Thyroid cytopathology recent advances october 21, 2017 dr. The objective of this study is to evaluate the thyroid cytology smear by tbsrtc. The bethesda system for reporting thyroid fineneedle aspiration fna specimens 1 undoubtedly represents a major step toward standardization, reproducibility, and ultimately improved clinical significance, usefulness, and predictive value of thyroid fna during the past decade, several classification schemes for thyroid gland fna have been proposed by various professional. They may be hyperplastic or tumorous, but only a small percentage of thyroid tumors are malignant. Update on the bethesda system for reporting thyroid cytology. The objective of this study was to analyze the thyroid cytology smears by tbsrtc, to determine the distribution of diagnostic categories and subcategories, to analyze cytological features, and to correlate the cytopathology. Sporea et al 39 reported combining two elastographic methods could obtain a high. The bethesda system for reporting of thyroid cytopathology. The bethesda system for reporting thyroid cyto pathology bsrtc is a standardized reporting system for classifying thyroid fineneedle aspiration results comprising of 6 diagnostic categories with unique risks o malignancy and recommendations for clinical management. Subsequently a monograph the bethesda system for reporting thyroid cytopathology tbsrtc which includes definitions, diagnosticmorphologic criteria, explanatory notes, and a brief management plan for each diagnostic category was published. Malignancy rate in thyroid nodules classified as bethesda. The bethesda system for reporting thyroid cytopathology is one of the main.
The bethesda system for reporting thyroid fineneedle aspiration. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules. Incidentally detected lesions in the surgical specimens that were not the target of the thyroid fna were excluded from the analysis. A comparative study between conventional system and the. Contents introduction bethesda categories nondiagnostic or unsatisfactory benign atypia of undetermined significance or follicular lesion of undetermined significance follicular neoplasm or suspicious for a. The recent reclassification of some thyroid neoplasms as noninvasive follicular thyroid neoplasm with papillarylike nuclear features niftp has im plications for. Thyroid thyroid cytopathologycytopathology recent advances.
This atlas is the offspring of the the national cancer institute nci thyroid fine needle aspiration fna state of the science conference, hosted by the nci and organized by dr. The 2017 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. The bethesda system for reporting thyroid cytopathology. Click on document the bethesda system for reporting thyroid cytopathology. Fineneedle aspiration fna remains the most effective and safe method of evaluating thyroid nodules for potential surgical management. Present 3 uk rcpath 2015 italy 2014 usa bethesda 2008 australasia classification 2014 japan thyroid association 20 diagnostic category diagnostic category terminology categories terminology. Implied risk of malignancy and recommended clinical management open in new tab a repeated aspiration with ultrasound guidance is recommended for nduns and clinically or sonographically worrisome cfo cases and is diagnostic in 50% to 88% of cases, 2, 6, 9, 11, , 14 but some nodules. The adoption of the system will facilitate communication among the cytopathologist, surgeon, endocrinologist and radiologist and also allow easy and reliable sharing of data from. A twoyear prospective study in an academic institution table 1 the bethesda system for reporting thyroid cytopathology.
An autonomous thyroid nodule or hot nodule is one that has thyroid function independent of the homeostatic control of the hpt axis hypothalamicpituitarythyroid axis. Pdf the 2017 bethesda system for reporting thyroid. Thyroid cytopathology reporting by the bethesda system. The bethesda system for reporting thyroid cytopathology is effective for clinical management of thyroid nodules jerome m. Bethesda classification of thyroid nodule fine needle aspirations i. Ata initiatives to reduce the extent of surgery for many low risk thyroid cancers 4 cm or smaller, without extra thyroidal extension and lacking. Nodules that grow larger or produce symptoms may eventually need medical care. C professor, department of pathology mcgill university director, cytopathology laboratory. Twentythree items of feedback were received and the document was. An update to the bethesda system for reporting thyroid nodule cytopathology is set to alter clinical practice, with the primary aim of reducing the number of unnecessary thyroid surgeries. The bethesda system for reporting thyroid cytopathology categorizes thyroid cytology findings into six groups, with each group assigned a putative malignancy risk. Proposed modifications and updates for the thyroid.
In the bethesda classification system for thyroid lesions, bethesda iii is the most heterogeneous category because it merges follicular lesions. This accounts for 10 percent of the biopsies, even in the most. Fine needle aspiration fna remains the firstline diagnostic in management of thyroid nodules and reduces unnecessary surgeries. It is expected that the many benefits, clinical and investigational, of the bethesda cervical terminology will. Pdf bethesda categorization of thyroid nodule cytology. Of note, the cytopathologist cannot combine cells present in two or more nduns. This atlas is the offspring of the the national cancer institute nci thyroid fine needle aspiration fna state of the science conference, hosted by. Nature of the nodule location, size, cystic component skills of operator and reader. Pdf the bethesda system for reporting thyroid cytopathology tbsrtc is an evidencebased standardized reporting system for thyroid. This can happen when a cyst is aspirated or when the specimen is almost entirely composed of blood. The 2017 bethesda system for reporting thyroid cytopathology. Bethesda classification of thyroid nodule fine needle. The bethesda system for reporting thyroid cytopathology is. It represents the results of the multidisciplinary national cancer institute thyroid fine needle aspiration state of the science conference, held in bethesda, md in october, 2007.
Oct 15, 2015 the bethesda system for reporting thyroid cytopathology bsrtc dr. Using tbsrtc, cytopathologists can communicate their interpretations to the referring physician in terms that are succinct, unambiguous, and clinically. Malignancy rates for bethesda iii subcategories in thyroid fine. Request pdf the bethesda system for reporting thyroid fineneedle aspiration specimens reply the bethesda system for reporting. Rapid on site evaluation helps assess adequacy after sampling. The bethesda system for reporting thyroid cytopathology tbsrtc was formalized in october 2007 by experts in thyroidology at the national institute of health in bethesda, maryland. The bethesda system for reporting thyroid cytology tbsrtc was proposed in 2007 at the national cancer institute thyroid fine needle aspiration state of the art and science. History introduced and formed in 2007, nci thyroid fna state of science conference bethesda, maryland, by various cytopathologists and summarised by baloch et al. A comparative study between conventional system and the bethesda system applied for reporting thyroid cytopathology available online at received on. Guidance on the reporting of thyroid cytology specimens.
The thyroid web atlas contains 300 images of key thyroid lesions in an easytosearch format. Classifying your thyroid fna specimens using bethesda. The bethesda system for reporting thyroid cytopathology will provide the reader with a unified approach to diagnosing and reporting thyroid fna interpretations. Definitions, criteria and explanatory notes 2010th edition, kindle edition by syed z. Fine needle aspiration of thyroid nodules using the. The bethesda system for reporting thyroid cytopathology, 2017 laila khazai 11417. To compare the conventional and the bethesda system for reporting thyroid. Thyroid association aaceameeta recommend to combine. Evaluation of thyroid nodules classified as bethesda category iii on. Jan 24, 2017 the bethesda system for reporting thyroid cytopathology moderator dr g k parvathidevi presenter dr dhanya a n 2. Thyroid association aaceameeta task force combine bethesda. The bethesda system for reporting thyroid cytopathology, 2017. Apr 25, 2018 the 2017 bethesda system for reporting thyroid cytopathology. Tbsrtc is a sixcategory scheme of thyroid cytopathology reporting table 1.
Pdf introduction to the second edition of the bethesda system for. The bethesda system for reporting thyroid cytopathology, 2nd edition, 2018. Small, asymptomatic nodules are common, and often go unnoticed. The bethesda system for reporting thyroid cytopathology book. Bethesda system for reporting thyroid cytopathology. According to a 1993 article, such nodules need to be treated only if they become toxic. Proposed modifications and updates for the thyroid bethesda. The conclusions of the meeting led to the bethesda thyroid atlas project and formed the framework for the bethesda system for reporting thyroid cytology tbsrtc. Table 1 thyroid cytopathology reporting by the bethesda. Research article thyroid nodules with atypia or follicular. It will serve as a reference guide not just for pathologists, but also endocrinologists, surgeons, and radiologists. The bethesda system for reporting thyroid cytopathology bsrtc is a standardized reporting system for classifying thyroid fineneedle aspiration results comprising of 6 diagnostic categories with unique risks o malignancy and recommendations for clinical management. The bethesda system for reporting thyroid cytolopathology.
The introduction of the bethesda system for reporting thyroid cytopathology tbsrtc, following the national cancer institute thyroid fine needle aspiration state of the science conference held in bethesda, md, in 2007, offered the opportunity to establish a uniform sixtiered reporting system for thyroid fna 1the. The aim was to address the inconsistent and sometimes confusing reporting terminologies used for thyroid fna throughout the world. The bethesda system for reporting thyroid cytopathology tbsrtc established a standardized, categorybased reporting system for thyroid fineneedle aspiration fna specimens. How to interpret thyroid fineneedle aspiration biopsy. Thyroid nodules are nodules raised areas of tissue or fluid which commonly arise within an otherwise normal thyroid gland. The bethesda system for reporting thyroid cytopathology tbsrtc is considered standard reporting system for categorization of thyroid lesions in cytology.
Description of the book the bethesda system for reporting thyroid cytopathology. Application of the bethesda classification for thyroid fineneedle. The american thyroid association guidelines task force on thyroid nodules and. The bethesda system for reporting thyroid cytopathology bsrtc dr. Classifying your thyroid fna specimens using bethesda terminology. Tendency to report a high percentage of benign hurthlecell nodules as. Ata initiatives to reduce the extent of surgery for many low risk thyroid cancers 4 cm or smaller, without extra thyroidal extension and lacking regional nodal metastasis and decreased routine use of postoperative radioactive iodine treatment increasingly raise the possibility for lobectomy as initial surgical management. It serves as a reference guide not just for pathologists, but also endocrinologists, surgeons, and radiologists. The bethesda system for reporting thyroid cytopathology bsrtc has standardized. In these biopsies not enough thyroid cells were obtained to render a diagnosis. W ith its inception, the bethesda system for reporting thyroid cytopathology tbsrtc established a standardized reporting system with a limited number of diagnostic categories for thyroid fineneedle aspiration fna specimens. Thyroid imaging reporting and data system in assessment of. The bethesda system for reporting thyroid cytopathology moderator dr g k parvathidevi presenter dr dhanya a n 2.
Indeed, combining our suspicious for papillary carcinoma. Pdf the bethesda system for reporting thyroid cytopathology. Click on the thumbnails to see the intermediate images. This study aimed to examine the results of thyroid fna using the bethesda system for reporting thyroid cytopathology tbsrtc to establish the level of accuracy. To assess the usefulness of thyroid imaging reporting and data system tirads for cytological bethesda category iii thyroid nodules tns.
An inspiration for the thyroid proposal was the bethesda system for reporting cervical cytology interpretations, first developed at an nci workshop in 1988 and widely adopted in the united states for reporting papanicolaou test results. Use of adjunct molecular reflex testing constantine theoharis, md assistant professor david chhieng, md, mba, mshi professor director of cytology department of pathology yale university new haven ct. Comments this document replaces the 1st edition of guidance on the reporting of thyroid cytology specimens, published in 2009. The bethesda system for reporting thyroid cytopathology tbsrtc has attempted to standardize reporting and cytological criteria in aspiration smears. Risk stratification of thyroid nodules with bethesda category iii. This retrospective study included 121 patients with 121 tns classified as bethesda category iii at fine needle aspiration fna cytology and thereafter underwent surgery. Bethesda classification of thyroid nodule fine needle aspirations. The bethesda system for reporting thyroid cytopathology is the standard.
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