRTC correlates with an improvement in clarity of reporting language. The decreases in Categories 1 and 3 could be the result of more strict use of diagnostic reporting criteria. Retrospective review of ‘unclear’ and ‘equivocal’ reports can be useful to monitor and improve reporting approach. This study is an evaluation of thyroid fine-needle aspiration (FNA) diagnostic reports from 2008 to 2013, during which there was continual implementation of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Thyroid FNA reports from 2008 to 2013 (inclusive) were reviewed by the author and categorised 1 to 6 according to TBSRTC. Reports interpreted as ‘unclear’ or ‘equivocal’ as to the category were retrospectively coded by the original reporting cytopathologist. FNA reports were counted, tabulated and analysed. A total of 2956 FNA reports were reviewed. From 2008 to 2013, there was an overall increase in FNAs reported; concurrently there was a decrease in Categories 1 (e.g. ‘nondiagnostic’ and ‘insufficient’ FNAs) and 3 [e.g. follicular lesion of uncertain significance (FLUS) and atypia of indeterminate significance (AUS)]. The aggregate mean data correlates well with TBSRTC recommendations for distribution of categories. The continual adoption of TBSRTC correlates with an improvement in clarity of reporting language. The decreases in Categories 1 and 3 could be the result of more strict use of diagnostic reporting criteria. Retrospective review of ‘unclear’ and ‘equivocal’ reports can be useful to monitor and improve reporting approach.