The Bethesda System for Reporting Thyroid Cytopathology: A Four-Year Single Academic Institution Experience
David C Chhieng1, Constantine Theoharis1, Diane Kowalski1, Tobias Carling2, Robert Udelsman2, Adebowale J. Adeniran1
Departments of 1Pathology and 2Surgery, Yale School of Medicine, New Haven, CT, USA
ABSTRACT
Background: The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) is a standardized reporting system for classifying thyroid fine-needle aspiration results comprising of 6 diagnostic categories with unique risks of malignancy and recommendations for clinical management. Our objective was to report our past 4-year experience with the BSRTC, review its distribution and evaluate its efficiency based on the cytologic-histologic correlation.
Design: A total of 12,930 thyroid nodules undergoing FNA were examined at our institution between January 2008 and December 2011. All FNAs were classified prospectively into unsatisfactory, benign, FLUS/AUS (follicular lesions or atypia of undetermined significance), follicular neoplasm (FN), suspicious for malignancy, or positive for malignancy. The Cyto-histologic correlation was recorded.
Results: Table 1 summarizes the diagnostic frequencies. The false positive rate for a malignant and suspicious diagnosis was 0.4% and 9.9%, respectively. The specificity of diagnosing malignant thyroid nodules was 97.7% whereas the specificity as a screening test for all neoplasms was 89.6%.
Conclusions: The BSRTC shows excellent specificity in diagnosing malignant nodules and in screening for neoplasms. Each diagnostic category conveys specific risks of malignancy, which offers guidance for clinical management. In addition, the frequency distribution of the individual diagnostic categories remained relatively stable over time.
©2013 Yale Department of Pathology. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. You may not, except with express written permission of the author or the Department of Pathology, distribute or commercially exploit the content, nor may you transmit it or store it in any other website or other form of electronic retrieval system, including use for educational purposes.