Bethesda System For Thyroid Cytopathology Research Articles

Nitric oxide, thyroglobulin, and calcitonin: unraveling the nature of thyroid nodules.

Thyroid nodules (TN) are localized morphological changes in the thyroid gland and can be benign or malignant. The present study investigates the relationships between biochemical markers in serum (s) and their homologs in washout (w) after fine-needle aspiration biopsy (FNAB) of the TN of interest and their correlation with cytology specimen findings. We investigated the relationships between serum biochemical markers nitric oxide (NO), thyroglobulin (TG), and calcitonin (CT), their homologs in washout after FNAB of the TN of interest, and cytology findings of biopsy samples classified according to the Bethesda system for thyroid cytopathology in this study, which included 86 subjects. Washout TG (TGw) level positively correlates with the cytology finding of the biopsy. A higher level of TGw correlates with higher categories of the Bethesda classification and indicates a higher malignant potential. The levels of serum NO (NOs), serum TG (TGs), serum CT (CTs), and washout CT (CTw) do not correlate with the cytology finding of the biopsy, and the higher levels of washout NO (NOw) correspond to the more suspicious ultrasound findings. The findings of our study suggest that TGw and NOw could be used as potential predictors of malignancy in TN.

Radio-Pathological Correlation of Suspected Malignant Thyroid Nodules using Elastography strain ratio and Bethesda Classification for Thyroid Cytopathology

Objectives: To determine the diagnostic performance of elastography strain ratio (SR) for the diagnosis of malignant thyroid nodules taking fine needle aspiration cytology (FNAC) as the gold standard at a tertiary care hospital in Pakistan. Methods: This is a cross-sectional study. A total of 150 cases aged 20-60 years, of either gender, who presented with palpable/suspected malignant thyroid nodules of any size with Thyroid Imaging Reporting and Data System (TIRADS) category 3 or above on ultrasonography were included. These were further evaluated by elastography and ultrasoundguided fine needle aspiration cytology (FNAC). The elastography SR of the nodules was assessed. Final diagnosis was made using ultrasound-guided FNAC. Relevant clinical and demographic data were obtained from patient charts. The diagnostic sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were calculated for elastography using FNAC as a gold standard. Results: The mean age of all patients was 41.8±8.6 years (range: 20-60 years). There were 97 (64.67%) males and 53 (35.33%) females. The majority of patients, 50 (33.33%), belonged to age category of 41 to 50 years. Taking elastography SR of > 2.32 as the cut-off, 69 (46.0%) nodules were positive, and 81 (54.0%) were negative. The FNAC results showed that 72 (48.0%) were positive, and 78 (52.0%) were negative. The diagnostic sensitivity of SR was 92.31%, specificity, 87.50%, positive predictive value, 88.89% and negative predictive value was 91.30%. The overall diagnostic accuracy was estimated to be 87.5%. Conclusion: The results from this study show that elastography and SR are highly valuable in discriminating benign from malignant thyroid nodules. These may serve as an affordable and reliable alternative diagnostic technique, particularly in the developing world. Keywords: Bethesda system for thyroid cytopathology, elastography, strain ratio, thyroid incidentalomas, thyroid nodules

Thyroid Lesions: Cytomorphological Classification of Fine Needle Aspiration Cytology into Modified Bethesda System: A 3-Year Retrospective Study

Introduction Thyroid nodule is a common disorder found among the Indian population. Fine Needle Aspiration Cytology (FNAC) is a useful initial screening test for thyroid nodules. FNAC also avoids unnecessary surgery done in the case of benign thyroid nodules. Materials and Methods A retrospective study over three years (January 2019 to December 2021). All Thyroid nodule patients were sent for FNAC. Results A total of 160 totals were studied in three years. The Cytopathological diagnosis was made and categorization was done on basis of, The Bethesda System for Thyroid Cytopathology (TBSRTC). Conclusion FNAC is the most cost-effective, simple, rapid, and useful preliminary method of examination that leads to the diagnosis of thyroid lesions. TBSRTC is a very valuable, practical, and universally acceptable standardized system of reporting thyroid lesions that helps in assessing the risk of malignancy in each Category.

Malignancy Rates in Thyroid Nodules Classified as Bethesda III and IV; Correlating Fine Needle Aspiration Cytology with Histopathology.

Fine needle aspiration cytology (FNAC) is an integral part in the diagnostic work up of thyroid nodules. FNAC reports are based on Bethesda system for thyroid cytopathology which is one of the most commonly used systems worldwide. The main objective of the present study was to evaluate the malignancy rates in Bethesda category III and IV thyroid nodules over a six-year period. 642 thyroid FNAC were performed over a six-year period. The medical records of all these patients were reviewed using electronic patient records. Cases reported to have Bethesda category III and IV were included in the study. Data for these patients were reviewed to determine the relationship between these categories and thyroid cancer. There were 41 cases of category III of which 19 underwent surgery and the malignancy rates were found to be 26.3%. Category IV consisted of 50 cases of which 45 underwent surgery and the malignancy rates were 26.6%. The results from our study are similar to findings in larger multicentric studies which found that malignancy rates for Bethesda category III and IV were 10-30% and 25-40%, respectively.

A Retrospective Study Correlating Ultrasound Based Thyroid Imaging Reporting and Data System (TIRADS) with Bethesda System for Thyroid Cytopathology in Thyroid Nodule Risk Stratification

Objective: To evaluate the efficacy of the ultrasound-based Thyroid Imaging Reporting and Data System (TIRADS) in estimating the risk of malignancy in thyroid nodules by correlating it with the Bethesda system of thyroid cytopathology. Methods: A retrospective single-center study was conducted in a specialty hospital in UAE from November 2017 to November 2019 on 259 thyroid nodules that underwent ultrasound and fine-needle aspiration cytology (FNAC). Thyroid nodules were evaluated using American College of Radiology (ACR) TIRADS and categorized as benign (TR1), not suspicious (TR2), mildly suspicious (TR3), moderately suspicious (TR4), or highly suspicious (TR5) for malignancy. The risk of malignancy associated with each TIRADS category was evaluated by comparing it with the Bethesda classification system of cytopathology. Results: Ultrasound and FNAC data of 259 nodules were reviewed. Out of these, 33 (12.7%) nodules were excluded because FNAC revealed atypia of undetermined significance or follicular lesion of undetermined significance. The estimated risk of malignancy in TR 3 was 13.6%, TR4 was 27%, and TR5 was 63.6%. There was a statistically significant correlation between TIRADS and Bethesda system, which was determined using the Chisquare test (p < 0.001). The receiver operating curve (ROC) analysis revealed specificity of 81.3% [95% CI, 74.9 - 86.6%], NPV of 91% [95% CI, 87.1 – 93.8%] and accuracy of 77.9% [95% CI, 71.9 – 83.1%], when differentiating benign from malignant nodules. Conclusion: The ultrasound-based ACR-TIRADS scoring correlates well with the Bethesda cytopathology in thyroid nodule risk stratification. Thus, it can be used as a simple and effective tool to decide further management and avoid unnecessary FNAC and surgeries in thyroid nodules.

A PROSPECTIVE STUDY FOR REPORTING THYROID FINE NEEDLE ASPIRATES BY THE BETHESDA SYSTEM WITH HISTOLOGICAL CORRELATION

BACKGROUND: To reduce ambiguity in diagnostic terminology in thyroid ne needle aspiration cytology (FNAC),The Bethesda System for Reporting Thyroid cytopathology (TBSRTC) system is a universal reporting system for standardization and could help in assessing the prognosis by estimating the malignant potential of each category . AIMS:The aim of the study is cytodiagnosis of thyroid ne needle aspirates and uniformity in the reporting as per Bethesda system. Histological examination was also conducted so that a correlation between cytodiagnosis and histopathological examination could be made. MATERIALS & METHODS: This prospective study done on patients (125) presenting with thyroid swelling and advised for FNAC by clinicians, diagnosed according to the Bethesda system of thyroid cytopathology reporting . Then, correlation with histopathological report done in cases(55) in which surgery were done. RESULTS:The distribution of cases were as follows: 2 nondiagnostic(1.6%),89 cases(71.2%) were classied as benign, 6 cases (4.8%) were classied as atypia of undetermined signicance /follicular lesion of undetermined signicance/AFLUS, 7 cases(5.6%) were classied as follicular neoplasm/SFN, 3 cases( 2.4% ) were classied as suspicious, and 18 cases( 14.4%) were classied as malignant.In our study, rates of malignancy for each category are : nondiagnostic-0%, benign-4.76%, AFLUS- 16.67% ,SFN-28.57%, suspicious- 66.67% and malignant-94.12%.

Indian experience of AUS/FLUS diagnosis: is it different from rest of Asia and the West?-A systematic review and meta-analysis.

Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is the most heterogeneous subcategory of the Bethesda system for thyroid cytopathology with laid down permissible limits of frequency and risk of malignancy (ROM). Due to differences in thyroid clinical practice worldwide, variations have been found in frequency, resection rates (RR) and ROM. Therefore, this systematic review and meta-analysis of AUS/FLUS across different regions was conducted and comparison of data from India was done with the rest of Asia and the West. We searched PubMed and Google search engines from January 2009-Dec 2019 using terms "AUS Thyroid" and "FLUS Thyroid". Meta-analysis was performed using DerSimonian-Laird method and 95% confidence intervals were calculated using random effects model. Independent samples t-test was used to compare frequency, RR, and ROM of AUS/FLUS between India, rest of Asia and the West. Out of 15,000 studies on internet, 60 (18 Indian, 12 Asian and 30 Western) were included. Total aspirates were 201,657; 14,279 Indian, 62,448 Asian, 124,930 Western. Pooled estimates were: frequency 7.3% (6.3-8.3%), RR 41.9% (37.4-46.6%), ROM 33.3% (26.8-39.9%). Pooled prevalence of rate did not vary significantly across the three regions. Pooled prevalence of RR was highest in India (52.9%) and lowest in rest of Asia (26.5%); of ROM was highest in Asia (45.9%), lowest in the West (26.3%) (P<0.01). Statistical analysis demonstrated publication bias, limited to Indian and Western studies. Papillary thyroid carcinoma was the most common surgical diagnosis (87.9%; 1,082/1,231). This meta-analysis showed differences in thyroid clinical practice followed in India, rest of Asia and the West. Although pooled prevalence of rate of AUS/FLUS was similar across the three, pooled RR and ROM varied. AUS/FLUS nodules were more frequently resected in Indian and Western studies than in rest of Asia. ROM was higher than recommended values in all three areas, being intermediate for India.

Evaluation of fine needle aspiration cytology of thyroid lesions by Bethesda system and its histopathological correlation

: The Bethesda system of thyroid cytopathology (TBSRTC) established a standardized, category –based reporting system for thyroid fine needle aspiration cytology. The objective of this study was to analyse the thyroid cytology smears by TBSRTC, and to determine the distribution of diagnostic categories and subcategories, to analyse cytomophologic features and to correlate cytopathology with histopathology wherever surgery was done. In this study FNA of 248 patients of clinically palpable thyroid and deep-seated lesions were evaluated and categorised according to bethesda system of reporting thyroid cytopathology. 66 patients underwent surgical management in our hospital. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNA reported under bethesda system were obtained by comparing the cytological and histopathological diagnosis where ever possible. The distribution of various categories from 248 evaluated thyroid nodules is as follows: 2.82% ND/UNS, 83.87% Benign, 4.03% AUS/FLUS, 2.41% FN, 0.8% SFM and 6.04% malignant. Sensitivity, specificity, positive predictive value, negative predictive value were calculated. Simplicity, diagnostic accuracy and most of all cost effectiveness of FNA of thyroid has gained wide spread acceptance as first-line diagnostic test in the pre-operative evaluation of thyroid lesions. TBSRTC is an excellent reporting system for thyroid FNA. It also provides clear management guidelines to clinicians.

Comparative evaluation of Bethesda system with conventional reporting method in assessment of thyroid malignancy rate

Introduction: Fine needle aspiration cytology (FNAC) of thyroid is non-invasive, cost-effective & extremely useful technique in identifying a substantial proportion of thyroid nodules as benign & appropriately triages patients with thyroid cancer to appropriate surgery. The Bethesda system for reporting thyroid cytology represents a major step towards improved clinical significance, reproducibility, standardization & greater predictive value of FNAC thyroid. Objective: To categories thyroid lesions according to Bethesda system & to determine the rate of malignancy in each cytologic category by correlating the result with histopathologic diagnosis on the resected specimens. Material & Methods: The present study was carried out on 100 patients of thyroid swelling referred to the department of pathology, for FNAC. The reporting was done by using Bethesda system of thyroid cytopathology in comparison to the conventional reporting system. The malignancy rate based on final histopathologic evaluation was analyzed for each of the cytologic groups. Results: Rates of malignancy in each category of conventional system reported on follow up HPE were 16.66% in non-diagnostic group, 2.17% in colloid garter, nil in colloid cyst, 25% in thyroiditis, 7.69% in follicular lesion/ neoplasm, 33.33% in indeterminate group, 75% in suspicious for malignancy & 100% in malignant category. Rates of malignancy in each category of Bethesda system on follow up HPE were 16.66% in Non Diagnostic, 1.58% in benign category, 28.57% in atypical of undermined significance, 18.18% in suspicious for follicular neoplasm, 80% in suspicious for malignancy & 100% in malignant category. Conclusion: By adapting the Bethesda cyto-pathology reporting system malignancy risk in the categories of AFLUS, SM & Malignant category help to determine a better patient outcome due to proper clinical management.

Efficiency of the Bethesda System for Thyroid Cytopathology

IntroductionFine-needle aspiration biopsies are a key tool for preoperative assessment of thyroid nodules, and the Bethesda system is the preferred method to report cytological analysis. The purpose of this study is to assess the efficiency of the Bethesda system to identify the malignancy risk of thyroid nodules. MethodsPatients who underwent thyroid surgery between June 2010 and June 2017 were included. Samples were classified into six categories according to rates of malignancy associated with each diagnostic category. In order to investigate the correlation between categories, a statistical analysis compared the categories with pathology reports. Diagnostic indicators were calculated as a screening test (categories IV, V, VI as true-positive) and as a method to identify malignancy (V, VI as true-positive). ResultsIn a series of 522 patients, we found 184 (35.2%) malignant tumors, papillary carcinoma being the most prevalent with 155 cases (84.2%). Malignant rates for diagnostic categories were: I, 0%; II, 1.5%; III, 6.4%; IV, 31%; V, 86.5%; VI, 100%. A robust correlation was identified between categories on statistical analysis. For the “screening test” analysis, sensitivity was 98.9%, specificity 84.4%, positive predictive value 69.6%, negative predictive value 99.5%, and diagnostic accuracy 88.2%. Analysing the accuracy to detect malignancy, values were: sensitivity 98.6%, specificity 97.6%, positive predictive value 93.5%, negative predictive value 99.5%, diagnostic accuracy 97.9%. ConclusionThe Bethesda system is a clear and reliable approach to report thyroid cytology and therefore is an effective tool to identify malignancy risk and guide clinical management.

What Are the New Features of the 2017 Bethesda System for Thyroid Cytopathology?

What Are the New Features of the 2017 Bethesda System for Thyroid Cytopathology?

Better thyroid cytopathology reporting and interpretation using different classification systems

Context: Palpable thyroid nodules may be found in 4-7% of the general population and can be approached by fine needle aspiration cytology (FNAC). Standardized terminology for thyroid cytopathology reporting is due need of the time. Aims: To (1) classify various thyroid lesions in Bethesda reporting pattern. (2) Classify the various thyroid lesions in the UK the British Thyroid Association/The Royal College Pathologist (BTA/RCP) Thy 1−Thy 5 categories. (3) Compare the results of both systems with old conventional system of reporting. Settings and Design: UP Rural Institute of Medical Sciences and Research, Saifai, Etawah and Jawaharlal Nehru Medical College, Sawangi, Wardha. Subjects and Methods: Totally, 300 thyroid lesions who attended the pathology department of both colleges were taken and classified in different classification systems, and their comparative analysis was done. Statistical Analysis Used: SPSS. Results: Total number of patients was 300. The age range was 10-70 years for both genders. Maximum Number of cases was in 20-29 years of age. The conventional reporting pattern classified 33 cases as inadequate, 233 cases as benign, Follicular adenoma 10 cases, indeterminate 13 cases, and malignancy 11 cases. In the Bethesda System of thyroid cytopathology, there were 234 cases, 6 cases, 9 cases, 3 cases, and 15 cases in category II, III, IV, V, VI, respectively. The RCP Thy 1−Thy 5 categories included 18 cases in Thy 1, 15 cases in Thy 1c, 171 cases in Thy 2, 63 cases in Thy 2c, 6 in Thy 3a, 9 in Thy 3f, 3 in Thy 4, and 15 in Thy 5 categories, respectively. Conclusions: The Bethesda System of thyroid classification and UK the BTA/RCP has superior edge over the conventional reporting pattern and should be followed more commonly and should be incorporated in routine reporting pattern for thyroid FNAC.