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Background: Thyroid fine needle aspiration cytology (FNAC) is an important diagnostic tool for thyroid disorders. The Bethesda technique for Reporting Thyroid Cytopathology (TBSRTC) is an unambiguous, six-category reporting system for thyroid fine needle aspiration (FNA) that is widely acknowledged as a standard reporting guideline for institutes across continents which can minimize needless surgeries. Material and Methods: The study was carried out at the Pathology Department of the Assam Medical College and Hospital, Dibrugarh, Assam, India, from March 2023 to February 2024. The aim is to study the different cytological pattern in thyroid lesion by FNAC The results are interpreted using the features and categories specified in the TBSRTC. A total of 182 cases were studied. The distribution of the various categories from evaluated thyroid FNAs are as follows: nondiagnostic/unsatisfactory-8.2%, benign-75.9%, atypia of undetermined significance-6.0%,follicular neoplasm (FN) or suspicious for a FN-4.3%,suspicious for malignancy - 1%, malignant - 4.3%.Conclusion: The results of a FNA according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) give a standard and systematic approach to managing these nodules. Its standardized nomenclature enhanced thyroid FNAC reporting by facilitating communication and interlaboratory agreement among cytopathologists and clinicians, potentially leading to more standardized patient care management. [ABSTRACT FROM AUTHOR]

Objective: Thyroid fine‐needle aspiration (FNA) is a principal diagnostic procedure for thyroid nodules. A specific cytomorphological structure, known as the thyroid spherule, is often seen in FNA specimens. The clinical significance of these spherules in terms of diagnosis and prevalence remains largely unexplored. Methods: We performed a retrospective study on 310 thyroid FNA specimens and categorized them according to the Bethesda System for Reporting Thyroid Cytopathology. The presence, size and number of thyroid spherules in each specimen were examined and these data were subsequently correlated with the clinicopathological features. Results: Thyroid spherules were almost exclusively detected in benign cases, comprising 7.6% of all benign diagnoses. The average diameter of spherules in benign cases was 84.9 μm. Benign cases and cases with atypia of undetermined significance cases primarily exhibited low cellularity, while follicular neoplasms and malignant cases typically showed moderate to high cellularity. In the subgroup of FNA cases with moderate to high cellularity, spherules were identified in 12 (20%) of 59 benign FNA cases. Within this group, the sensitivity and specificity of thyroid spherules for detecting benign FNA cases were 20% and 100%, respectively. Conclusions: Our results suggest that the presence of thyroid spherules in FNA specimens can serve as a highly specific marker for benign thyroid conditions. The prevalence of spherule detection is strongly influenced by the cellularity. In cases with moderate to high cellularity, the identification of spherules can assist the cytopathologists in diagnosing thyroid FNA cases as benign. [ABSTRACT FROM AUTHOR]

Background: Molecular testing (MT) has become standard practice to more accurately rule out malignancy in indeterminate Bethesda III (BIII) thyroid lesions. We sought to assess the adoption of this technology and its impact on cytology reporting, malignancy yield, and rates of surgery across community and academic sites affiliated with a tertiary medical center. Methods: We performed a retrospective cross-sectional study including all fine-needle aspirations (FNAs) analyzed at our institution from 2017 to 2021. We analyzed trends in MT utilization by platform and by community or academic site. We compared BIII call rates, MT utilization rates, rates of subsequent surgery, and malignancy yield on final pathology before and after MT became readily available using chi-square analysis and linear regression. Results: A total of 8960 FNAs were analyzed at our institution from 2017 to 2021. There was broad adoption of MT across both community and academic sites. There was a significant increase in both the BIII rate and the utilization of MT between the pre- and post-MT periods (p < 0.001 and p < 0.001). There was no significant change in the the malignancy yield on final pathology (57.1% vs. 50.0%, p = 0.347), while the positive predictive value of MT decreased from 85% to 50% (p = 0.008 [confidence interval 9.5–52.5% decrease]). Conclusions: The use of MT increased across the institution over the study period, with the largest increase seen after a dedicated pass for MT was routinely collected. This increased availability of MT may have led to an unintended increase in the rates of BIII lesions, MT utilization, and surgery for benign nodules. Physicians who use MT should be aware of potential consequences of its adoption to appropriately counsel patients. [ABSTRACT FROM AUTHOR]

Background: The Bethesda System for Reporting Thyroid Cytopathology is a commonly used classification for fine needle aspiration (FNA) cytology of suspicious thyroid nodules. The risk of malignancy (ROM) for each category has recently been analyzed in three international databases. This paper compares the diagnostic performance of the Bethesda classification in a high‐volume referral center in Belgium. Methods: All consecutive thyroid procedures were registered in a prospective database from January 2010 till August 2022. Patient and surgical characteristics, preoperative Bethesda categories, and postoperative pathology results were analyzed. Results: Out of 2219 consecutive thyroid procedures, 1226 patients underwent preoperative FNA. Papillary thyroid cancer was the most prevalent malignancy (N = 119, 70.4%), followed by follicular (N = 17, 10.1%) and medullary thyroid cancer (N = 15, 8.9%). Micropapillary thyroid cancer was incidentally found in 46 (3.8%) patients. Bethesda categories I, II, III, IV, V, and VI, respectively, represented 250 (20.4%; ROM 4.4%), 546 (44.5%; ROM 3.8%), 96 (7.8%; ROM 20.8%), 231 (18.8%; ROM 15.2%), 62 (5.1%; ROM 72.6%), and 41 (3.3%; ROM 90.2%) patients. Overall ROM was 13.8%. An negative predictive value (NPV) of 96.2% was found. Overall specificity was 64.2% with a positive predictive value (PPV) of 31.9%. Diagnostic accuracy was 67.8%. Compared to international databases (CESQIP, EUROCRINE, and UKRETS), ROM in this study appeared lower for Bethesda category IV (15.2 vs. 26.7% and p = 0.612). Conclusion: Despite being validated in numerous studies, ROM based on preoperative FNA cytology classified according to the Bethesda classification may vary among surgical centers and countries as this study reveals a higher NPV and lower PPV. [ABSTRACT FROM AUTHOR]

Background: Fine-Needle Aspiration Cytology (FNAC) is a valuable, minimally invasive diagnostic tool for discerning benign and malignant thyroid lesions. In the realm of thyroid cytopathology, both the traditional approach and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) are widely utilized for diagnosing and categorizing these lesions. Aims and Objectives: This study aims to classify thyroid cytology smears using both the conventional method and the Bethesda system and to compare their findings with histopathological diagnoses. Method and Materials: A hospital-based cross-sectional study was conducted over one year, spanning from February 1, 2022, to January 31, 2023. We included 191 cases of FNAC thyroid lesions and categorized them following the guidelines of both the conventional system and the Bethesda system for reporting thyroid cytopathology. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for both systems were calculated, with histopathology serving as the gold standard for comparison. Furthermore, we calculated the Risk of Malignancy (ROM) for each category within the Bethesda system. Results: The Bethesda system exhibited a notably high sensitivity of 83.33%, surpassing the conventional method's sensitivity of 50%, while both systems shared the same specificity of 90%. The diagnostic accuracy of the Bethesda system, at 89.13%, outperformed that of the conventional method, which stood at 84.78%. Conclusion: This study demonstrates a strong positive correlation with histopathology, indicating high sensitivity, specificity, and accuracy when employing TBSRTC, in contrast to the conventional method. [ABSTRACT FROM AUTHOR]

The guidelines for the workup of thyroid nodules have been established in adult populations and secondarily applied to paediatric populations. In particular, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is commonly applied to both adult and paediatric thyroid nodules. However, as paediatric nodules have distinct molecular drivers and behavioural trajectories, there is renewed interest in diagnostic and management strategies that are paediatric specific. Here, we review key differences between paediatric and adult thyroid cancer and recent literature evaluating the use of TBSRTC in paediatric populations. [ABSTRACT FROM AUTHOR]

Objectives: To correlate the screening ability of ultrasound-based TIRADS with the FNAC-based Bethesda system when the latter is kept as a gold standard. Material and methods: A cross-sectional study was conducted in the Histopathology department, Rehman Medical Institute, Peshawar 15th June 2022-14th June 2023. A total of 363 patients from any age group of either gender diagnosed with thyroid nodules were included in the trial. All the participants underwent ultrasound followed by ultrasound-guided fine needle aspiration of thyroid nodules. TIRADS and Bethesda grading was done for each participant. Demographics and grading scores were recorded. Keeping Bethesda scoring as gold standard diagnostic performance of TIRADS grading was calculated. Results: Mean age of the patients was 46.68 ± 12.28 years with a female-to-male ratio of 2.3:1. TIRADS grading revealed 210 (69.8%) from TIRADS 2 while 70(82.4%), 12(50%), and 09(23.7%) patients were from TIRADS 3, 4 and 5 categories respectively. Bethesda grades were 301(82.9%), 21(5.8%), 09(2.5%), 28(7.7%), and 04(1.1%) from Bethesda 2, 3, 4, 5, and 6 categories respectively. The sensitivity of the TIRADS was 93.8%, specificity 89.1%, positive predictive value 45%, negative predictive value 99.3%, and a diagnostic accuracy of 89.5%. Conclusion: TIRADS grading has a high diagnostic ability when Bethesda scoring is kept as the gold standard. It can be used effectively in segregating benign from malignant nodules and is recommended for screening patients presenting with thyroid nodules. [ABSTRACT FROM AUTHOR]

Background: The age‐standardised incidence rate of thyroid cancer in India is 1 in 416 in the general population. This increased incidence has mainly been attributed to improved detection methods for small thyroid lesions. Two such methods are the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TIRADS) and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Aims and Objectives: To study the correlation between ACR TIRADS and TBSRTC, and between each system and the final histopathological report. Materials and Methods: Thyroid cytopathology cases were retrieved for the period January 2019 to July 2022. For each case, the TIRADS score and Bethesda category were noted. Histopathology specimens were also traced. Results: The study comprised 1100 cases, with 955 female and 145 male patients (M:F = 1:6.59), and ages ranging between 7 and 85 years. The TIRADS scoring was available for 1036 cases. Histopathology was available for 231 cases. There was a significant correlation between TIRADS and TBSRTC, with a p‐value of 0.000 and a substantial Kappa agreement of 0.688. Both TIRADS and TBSRTC also had significant correlations with the histopathology data, with a p‐value of 0.000 for each. The sensitivity values for TBSRTC and TIRADS were 69.4% and 65.8%; specificity, 99.3% and 96.5%; positive predictive value (PPV), 98.3% and 91.8%; and negative predictive value (NPV) 84.7% and 84.4%, respectively. The risk of malignancy (ROM) was also calculated and was found to be high, especially for TBSRTC II, III, IV and V (11.3%, 20%, 61.5%, 97.4% respectively) and TIRADS 2 and 3 (10.3% and 29.6% respectively). Conclusion: The TIRADS and TBSRTC systems of categorisation of thyroid lesions are concordant and could help improve the overall survival rate of patients with thyroid malignancies. [ABSTRACT FROM AUTHOR]

Since the publication of the first edition in 2010, The Bethesda System for Reporting Thyroid Cytopathology has allowed cytopathologists to use a standardized, category-based reporting system for thyroid fine needle aspirations. The third edition builds on the success of the 2 earlier editions and offers several key updates. The most important is the assignment of a single name for each of the 6 diagnostic categories: (i) nondiagnostic; (ii) benign; (iii) atypia of undetermined significance; (iv) follicular neoplasm; (v) suspicious for malignancy; and (vi) malignant. Each of the categories has an implied risk of malignancy (ROM), which has been updated and refined based on data reported after the second edition. The third edition offers an average ROM for each category, in addition to the expected range of cancer risk. The atypia of undetermined significance subcategorization is simplified into 2 subgroups based on the implied ROM and molecular profiling. A discussion of pediatric thyroid disease has been added, and pediatric ROMs and management algorithms are discussed in the relevant sections. Nomenclature has been updated to align with the 2022 World Health Organization Classification of Thyroid Neoplasms. Two new chapters have been added: one that addresses the significant and expanded use of molecular and ancillary testing in thyroid cytopathology, and another that summarizes clinical perspectives and imaging findings in thyroid disease. [ABSTRACT FROM AUTHOR]

The Bethesda system for reporting thyroid cytopathology (TBSRTC) has attempted to standardize thyroid fine needle aspiration cytology (FNAC) reporting internationally into six diagnostic categories and help in clinical decision making. But there exists a significant variation in the reporting percentage and rates of malignancies in each category across the centres which complicates clinical decision making. To study the usefulness of TBSRTC in surgical planning of thyroid nodules and to correlate TBSRTC with final histopathology. 85 patients with thyroid nodules who underwent surgery were evaluated prospectively. Preoperatively FNAC and TBSRTC reporting was done and following surgery histopathology was correlated with cytology. Distribution of 85 patients amongst the six categories of TBSRTC was as follows: 2.35% in Category I, 68.23% II, 7.05% III, 16.47% IV, 2.35% V and 3.52% VI. In 93% (79) of patients TBSRTC correlated with histopathology whereas in 7% (6) it did not. Risk of malignancy calculated was 0% in II, 33.33% in III, 7.14% in IV and 100% in V and VI categories. Sensitivity, specificity, Positive Predictive Value and Negative Predictive Value of TBSRTC was 100% for V, VI categories, whereas it was 100%, 78%, 15% and 100% respectively for III, IV. The diagnostic accuracy in our study is 100% for Category V and VI whereas it is 79% for Category III and IV. TBSRTC proved to be a very good screening platform for triaging patients with thyroid nodules into benign and malignant groups, as it is directly related to risk of malignancy in each category. It has helped in appropriate surgical planning in 96.4% of our patients. [ABSTRACT FROM AUTHOR]

Background: FNAC is considered as an excellent non-invasive technique for diagnosis of thyroid lesions. FNAC also help in guiding the clinician for further management of patient with thyroid lesions. Aim: This study was carried out for classifying various thyroid lesions on the basis of "The Bethesda System for Reporting Thyroid Cytopathology". Materials and Methods: This retrospective study was performed on 81 patients in the Department of Pathology, Maharaja Agrasen Medical College, Agroha. FNAC was performed by using non-aspiration technique. The smears were prepared, processed with routine stains and classified them according to the Bethesda system. Results: The ratio of male to female was 1:4.4 and most common affected age group was 30- 50 years. According to the Bethesda system, out of 81 cases 2.46% (n=2) were diagnosed as non-diagnostic/unsatisfactory, 86.41% (n=70) were benign, 1.23% (n=1) were AUS/FLUS, 4.93% (n=4) were FN/SFN, 1.23% (n=1) were suspicious for malignancy and 3.7% (n=3) were reported as malignant. Conclusion: FNAC is simple, easy to perform and painless procedure for diagnosis of thyroid lesion. "The Bethesda system for Reporting Thyroid Cytopathology" is useful in classifying benign and malignant lesions and also allows standardization in reporting which further provides medical and surgical management. [ABSTRACT FROM AUTHOR]

Objectives: Implementation of quality control measures ensures acceptable performance by a laboratory. This study aims to assess the quality of cervical cytopathology reporting using quality metrics like atypical squamous cells (which include both atypical squamous cells of undetermined significance and atypical squamous cell ‐cannot rule out high grade squamous intraepithelial lesion)/squamous intraepithelial lesion (ASC/SIL), cytohistological correlation (CHC) and positive predictive value (PPV) of Papanicolaou (Pap) smears for squamous lesions of cervix. Methods: A retrospective study of Pap smears from 2015 to 2020 was performed. The quality metrics analysed include diagnoses of ASCUS, ASC‐H and ASCUS/SIL ratio, CHC and PPV. Cases with cervical biopsies/hysterectomy were included for CHC, and discrepancy was defined as discordance in diagnostic category between cytology and histology in the CHC. Results: A total of 22,695 cervical cytology smears were reported. Unsatisfactory smears (n = 290) were excluded. Squamous lesions were reported in 233 smears, and the Bethesda system of nomenclature was followed. A definitive diagnosis (SILs and SCC) was given in 74% of cases. ASCUS and ASC‐H were reported in 47 and 14 cases, respectively. The most common lesion on Pap smear was high‐grade squamous intraepithelial lesion (HSIL; n = 92), followed by low‐grade squamous intraepithelial lesion (LSIL; n = 64), and two were ungradable SIL. Squamous cell carcinoma (SCC) was reported in 14 smears. The ASC/SIL ratio was 0.38. CHC (n = 139) was 100% for ASC‐H, LSIL, SCC and 84.7% for HSIL. A review of discrepant cases suggested sampling and interpretational discrepancy in five and one cases, respectively. The PPV of Pap smear for squamous lesions was 96.4%. Conclusion: It is essential to have good quality cytopathology reports for early identification, which enables appropriate management. The most commonly used quality indicator for cytopathology is the ASCUS/SIL ratio. This study suggests the inclusion of the CHC and PPV values as quality metrics for Pap smear, since these are easily measurable and serve as a good indicator of quality in cervical cytopathology reporting. [ABSTRACT FROM AUTHOR]

Introduction Fine needle aspiration cytopathology (FNAC) is widely used for the stratification of thyroid nodules. Objective The objective of the present study is to validate FNAC reporting based on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) at our institution and to calculate the risk of malignancy in each category. Methods This was a descriptive cross-sectional study conducted jointly at the Department of Ear, Nose and Throat and at the Department of Pathology for a period of 1.5 years (May 2018 to November 2018). All cases presenting with thyroid swelling in the outpatient department were investigated with ultrasonography (USG) of the neck, thyroid function test, and FNAC. All FNAC reporting was done according to TBSRTC. Results A total of 134 thyroidectomies were performed during the study period. The female tomale ratiowas 5.3:1. The age ranged from11 to 74 years old. with amean age of 51 years old. The FNAC has a specificity of 84.9%, a sensitivity of 89.4%, a positive predictive value of 86.4%, a negative predictive value of 88.2%, and an accuracy of 87.3% in detecting thyroid cancer. The implied risk of malignancy (ROM) in Bethesda II, III, IV, V and VI is 11.7%, 25%,40%,76.6% & 96%, respectively. Conclusion The four studied categories had a ROM comparable to other studies, except for the Bethesda III category. Further studies with larger sample sizes and with the use of USG guidance for the aspiration from the thyroid swelling may give better results by reducing the number of false negative and false positive cases. [ABSTRACT FROM AUTHOR]

Purpose: Managing intermediate thyroid nodules remains challenging. The CUT score is an Italian metanalysis-based cytologic (SIAPEC-IAP) scoring system, designed to assist clinicians. However, it was never evaluated against the Bethesda system for reporting thyroid cytopathology (BSRTC). This study aims to validate its utility for BSRTC III and IV nodules in a non-Italian population. Methods: We collected all BSRTC III and IV thyroid nodules with a documented final pathology between 2010 and 2020. We calculated the C + U components of the CUT score using retrospective clinical (C) data collection and reevaluation of preoperative sonography (U) examination. The cytology (T) component which originally referred to the five-tiered SIAPEC-IAP cytologic classification was replaced by the corresponding BSRTC categories. Optimal test performances were calculated using receiver operating characteristic (ROC) curve analysis. Data were analyzed twice with considering of NIFTP as benign and as malignant. Results: After exclusions, 62 nodules from 61 patients were included (50% BSRTC III, 50% BSRTC IV). Malignant nodules demonstrated a significantly higher C + U score compared with benign in both categories. The C + U cutoff value for BSRTC III was 5.25 (sensitivity and specificity of 69.23% and 66.67%, respectively, AUC = 0.72, p-value = 0.016), and 5.75 for BSRTC IV (sensitivity and specificity of 85.7% and 76.5%, respectively, AUC = 0.84, p-value < 0.001). Conclusion: Our study suggests that the CUT score is applicable for both BSRTC III and IV nodules, and highlights the need for internal validations, since the cutoffs found were higher than previously reported. [ABSTRACT FROM AUTHOR]

Background: Little is known about the application of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules. This meta-analysis was aimed to investigate the use of TBSRTC in the pediatric population. Methods: Relevant articles were searched in PubMed and Web of Science. Meta-analysis of proportion and its 95% confidence interval (CI) were computed utilizing the random-effect model. We used subgroup analyses and meta-regression to explore the sources of heterogeneities. Egger's regression test and funnel plot visualization were used to examine publication bias. Results: We included 17 articles comprising of 3687 pediatric thyroid nodules for meta-analyses. TBSRTC outputs including frequency and risk of malignancy (ROM) for the majority of categories were not statistically different from recently published meta-analysis of 145,066 thyroid nodules in adult patients. The resection rate (RR) in the pediatric group was significantly higher in most of the categories compared with published adult data: benign, 23.2% [CI = 18.6–27.9] vs. 13.0% [CI = 9.5–16.5]; atypia of undetermined significance/follicular lesion of undetermined significance, 62.6% [CI = 50.3–74.9] vs. 36.2% [CI = 29.9–42.5]; follicular neoplasm/suspicious for follicular neoplasm, 84.3% [CI = 75.2–93.4] vs. 60.5% [CI = 54.5–66.5]; and suspicious for malignancy, 93.8% [CI = 90.1–97.6] vs. 69.7% [CI = 64.0–75.5]. Conclusion: TBSRTC is a valuable tool to make clinical decisions for pediatric patients with thyroid nodules. Pediatric patients with benign and indeterminate thyroid nodules had a higher RR than adult counterpart, but ROM of these categories in adults and children was not statistically different suggesting a potential risk of overtreatment in pediatric patients. Determining the best treatment guidelines and additional tools for risk stratification must be a top priority to precisely identify the target patient groups for surgical intervention. [ABSTRACT FROM AUTHOR]

Introduction: Fine needle aspiration (FNA) is fundamental in the pre‐operative assessment of thyroid nodules. However, the shining success of thyroid FNA is occasionally eclipsed by false positive (FP) cytological diagnoses. We describe our experience regarding FP cytological diagnoses and present a literature review concerning FP rates. Materials and methods: We retrospectively analyzed 2031 consecutive cytology reports. FP was defined as a case with "suspicious for malignancy" or "malignant" cytology, whose surgical follow‐up failed to confirm the initial diagnosis of malignancy. We used the PubMed database for the literature review using specific search terms ("thyroid", "cytology", "false positive"). Results: Out of 2031 FNA reports, 93 cases with "suspicious for malignancy" or "malignant" cytology underwent surgical excision. Histopathology did not confirm malignancy in 10 cases (0.6% FP rate). Nodules with FP cytology were significantly larger (P = 0.0024) than those with with TP (true positive) cytology. A review of 25 publications shows comparable results to ours with some slight differences. The majority of studies achieve a FP rate below 3%. Most FP cytological diagnoses turn out to be non‐neoplastic lesions (nodular hyperplasia, adenomatous nodule, lymphocytic thyroiditis), which combined account for 80.5% of all histological diagnoses. Conclusions: Thyroid nodules with FP cytology were larger than nodules with TP cytology. Most studies manage to adhere to the recommended FP rates, or values close to them, with some outliers. Nevertheless, the mean FP rate values are very close to the value recommended by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The FP rate value depends on how one defines true negative cases, which can be either histologically proven benign cases, via a benign clinical course, or by assuming that cytologically benign cases remain as such. The shining success of thyroid FNA is occasionally eclipsed by false positive (FP) cytological diagnoses. This article presents the authors' experience regarding FPs, and a brief review of 25 publications in search of FP rates. Most studies adhere to the recommended FP rates, or values close to them, with some outliers. The FP rate value depends on how one defines true negative cases, which can be either histologically proven benign cases, via a benign clinical course, or by assuming that cytologically benign cases remain as such. [ABSTRACT FROM AUTHOR]

Background: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is widely utilised by cytopathologists. The American College of Radiology (ACR) has also proposed a thyroid imaging reporting and data system (TIRADS) to classify thyroid nodules and guide their selection for fine needle aspiration (FNA). The current study aimed to analyse the usefulness of TBSRTC in thyroid cytology reporting, to examine its histological correlation with TIRADS, and to compare the management of lesions in each cytological category in our institute to the TBSRTC recommendations. Materials and methods: A retrospective study was performed on all thyroid FNAs from a 2‐year period at a tertiary care centre. Histological correlations of TBSRTC and ACR TIRADS were examined for cases with surgical follow‐up, and the risk of malignancy in each TBSRTC category, and sensitivity and specificity of FNA and TIRADS, were calculated. Results: A total of 337 thyroid FNAs were examined, with histological follow‐up in 99 cases. Risk of malignancy in categories I‐VI was 9.5%, 2.3%, 0.0, 8%, 87.5% and 100.0%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of FNA were 60.0%, 99.0%, 85.7%, and 97.5%, respectively, while those values for thyroid ultrasound were 90.3%, 72.2%, 92.9% and 65%, respectively. Conclusion: The study substantiates the usefulness of TBSRTC in arriving at a more precise diagnosis. Hurthle cell lesions with atypia were the common cause of misdiagnosis. The combination of TIRADS and TBSRTC aids in better stratification of thyroid nodules and in decision making for management of lesions. The reporting of AUS/FLUS lesions with a supplementary note describing the presence of architectural and/or cytological atypia may be helpful in treatment decisions since cytological atypia could suggest the possibility of NIFTP or malignancy. TIRADS score in conjunction with TBSRTC cytological diagnosis can aid in better stratification of thyroid nodules. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to provide the Asian experience with the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules.Methods: Consecutive thyroid fine-needle aspirates (patient age, ≤18 years) were retrospectively collected from 7 tertiary centers in 5 Asian countries.Results: Of 194,364 thyroid aspirates, 0.6% were pediatric cases (mean age, 15.0 years). Among 827 nodules with accessible follow-up, the resection rate and risk of malignancy (ROM) were 36.3% and 59.0%, respectively. Malignant nodules (n = 179) accounted for 59.7% of resected nodules and 21.6% of all thyroid nodules with available follow-up. Compared with the published adult series, pediatric nodules had a higher resection rate and ROM, particularly in the indeterminate categories.Conclusions: Our study demonstrates that Asian pediatric thyroid nodules had higher ROM than those from adults. The prototypic outputs of TBSRTC may need to be adjusted in the pediatric population. [ABSTRACT FROM AUTHOR]

Objective: The 2017 revised Bethesda System for Reporting Thyroid Cytopathology (BSRTC) included new malignancy rates for each category as well as new management recommendations. Here, we evaluate the malignancy rate and test performance for BSRTC categories in a middle‐sized institution outside the United States (US). Design: Retrospective single centre case series with chart review. Patients: All patients who underwent thyroid surgery with a preoperative BSRTC between the years 2010 and 2018 at our institution. Measurements: In order to assess the malignancy rate for each BSRTC, all medical records were reviewed to collect demographics, nodule's size, BSRTC and final pathology. Results: Three hundred and sixty‐four patients were included, with an overall malignancy rate of 34.3%. The malignancy rate for BSRTC categories I‐VI was as follows: 13.3%, 5.1%, 25.0%, 24.4%, 91.3% and 95.2%, respectively. The most sensitive test was when BSRTC III‐VI were evaluated (91%). Overall best performance (sensitivity, specificity, PPV, NPV and accuracy) was obtained when BSRTC V‐VI were grouped together with a substantial decrease when adding BSRTC III‐IV (90%, 97%, 94%, 95%, 95% vs, respectively, 91%, 73%, 62%, 95%, 79%, respectively). Conclusions: Despite differences from the reported 2017 BSRTC malignancy rates, we demonstrated that the revised 2017 BSRTC management recommendations for thyroid nodules are also valid in smaller non‐US centre, supporting its use globally. [ABSTRACT FROM AUTHOR]

The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) standardizes thyroid cytopathology reporting in six tier diagnostic categories. In recent years, noninvasive encapsulated follicular variant of papillary thyroid carcinoma was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This study examines the impact of NIFTP on the BSRTC risk of malignancy (ROM). This was a retrospective review of prospectively collected data from 565 patients who underwent fine needle aspiration and thyroidectomy at a single institution. ROM for each Bethesda category was analyzed and calculated with NIFTP classified as a malignant and nonmalignant lesion. Absolute and relative differences between ROM were compared. Of 565 patients, 19 were Bethesda I, 159 were Bethesda II, 178 were Bethesda III, 46 were Bethesda IV, 42 were Bethesda V, and 121 were Bethesda VI. ROM differences with NIFTP classified as malignant versus nonmalignant for each class were as follows: Bethesda I, no change; Bethesda II, 18%-14%; Bethesda III, 55%-48%; Bethesda IV, 50%-35%; Bethesda V, 93%-91%; and Bethesda VI, 99%-98%. Absolute ROM differences for each category were as follows: Bethesda I, 0%; Bethesda II, 4%; Bethesda III, 7%; Bethesda IV, 15%; Bethesda V, 2%; and Bethesda VI, 1%. A decreasing trend in absolute and relative ROM was seen in Bethesda II, III, and IV categories; however, exclusion of NIFTP as a malignant lesion did not significantly alter the ROM of BSRTC categories. Surgeons should assess their respective institution's experiences with NIFTP and the BSRTC. [ABSTRACT FROM AUTHOR]

Background: Hürthle cell/oncocytic change is commonly reported on thyroid fine-needle aspiration (FNA) and may be considered an "atypical cell" by clinicians. This study aims to delineate the association between Hürthle cells in preoperative cytology and subsequent pathology of the indexed thyroid nodule and to report rates of malignancy. Methods: Retrospective review of records of 300 patients with Hürthle cell/oncocytic change on FNA and final surgical pathology at a tertiary referral center between 2000 and 2013 was performed and compared with a multi-institutional FNA cohort. The degree of Hürthle cell presence was correlated with histopathologic diagnoses. Results: In the Hürthle cell FNA group, Bethesda System for Reporting Thyroid Cytopathology (BSRTC) categories were as follows: I (nondiagnostic) 14 (4.7%); II (benign) 113 (37.7%); III (atypia of undetermined significance/follicular lesion of undetermined significance) 33 (11%); IV (follicular neoplasm/suspicious for a follicular neoplasm) 125 (41.6%); V (suspicious for malignancy) 12 (4%); and VI (malignant) 3 (1%). When categorized based on the degree of Hürthle cell change, 59 (29%) were classified as mild, 13 (6%) moderate, and 131 (65%) as predominant. When comparing the results with a multi-institutional FNA cohort (all with surgical confirmation), the presence of Hürthle cells was found to be associated with a lower risk of malignancy in all BSRTC categories, with a statistically significant difference in the BSRTC IV and V groups. The sole exception was when Hürthle cell presence was classified as predominant (defined as >75% of the cellular population); the rate of malignancy was significantly elevated in FNAs interpreted as benign/Bethesda II. Conclusions: Although Hürthle cells have been considered by clinicians as an "atypical cell," their presence does not increase the risk of malignancy within BSRTC categories overall. However, when predominant Hürthle cell change is present, the risk of malignancy is increased in the benign cytology/BSRTC category II. [ABSTRACT FROM AUTHOR]

Background: The Bethesda system for cytopathology (TBSRTC) is a 6-tier diagnostic framework developed to standardize thyroid cytopathology reporting. The aim of this study was to determine the risk of malignancy (ROM) for each Bethesda category. Methods: Thyroidectomy-related data from 314 facilities in 22 countries were entered into the following outcome registries: CESQIP (North America), Eurocrine (Europe), SQRTPA (Sweden) and UKRETS (UK). Demographic, cytological, pathologic and extent of surgery data were mapped into one dataset and analyzed. Results: Out of 41,294 thyroidectomy patient entries from January 1, 2015, to June 30, 2017, 21,746 patients underwent both thyroid FNA and surgery. A comparison of cytology and surgical pathology data demonstrated a ROM for Bethesda categories 1 to 6 of 19.2%, 12.7%, 31.9%, 31.4%, 77.8% and 96.0%, respectively. Male patients had a higher rate of malignancy for every Bethesda category. Secondary analysis demonstrated a high ROM in male patients with Bethesda 3 category aged 31–35 years (52.1%, 95% confidence interval (CI) 37.9–66.2%), aged 36–40 years (55.9%, 95% CI 39.2–72.6%) and aged 41–45 years (46.9%, 95% CI 33–60.9%). Patients with Bethesda 5 and 6 scores were more likely to undergo total thyroidectomy (65.9% and 84.6%); for patients with Bethesda scores 2 and 3, a higher percentage of females underwent total thyroidectomy compared to males in spite of a higher ROM for males. Conclusions: These data demonstrate that Bethesda categories 1–4 are associated with a higher ROM compared to the first edition of TBSRTC, especially in male patients, and validate findings from the second edition of TBSRTC. [ABSTRACT FROM AUTHOR]

Objectives: Long-term follow-up is important for determining performance characteristics of thyroid fine-needle aspiration (FNA).Methods: Histologic or 3 or more years of clinical follow-up was used to calculate performance characteristics of thyroid FNA before and after implementation of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) classification was also investigated.Results: Follow-up was obtained for 1,277/1,134 and 1,616/1,393 aspirates/patients (median clinical follow-up, 9.9 and 4.4 years, pre- and post-TBSRTC, respectively). Nondiagnostic, suspicious for follicular neoplasm, and suspicious for malignancy (SFM) diagnoses decreased and benign diagnoses increased post-TBSRTC, while atypical rate remained less than 1%. Negative predictive value for benign nodules and positive predictive value (PPV) for SFM increased significantly. Eleven nodules were reclassified as NIFTP, slightly decreasing PPV/risk of malignancy (ROM).Conclusions: Appropriate ROM for thyroid FNA can be achieved through application of TBSRTC terminology with minimal use of atypical category. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to evaluate the disease spectrum of thyroid cytopathology and correlation of the Bethesda reporting system with final histopathology in our medical centre. Methods: This retrospective study was conducted from histopathology reports from Galilee Medical Center between August 2013 and September 2017. Results: A total of 287 thyroid fine needle aspirations were included in the study. The majority (55.1%) of these were benign (B2). Surgery was performed on 53 cases and the total malignancy rate was 39.6%. Our study had a favourable accuracy rate of 70%. A B4 Bethesda category had a higher malignancy rate (50%) than previously reported. Conclusion: We found a higher malignancy rate (50%) based on the Bethesda B4 category of the fine needle aspirations in our series, yet it is based on a small sample. The differences in malignancy rates between centres have an important impact on clinical decisions. In this retrospective study we reviewed thyroid fine needle aspirations and compared them to final pathology. We found an accuracy rate of 70%, and a higher Bethesda 4 category malignancy rate than previously reported. [ABSTRACT FROM AUTHOR]

Background: Fine-needle aspiration cytology (FNAC) plays an important role in evaluation of nodular thyroid lesions and in planning appropriate management. Aim: the aim of the study is to reinterpret the FNAC diagnosis using the new 2017 Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and explore its utility and to review the accuracy by correlating with histopathology and analyze the distribution of thyroid lesions. Settings and Design: A retrospective study for a period of 1 year will be undertaken, and all the cases of thyroid FNAC during the study period will be included in the study. Materials and Methods: All FNACs of the thyroid, which were done during the year 2011, were retrieved. The results of adequate FNAC samples were correlated with the histological diagnoses in 50 cases. Statistical Analysis: the statistical analysis was performed using MedCalc Statistical Software Results: About 592 cases were included in the study, after recategorization according to the TBSRTC, Bethesda I – 2 cases (0.33%), Bethesda II – 473 cases (79.8%), Bethesda III – 54 cases (9.1%), Bethesda IV – 23 cases (3.8%), Bethesda V – 3 cases (0.5%), and Bethesda VI – 37 cases (6.25%). The false-negative rate is 9%, accuracy rate is 91%, and rate of malignancy in atypical lesions is 53.3%, with overall rate of accuracy of 61.5%. The incidence of microcarcinoma was 4/50 (8%). Conclusions: The distribution of thyroid lesions in our institute is similar to that seen elsewhere. The rate of malignancy in indeterminate lesions was 33.33%. FNA has a low false-negative rate for diagnosis of thyroid malignancy; however, controversy exists regarding the accuracy of FNA for nodules smaller than 1 cm. The nomenclature change of follicular variant of papillary thyroid carcinoma to noninvasive follicular thyroid neoplasm with papillary-like nuclear features has led to necessary changes in definitions of various categories in 2017 TBSRTC as well and is discussed in this paper. [ABSTRACT FROM AUTHOR]

Objective: Bethesda System for Reporting Thyroid Cytopathology (BSRTC) categories I, III, and V account for a significant proportion of fine needle aspiration cytology (FNAC) diagnoses. This study aimed to compare the diagnostic efficacy of BRAFV600E mutation and the Thyroid Imaging Reporting and Data System (TIRADS) classification in differentiating papillary thyroid cancers (PTCs) from benign lesions among BSRTC I, III, and V nodules. Methods: A total of 472 patients with 479 nodules were enrolled in this prospective study. Ultrasound, BRAFV600E mutation testing, and FNAC were performed in each nodule, followed by surgery or regular ultrasound examination. Results: In the BSRTC I category, BRAFV600E showed similar sensitivity, higher specificity, and lower accuracy when compared with TIRADS. In the BSRTC III/V category, the sensitivity, specificity, and accuracy of BRAFV600E were similar to those of TIRADS. In comparison to BRAFV600E alone, the combination of the two methods significantly improved sensitivity (BSRTC I: 93.6% vs. 67.7%, P < 0.01; BSRTC III: 93.8% vs. 75.0%, P < 0.01; BSRTC V: 96.0% vs. 85.3%, P < 0.001). When compared with TIRADS alone, the combination improved sensitivity in BSRTC I nodules (93.6% vs. 74.2%, P < 0.05), increased sensitivity and decreased accuracy in BSRTC III nodules (93.8% vs. 75.0%, P < 0.01, 91.0% vs. 93.6%, P < 0.01), and improved both sensitivity and accuracy in BSRTC V nodules (96.0% vs. 82.0%, P < 0.001; 94.2% vs. 81.3%, P < 0.001). Conclusions: BRAFV600E exhibited higher specificity and lower accuracy compared with TIRADS in BSRTC I nodules, while the two methods showed similar diagnostic value in BSRTC III/V nodules. The combination of the two methods distinctly improved sensitivity in the diagnosis of PTCs in BSRTC I, III, and V nodules. [ABSTRACT FROM AUTHOR]

The potential complimentary role of various molecular imaging modalities [fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT), ultrasound (US)-elastography, and diffusion weighted imaging-magnetic resonance imaging (DWI-MRI)] in characterizing thyroid nodules, which have been designated as "intermediate risk category" on the Bethesda thyroid cytopathology reporting system (BTCRS), is illustrated in this communication. The clinical cases described (category III thyroid nodules on BTCRS) show the imaging features and the final diagnostic impressions rendered by the interpreting physicians with the modalities that have been independently compared in a tabular format at the end; of particular note is the high negative predictive value of these (specifically FDG-PET/CT), which could aid in enhancing the diagnostic confidence in the reported "intermediate risk category" thyroid nodules, a "gray zone" from the patient management viewpoint. [ABSTRACT FROM AUTHOR]

B Dear Editor: b We read with interest this meta-analysis by Vuong, I et al. i synthesizing the evidence on the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in pediatric thyroid nodules ([1]). References 1 Vuong HGG, Chung DGB, Ngo LM, Bui TQ, Hassell L, Jung CK, Kakudo K, Bychkov A2021The use of the Bethesda System for Reporting Thyroid Cytopathology in pediatric thyroid nodules: a meta-analysis. On our simplified reanalysis of the data presented, the ROM among all atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) nodules was 2.5-fold higher in children (23.2% vs. 9.2%, I p i < 0.00001, I i SP 2 sp analysis), and it was twofold higher among follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN) nodules (35.1% vs. 17.5%, I p i < 0.00001). [Extracted from the article]

Since Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) was introduced as a new thyroid tumour entity, many studies, and meta-analyses on diagnosing NIFTP have been published. NIFTP-revised histopathological criteria emerged in 2018. NIFTP is defined as a histological entity and its diagnosis requires a careful histological examination. Its molecular profile is similar to follicular-like tumours. Ultrasound features are unable to differentiate NIFTP. NIFTP is not a cytological diagnosis, but it influences the risk of malignancy in several categories of The Bethesda System for Reporting Thyroid Cytopathology terminology. [ABSTRACT FROM AUTHOR]