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Bethesda classification of thyroid lesions and hypothyroidism: Bethesda Classification of Thyroid Nodule Fine Needle Aspirations

Musholt , Kate Newbold , Iain J. Acta Cytol —

The Royal College of Pathologists system uses the Thy originally suggested categories but with expanded specifications for each category. Histopathological specimens, wherever available, were processed as per standard methods. Jo, E. West, and E. Results 3.

  • Support Center Support Center. Table 3 Histopathology of thyroid fine needle aspiration cytology nodules by The Bethesda System for Reporting Thyroid Cytopathology categories.

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  • There were 33 FNA specimens referred for a second expert opinion, out of which 20 nodules were surgically removed.

  • As a function of these risk associations, each category is linked to evidence based clinical management guidelines.

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Mufti ST, Molah R. All patients were subjected to FNA sampling under ultrasound guidance by one of the two authors using Zajdela technique times randomly in different areas [ 6 ]. Table 1. Fine needle aspiration of the thyroid: Correlation with final histopathology in a surgical series of patients.

Table 5. This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Committee V of the NCI Thyroid Fine Needle Aspiration State of the Science Conference has provided guidelines for indications of ancillary studies, specific ancillary studies to be performed, and sample preparation for each study. Basak, D.

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Benjamin J. As a function of their risk associations, each category is linked to thyroid lesions, evidence-based clinical management recommendations. The BSRTC recommends subclassification of the atypia, even though this will not generally affect patient management. SadowFadi A. Catherine A. The recent reclassification of some thyroid neoplasms as noninvasive follicular thyroid neoplasm with papillary-like nuclear features NIFTP has implications for the risk of malignancy, and this is accounted for with regard to diagnostic criteria and optional notes. Susan C.

Using TBSRTC, cytopathologists can communicate their interpretations to the referring physician in terms that are succinct, unambiguous, and clinically useful 1—3. For this reason, nodules in this category typically require surgical removal to make a definitive diagnosis. McGettiganCesar A. LamLaila KhazaiZachary J.

BACKGROUND

Staerkel, MD, Edward B. New Password. Randolph, MD, Andrew A.

  • The rest were all benign thyroid lesions including one Hurthle cell neoplasm and one follicular adenoma.

  • Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance Biopsies in this category are adequate specimens, but the features seen on cytology are not diagnostic of either a benign process or of a tumor. PittMegan C.

  • Bongiovanni, A.

  • Histopathological specimens, wherever available, were processed as per standard methods. Unless otherwise specified, multiple visits and repeat FNA cytology on the same patient were treated as independent incidences.

  • Benson et al. Background was blood-mixed with colloid in

SadowFadi A. Camilo Gonzalez-Velazquez and Juan P. Using TBSRTC, cytopathologists can communicate their interpretations to the referring physician in terms that are succinct, unambiguous, and clinically useful 1—3. Ringeland Jennifer A.

In these biopsies not enough thyroid cells were obtained to render a diagnosis. Second edition. Henry, MD, Jeffrey F. LamLaila KhazaiZachary J. GoldnerTrevor E.

II. Benign

Paschke et al. A total of patients underwent FNAs during the study period. Twenty cases were benign by both cytopathology and histopathology. Yang, V.

In these biopsies not thyroid lesions thyroid hypothyroidis, were obtained to render a diagnosis. This accounts for 10 percent of the biopsies, even in the most experienced hands. CrossrefMedlineGoogle Scholar. The ROM differs according to the nature of the atypia. AngellHoward T. Benign In this category, the specimen was adequate and the cytopathologist can definitively call the nodule benign. For a thyroid FNA specimen to be satisfactory for evaluation and benignat least six groups of benign follicular cells are required, each group composed of at least 10 cells.

This can be useful in guiding the clinical team in the direction of lobectomy rather than classsification for this subset of SUS cases. If the address matches an existing account you will receive an email with instructions to reset your password. Forgot your password? Dianna L. The general recommendation is to repeat the fine needle aspiration biopsy in 6 weeks.

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Parathyroid hormone PTH assays on the needle washout of FNA specimen of suspected parathyroid tissue are further tools of localizing parathyroid adenomas [ classificayion19 bethesda classification of thyroid lesions and hypothyroidism. Charak, former Head of the department of surgery, and Dr. The pus obtained was negative for acid fast bacilli and fungus. An AUS result has been reported in 3. There is significant overlap in the cytomorphologic features of cells derived from parathyroid and thyroid gland, although previous study suggested that the presence of stippled nuclear chromatin, prominent vascular proliferation with attached epithelial cells, and frequent occurrence of single cells and naked nuclei are useful clues that favor parathyroid origin [ 17 ].

Histopathologically 3 of them turned out to be papillary thyroid carcinoma, but 2 were lymphocytic Hashimoto thyroiditis. Histopathology was received for 6 cases of SFM. Previous studies have reported nondiagnostic FNAs as having malignancy rates ranging 2— Preoperative detection of a parathyroid adenoma can sometimes be challenging.

Immunohistochemistry panels have been suggested for suspicious malignancies which include medullary carcinoma calcitonin, thyroglobulin, CEA, and chromograninhypothyroidism carcinoma pan-cytokeratinand metastatic carcinoma TTF None of the cases with a malignant diagnosis on cytology proved to be benign on biopsy and 3 cases out of 23 that were benign on cytology proved to be malignant lesion on examination of tissue specimen. Fine-needle aspiration of the thyroid: An overview. Thanks for visiting Endocrinology Advisor. This is the category with the greatest uncertainty, as follicular carcinomas resemble benign follicular neoplasms at the cellular level, making it difficult to distinguish between benign and carcinogenic nodules without additional indication.

Sterrett, and D. Ann Surg Oncol. The cytopathology files were searched for all thyroid FNAs performed between 1 January and 31 December Among the 6 cases of SPTC, 4 were confirmed to be malignant PTC after surgery, 1 case was benign, and 1 case was diagnosed as atypical parathyroid neoplasm by surgical pathology. Journal overview.

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Table 3. Most of these will turn out to be follicular adenomas which are benign. In our study, interestingly, repeated FNA had been done in 7 cases only out of 85 cases, while surgical resection was done in 25 cases.

This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any aand, provided the original work is properly cited. Committee IV dealt with diagnostic terminology and morphologic criteria for cytological diagnosis of thyroid lesions. References H. The present study had 16 7. INCIs are not specific for papillary thyroid carcinoma as they may be seen focally in benign thyroid nodules.

Oertel, MD, Martha B. Close Figure Viewer. For this subset, the following optional note or something similar may be useful 23 :. Password Changed Successfully Your password has been changed. Elsheikh, MD, William C.

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Malignant In this category, the cytopathologist sees all of the features necessary to make the hypothyriodism of malignancy. Benign In this category, the specimen was adequate and the cytopathologist can definitively call the nodule benign. Search for more papers by this author. In Partnership with Winthrop Surgical Associates. Consistent with a benign follicular nodule includes adenomatoid nodule, colloid nodule, etc.

Hypothyroldism clinicians were communicated implied risk of malignancy and recommended clinical management along with the report. Asa, K. It is difficult to determine if these lesions are benign, suspicious, or malignant, and these nodules often require re-evaluation. Pleomorphism was present only in 2. Slides were stained with Wright stain and Papanicolaou stain.

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Kessler, H. In contrast, the other systems do not bethesda classification of thyroid lesions and hypothyroidism elsions a risk of malignancy for each category, although their diagnostic categories are related to a management algorithm. Nondiagnostic or Unsatisfactory In these biopsies not enough thyroid cells were obtained to render a diagnosis. Previous studies have reported nondiagnostic FNAs as having malignancy rates ranging 2— Williams, and N. Similar to TBSRTC, all other reporting systems also provide categories for nondiagnostic cytology samples, benign lesions, and malignant lesions.

Materials and Methods: This study presents our experience with the Bethesda system in thyroid FNAs from patients in the period between January and December Twenty cases were benign by both cytopathology and histopathology. Consistent with lymphocytic Hashimoto thyroiditis in the proper clinical context. Rates of thyroid malignancy by FNA diagnostic category.

I. Nondiagnostic or Unsatisfactory

Using TBSRTC, cytopathologists can communicate their interpretations to the referring physician in terms that are succinct, unambiguous, and clinically useful 1—3. HellerEdmund S. Table 2. Subsequent experience, it is expected, will lead to further refinements to this terminology framework. JAMA Oncol —

Subsequent experience, it is expected, will lead to further refinements to this terminology framework. Hypothydoidism, MD, Andrew A. SmithErik K. Note: Although the architectural features suggest a follicular neoplasm, some nuclear features raise the possibility of an invasive follicular variant of papillary carcinoma or its recently described indolent counterpart, NIFTP; definitive distinction among these entities is not possible on cytologic material.

Ali AlmahariMD. Patients missing follow-up data were excluded. Four cases were malignant by both cytopathology and histopathology. Table 4 Terminology of thyroid cytology reporting classifications. Photomicrographs showing predominantly cohesive, syncytial-like clusters with few isolated plasmacytoid cells Smear, Giemsa stain.

International Journal of Endocrinology

Johnson, and M. Basak, D. Alexander, G.

Please review our privacy policy. Williams, S. More related articles. INCIs are not specific for papillary thyroid carcinoma as they may be seen focally in benign thyroid nodules.

  • In total, 27 out of 40, that is,

  • Such notes can be useful in helping guide surgical management.

  • Specifically, the study is to examine the incidence rates of thyroid cytological categories and the inadequate sampling rate from our practice in comparison to that from the literature. J Egypt Natl Canc Inst.

  • Cooper, MD, Barbara A.

The present study had 5 2. In cases that underwent thyroidectomy or thyroid lobectomy, the final diagnoses were determined by the reports of surgical pathology. Krauss, M. Fellegara et al. Related articles. However, patients on anticoagulation therapy were asked to stop taking their medication for 5 to 7 days prior to biopsy if possible.

The Bethesda system for bethesda classification of thyroid lesions and hypothyroidism thyroid fine bethedda aspirates: A cytologic study with histologic follow-up. Figure 3. This study presents our experience with the Bethesda system in thyroid FNAs from patients in the period between January and December It is noteworthy that, concerning the remaining year-old female case with SPTC cytology, the surgical pathology turned out to be an atypical parathyroid neoplasm. The most frequent categorization of malignant lesions was papillary thyroid carcinoma Am J Clin Pathol. Johnson, and M.

MeSH terms

JAMA Oncol — Thyroid Vol. It is worth pointing out that, of the two, AUS is more versatile; FLUS applies only to follicular lesions of undetermined significance and cannot be used if the cells are not clearly follicular in origin e. PH, Grace C.

The concordance rates between FNA cytology and surgical pathology were further analyzed. Guidance on the Reporting of Thyroid Cytology Specimens. Fine needle aspiration cytology FNAC of thyroid occupies an extremely important role worldwide. Of note, one elderly with PTC cytology who declined surgery secondary to comorbidities was not included in this further analysis. Histopathology was received for 6 cases of SFM. Ewen, and N.

Malignant In this category, the cytopathologist sees all of the features necessary to make the diagnosis of malignancy. Johnson, and M. Table 1. These 2 cases had on cytology abundant colloid in addition to follicular cells and hence were diagnosed as BFN.

Moon, and E. Bongiovanni et al. Histopathologically 3 of them turned out to be papillary thyroid carcinoma, but 2 were lymphocytic Hashimoto thyroiditis. Gerhard and S.

Thyroid — In the original BSRTC, cases that demonstrated the nuclear features of papillary thyroid carcinoma were excluded from this category. Near-total thyroidectomy or lobectomy bc. Response to Cherella et al.

  • The results of various statistical parameters are summarized in Table 5. The Bethesda System for reporting thyroid cytopathology: recommended diagnostic categories, implied risk of malignancy, and recommended clinical management.

  • For this subset, the following optional note or something similar may be useful 23 :. Every thyroid FNA should be evaluated for specimen adequacy.

  • Committee V of the NCI Thyroid Fine Needle Aspiration State of the Science Conference has provided guidelines for indications of ancillary studies, specific ancillary studies to be performed, and sample preparation for each study.

Volume 27 Issue 11 Nov Near-total thyroidectomy or lobectomy c. The general recommendation is to repeat the fine needle aspiration biopsy in 6 weeks. Surgery — Frable, MD, Kim R.

Search for more papers by this author. This can happen when a cyst is aspirated or when the specimen is almost entirely composed of blood. MusholtKate NewboldIain J. Pateland Richard T. In this category, the cytopathologist sees all of the features necessary to make the diagnosis of malignancy. Notes and recommendations are not required but can be useful in certain circumstances, particularly if the cytomorphologic features raise the possibility of NIFTP.

I. Nondiagnostic or Unsatisfactory

Brian And hypothyroidism. Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance Biopsies in this category are adequate specimens, but the features seen on cytology bethesad not diagnostic of either a benign process or of a tumor. Elena M. The revision reaffirms that every thyroid FNA report should begin with one of six diagnostic categories, the names of which remain unchanged since they were first introduced: i nondiagnostic or unsatisfactory; ii benign; iii atypia of undetermined significance AUS or follicular lesion of undetermined significance FLUS ; iv follicular neoplasm or suspicious for a follicular neoplasm; v suspicious for malignancy; and vi malignant.

There is no consensus on a lower number, however, and therefore the criteria have been retained, with the understanding that this is an evolving area that would benefit from more evidence. Centenoand Bryan McIver. Sidawy, MD, Gregg A. Cancer Cytopathol — Password Changed Successfully Your password has been changed. GoldnerTrevor E. For this reason, nodules in this category typically require surgical removal to make a definitive diagnosis.

Comparison of results of the and hypothyroidism study and random studies over the last 30 years. Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance Biopsies in this category are adequate specimens, but the features seen on cytology are not diagnostic of either a benign process or of a tumor. Summary of thyroid fine needle aspiration cytologys by The Bethesda System for Reporting Thyroid Cytopathology categories. Cytological differentiation of follicular thyroid carcinoma from PTC includes confirmation of follicular cells lacking nuclear atypia seen in PTC. There is marked decrease in positive predictive value also. Surgical Pathology Results In cases that underwent thyroidectomy or thyroid lobectomy, the final diagnoses were determined by the reports of surgical pathology. Cooper, G.

II. Benign

For this subset, the following optional note or something similar may be useful 23 :. The six general diagnostic categories are unchanged and are shown in upper case in Table 1. Table 1. Dianna L. Descriptive comments that follow are used to subclassify the malignancy and summarize the results of special studies, if any.

Learn More. Thyroid nodules. J Am Coll Surg. Show More. Abrams, B.

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Bethhesda, DO, Richard M. Table 2 shows revised risks of malignancy ROM based on data since Near-total thyroidectomy or lobectomy c. CherellaEdmund S. HellerEdmund S. NIFTP has added a wrinkle in this regard by excluding the noninvasive follicular variant of papillary thyroid carcinoma from the list of thyroid carcinomas.

Various reporting formats of thyroid FNACs have been used varying from two category schemes to six or more category schemes [ 1 ]. Of the thyroid nodules from patients which underwent FNAC, surgery was done for However a recent study found a rate of 8. Krauss, M.

The minimum requirement for group size allows one to determine by the evenness of the nuclear spacing whether it represents a fragment of a macrofollicle. PH, Grace C. A laboratory should choose the one it prefers and use it exclusively.

SmithErik K. William C. For this subset, the following optional note or something similar may be useful 23 :. Cancer — Enter your email address below and we will send you your username. Livhits and Michael W.

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Close Figure Viewer. Cibasand Ari J. Trevor E. Login to your account Username. Whitney S. Some categories have two alternative names.

Acta Cytol. Handa, S. Similar to TBSRTC, all other reporting systems also provide categories for nondiagnostic cytology samples, benign lesions, and malignant lesions. Photomicrograph showing lymphohistiocytic aggregates in lymphocytic Hashimoto thyroiditis Smear, Giemsa, x magnification.

PhayMatthew D. Follicular Thyroid Carcinoma: A Perspective. MacdonaldNadine P.

A laboratory should choose the one it prefers and use it exclusively for that category. Gilbert H. PH, Grace C. CrossrefGoogle Scholar 8 Renshaw AA Histologic follow-up of nondiagnostic thyroid fine needle aspirations: implications for adequacy criteria. MooreJustine A. Such notes can be useful in helping guide surgical management. NabhanChristian Nasrand Richard T.

  • Thompson, and S. Impact of the Bethesda system in reporting thyroid cytopathology.

  • RichmanMary C. BarlettaMatthew I.

  • Academic Editor: Marco Volante. Cooper, G.

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The actual ROM is between the values obtained using these two different calculations and thus requires extrapolation. GoldnerTrevor E. Stephanie Fish. Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance Biopsies in this category are adequate specimens, but the features seen on cytology are not diagnostic of either a benign process or of a tumor. Thyroid — NIFTP has added a wrinkle in this regard by excluding the noninvasive follicular variant of papillary thyroid carcinoma from the list of thyroid carcinomas.

Cibas, Eds. Patient with nodules in this category should undergo removal of the entire thyroid. View at: Publisher Site Google Scholar. Generally a repeat biopsy is needed several weeks after the first one.

Abstract Background. View at: Publisher Site Google Scholar. Table 6. Show More.

Diagn Cytopathol — AngellDanielle M. Some categories have two alternative names. As a function of their risk associations, each category is linked to updated, evidence-based clinical management recommendations.

  • Bongiovanni, A. World J Clin Oncol.

  • Create a new account Email. Oertel, MD, Martha B.

  • Related articles. Histologically, it turned out to be follicular adenoma.

  • Massimo BongiovanniGeorgios E.

The smears were prepared using conventional methods and stained with Giemsa and Papanicolaou stains. Abrams, B. Hence, consistent and reproducible diagnostic terminology is of utmost importance. Data were deidentified before the analysis. Franssila, and V. Guidance on the Reporting of Thyroid Cytology Specimens.

CiprianiMichael G. A laboratory should choose the one it prefers and use it exclusively. Lowering the required number of follicular cells bethesda classification of thyroid lesions and hypothyroidism save many patients a repeat FNA. Follicular Thyroid Carcinoma: A Perspective. Generally a repeat biopsy is needed several weeks after the first one. Suspicious for Malignancy Nodules in this category are very suspicious for malignancy, but the cytopathologist does not see all of the required features to make a definitive diagnosis.

Livhits and Michael W. McGettiganCesar A. Cancer — Masha J.

Biopsies in this category are adequate specimens, but the features seen on classificaiton are not diagnostic of either a benign process or of a tumor. However, whenever malignancy was identified in pathology reports, it was difficult to determine whether the carcinoma was the targeted nodule which had FNA or was just an incidental finding. Ali Almahari: moc. Article of the Year Award: Outstanding research contributions ofas selected by our Chief Editors. However a recent study found a rate of 8. However, they differ in terminologies used in reporting borderline lesions. Moroz, and E.

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The actual ROM is between the values obtained using these two different calculations and thus requires extrapolation. Cibasand Ari J. Thyroid — Brian W. PhayMatthew D. GoldnerTrevor E.

This can be useful in guiding the clinical team in the direction of lobectomy rather than thyroidectomy for this subset of SUS cases. Old Password. William C. Cibasand Ari J. Gilbert H.

Geisinger et al. As shown in Table 2all 6 cases with either benign or nondiagnostic FNA cytology were confirmed to have benign disease by surgical pathology. Of the nodules with histopathology follow-up, carcinoma was identified in 35 cases yielding an overall rate of malignancy of

Yang, MD, Matthew A. Create a new account Email. Such notes can be useful in helping guide surgical management. If the address matches an existing account you will receive an email with instructions to reset your password. Cibas and Syed Z. This is often a sparsely cellular sample but one that is comprised mostly of microfollicles.

  • There were 2.

  • Susan C. CrossrefMedlineGoogle Scholar.

  • Show More. The second case was a year-old euthyroid Caucasian female with medical history significant for coronary artery disease status postmyocardial infarction.

  • BarlettaMonica HollowellJessica R.

Enter your email address below and we will send you the reset instructions. Frable, MD, Kim R. FratesCarol B. RandolphKepal N. Near-total thyroidectomy or lobectomy bc.

BarlettaMatthew I. Adapted with permision from Ali and Cibas 7. SchneiderJason OrneCameron L. For a thyroid FNA specimen to be satisfactory for evaluation and benignat least six groups of benign follicular cells are required, each group composed of at least 10 cells. Syed Ali and Philippe Vielh, took place on May 30,and the discussions and recommendations from the symposium have been summarized in a publication by Pusztaszeri et al. Masha J.

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