1
|
Gan FJ, Zhou T, Wu S, Xu MX, Sun SH. Do medullary thyroid carcinoma patients with high calcitonin require bilateral neck lymph node clearance? A case report. World J Clin Cases 2021; 9:1343-1352. [PMID: 33644201 PMCID: PMC7896685 DOI: 10.12998/wjcc.v9.i6.1343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/24/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In clinical work, 85%-90% of malignant thyroid diseases are papillary thyroid cancer (PTC); thus, clinicians neglect other types of thyroid cancer, such as medullary thyroid carcinoma (MTC).
CASE SUMMARY We report a 53-year-old female patient with a preoperative calcitonin level of 345 pg/mL. There was no definitive diagnosis of MTC by preoperative fine-needle aspiration cytology or intraoperative frozen pathology, but the presence of PTC and MTC was confirmed by postoperative paraffin pathology. The patient underwent total thyroidectomy and bilateral central lymph node dissection. Close follow-up at 1.5 years after surgery revealed no signs of recurrence or metastasis.
CONCLUSION The issue in clinical work-up regarding types of thyroid cancer provides a novel and challenging idea for the surgical treatment of MTC. In the absence of central lymph node metastasis, it is worth addressing whether patients with high calcitonin can undergo total thyroidectomy and bilateral central lymph node dissection without bilateral lateral neck lymph node dissection.
Collapse
Affiliation(s)
- Feng-Jiao Gan
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Tie Zhou
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Shun Wu
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Meng-Xi Xu
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Su-Hong Sun
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| |
Collapse
|
2
|
Huang J, Shi H, Song M, Liang J, Zhang Z, Chen X, Liu Y, Wang S, Wu Z. Surgical Outcome and Malignant Risk Factors in Patients With Thyroid Nodule Classified as Bethesda Category III. Front Endocrinol (Lausanne) 2021; 12:686849. [PMID: 34594299 PMCID: PMC8477748 DOI: 10.3389/fendo.2021.686849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Thyroid nodules are a very common finding in the general population. Fine-needle aspiration (FNA) has been recommended as the initial test for the evaluation of thyroid nodules. The trend on reporting as atypia of undetermined significance (AUS) has been significantly increased, but the malignant risk is still controversial among different studies. The aim of this study is to investigate the malignancy risk of thyroid nodules reported as Bethesda category III (AUS/FLUS) on initial FNA. METHOD We reviewed 272 papillary thyroid cancer (PTC) patients with suspicious thyroid nodules who underwent fine-needle aspiration and received surgical treatment during 2019 to 2020. RESULTS One hundred ten (40.4%) patients were diagnosed with PTC. Multivariate analysis showed that microcalcification (p = 0.037, OR = 2.260, 95% CI: 1.051-4.860), shape (p = 0.003, OR = 4.367, 95% CI: 1.629-11.705), diameters (p = 0.002, OR = 0.278, 95% CI: 0.123-0.631), anti-thyroglobulin antibodies (TGAb) (p = 0.002, OR = 0.150, 95% CI: 0.046-0.494), anti-thyroid peroxidase antibody (A-TPO) (p = 0.009, OR = 4.784, 95% CI: 1.486-15.401), and nodule goiter (p < 0.001, OR = 0.100, 95% CI: 0.046-0.217) were independent malignant risk factors in patients with thyroid nodule classified as Bethesda category III. CONCLUSION In this study, malignant risk factors in patients with thyroid nodule classified as Bethesda category III were significantly associated with preoperative serum TGAb, A-TPO, microcalcification, irregular shape, and nodule diameters. Nodules with malignant factors should be carefully elevated; surgery may be the better option for those patients.
Collapse
Affiliation(s)
- Jianhao Huang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Hongyan Shi
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Muye Song
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Jinan Liang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhiyuan Zhang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaohang Chen
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yongchen Liu
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Sanming Wang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zeyu Wu
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Zeyu Wu,
| |
Collapse
|
3
|
Ooi LY, Nga ME. Atypia of undetermined significance/follicular lesion of undetermined significance: Asian vs. non-Asian practice, and the Singapore experience. Gland Surg 2020; 9:1764-1787. [PMID: 33224854 DOI: 10.21037/gs-20-555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Bethesda System for Reporting Thyroid Cytopathology has paved the way for comparisons of the practice of thyroid cytology in many different regions. However, there have been comparatively few studies documenting differences between Asian and non-Asian practice. Here, we aim to compare a few key parameters between the two regions, focusing on the indeterminate category of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS). We compared its incidence, resection rates (RRs), risk of malignancy (ROM), rate of repeat fine needle aspiration (rFNA), ROMs of cytomorphologic subcategories of nuclear atypia (AUS-N) vs. architectural atypia (AUS-A), and, finally, the incidence of papillary thyroid carcinoma (PTC) vs. follicular neoplasms (FNs) in resected AUS/FLUS cases in Asian and non-Asian regions. Where possible, these metrics were compared with the Singapore experience from a tertiary referral institution. While the incidence of AUS/FLUS was similar in both regions, we found geographical differences in the RRs and ROMs, which may reflect a higher collective threshold for surgery in Asian countries. However, both cohorts showed higher ROMs in the AUS-N subcategory as compared to the AUS-A subcategory, supporting the subclassification of the AUS/FLUS based on the presence of nuclear atypia. We also observed a higher incidence of AUS-N coupled with a higher incidence of PTC in resected AUS/FLUS nodules in Asian cohorts, while AUS-A and follicular-patterned neoplasms featured more prominently in the non-Asian cohorts. These incidences may account for the starkly different molecular approaches that we noted-in Asian (chiefly Korean and Chinese) centers, BRAF mutational analysis was favored, while gene panels and gene expression classifiers were more frequently applied in non-Asian centers (chiefly in the United States of America). Overall, the data from Singapore appears more closely aligned to non-Asian trends, despite its geographical location in Southeast Asia and its predominantly Asian population. We conclude that there is significant heterogeneity in the outcomes of the AUS/FLUS categories between and within regions, which is only partially explained by regional variations, and may also reflect different regional diagnostic and management practices. This highlights the importance of understanding the local context in the interpretation of indeterminate Bethesda categories, rather than adopting a "one-size fits all" approach.
Collapse
Affiliation(s)
- Li Yin Ooi
- Department of Pathology, National University Hospital, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore
| |
Collapse
|
4
|
Suh YJ, Choi YJ. Strategy to reduce unnecessary surgeries in thyroid nodules with cytology of Bethesda category III (AUS/FLUS): a retrospective analysis of 667 patients diagnosed by surgery. Endocrine 2020; 69:578-586. [PMID: 32297204 DOI: 10.1007/s12020-020-02300-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/30/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Fine-needle aspiration (FNA) is widely used for the diagnosis of thyroid nodules detected by ultrasonography. However, the cytology of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) often leads to unnecessary thyroid surgery. This study aimed to identify a strategy to reduce unnecessary surgeries in patients with AUS/FLUS nodules. METHODS Medical records of 667 patients with the cytology of AUS/FLUS who underwent surgery from January 2007 to December 2017 were retrospectively reviewed. Clinicopathological data were analyzed to identify malignant factors in thyroid nodules with AUS/FLUS. Factors were compared between patients with thyroid cancer and those with benign thyroid nodules, using stepwise multivariate logistic regression and decision tree model. RESULTS Pathological thyroid cancer was identified in 193 (43.3%) patients. There was a significant difference in malignancy incidence with respect to family history, number of nodules, number of FNAs, ultrasonographic finding, lymphocytic thyroiditis, and BRAFV600E mutation. Multivariate analysis showed that ultrasonography (K-TIRADS 5) was the most influential independent predictor of malignancy in AUS/FLUS (odds ratio = 11.02, p < 0.001), followed by possessing BRAFV600E mutation (odds ratio = 4.54, p < 0.001). This strategy enabled 226 (89.3%) patients to avoid unnecessary surgeries based on the decision tree model. There was no node of repeated FNA in the decision tree model, which reduced the risk of malignancy (odds ratio = 0.35, p = 0.029). CONCLUSION K-TIRADS 5 and BRAFV600E mutation were predictive of malignancy in nodules of AUS/FLUS. These factors should be considered in strategies to reduce unnecessary surgeries for AUS/FLUS.
Collapse
Affiliation(s)
- Yong Joon Suh
- Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang, 14068, Republic of Korea.
| | - Yeon Ju Choi
- Research Cooperation Center, Hallym University, Chuncheon, 24252, Republic of Korea
| |
Collapse
|
5
|
Lim JXY, Nga ME, Chan DKH, Tan WB, Parameswaran R, Ngiam KY. Subclassification of Bethesda Atypical and Follicular Neoplasm Categories According to Nuclear and Architectural Atypia Improves Discrimination of Thyroid Malignancy Risk. Thyroid 2018; 28:511-521. [PMID: 29596039 DOI: 10.1089/thy.2017.0274] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although The Bethesda System for Reporting Thyroid Cytopathology has provided clinicians with a standardized classification scheme for the diagnosis of thyroid fine-needle aspiration cytology (FNAC) specimens, the indeterminate categories of Bethesda III (B3)-atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS)-and Bethesda IV (B4)-follicular neoplasm/suspicious for follicular neoplasm (FN/SFN)-continue to pose challenges with regards to ideal diagnostic and therapeutic management. Having previously demonstrated the presence of nuclear atypia as a high-risk subgroup in B3, the objective of this study was to evaluate the malignancy rates in the B4 subgroup with nuclear atypia. METHODS A retrospective review of all thyroid FNACs diagnosed as B4 (FN/SFN) between 2008 and 2015 was conducted at a tertiary referral center in Singapore. Data on patient demographics, sonographic features, and final histological diagnosis were collected. This was compared to data from a previous analysis on all nodules diagnosed as B3 (AUS/FLUS) over a similar period. RESULTS A total of 137/309 (44.3%) and 88/111 (79.3%) FNACs diagnosed as B3 and B4, respectively, underwent surgical excision yielding final histopathological diagnoses. The malignancy rate of B4 was 31/88 (35.2%) compared to B3, which was 37/137 (27.0%). Subclassification based on the presence of architectural versus nuclear atypia showed significantly higher malignancy rates in B4 nodules with nuclear atypia (21.8% vs. 57.6%; p < 0.01). These findings corroborate previous results within the B3 category (malignancy rate of 14.7% vs. 36.8%; p < 0.01). The only sonographic features predictive of malignancy were the presence of macrocalcifications in B4 compared to irregularity of margins in B3. CONCLUSION The presence of nuclear atypia identifies subgroups with significant differential malignancy risks within both the B3 and B4 categories. This supports the notion that subclassification is a useful risk stratification tool that can guide diagnostic and therapeutic management of indeterminate thyroid nodules with heterogenous risk profiles.
Collapse
Affiliation(s)
- Joel Xue Yi Lim
- 1 Yong Loo Lin School of Medicine, National University of Singapore , Singapore
| | - Min En Nga
- 2 Department of Pathology, National University of Singapore , Singapore
| | | | - Wee Boon Tan
- 4 Division of Endocrine Surgery, National University of Singapore , Singapore
| | - Rajeev Parameswaran
- 4 Division of Endocrine Surgery, National University of Singapore , Singapore
| | - Kee Yuan Ngiam
- 4 Division of Endocrine Surgery, National University of Singapore , Singapore
| |
Collapse
|
6
|
Erivwo P, Ghosh C. Atypia of Undetermined Significance in Thyroid Fine-Needle Aspirations: Follow-Up and Outcome Experience in Newfoundland, Canada. Acta Cytol 2018; 62:85-92. [PMID: 29486467 DOI: 10.1159/000486779] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 01/12/2018] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The rates of atypia of undetermined significance (AUS) by fine-needle aspiration (FNA) and malignant outcomes have been estimated at < 7% and 5-15%, respectively. Initial AUS diagnosis is followed up clinically with serial ultrasounds, repeat FNA, molecular testing, or direct surgery. We investigated the incidence, follow-up modalities, and final outcomes of AUS in Newfoundland. METHODS All cases of AUS diagnosed at the Eastern Health Cytology Laboratory between 1 January 2010 and 31 December 2013 were identified. Electronic medical records were examined for follow-up modalities and final histologic diagnosis. The final outcomes were reported as benign, malignant, or undetermined. RESULTS Out of 3,285 thyroid FNAs, 181 (5.5%) were AUS. Fifty-seven (31.5%) had repeat FNA diagnosed as benign (38.6%), AUS (29.8%), or suspicious/malignant (8.8%). Eighty-four (46.4%) had surgery after the first AUS diagnosis, 39 (46.4%) of which were malignant. Twenty-four patients (13.3%) were followed up by serial ultrasound only, 2 (1.1%) by molecular testing, and 1 (0.6%) died of unrelated disease. Thirteen (7.2%) had no follow-up record. Our malignancy rate (MR) was 29.8%. CONCLUSION The MR in our population was higher than the rate proposed by The Bethesda System for Reporting Thyroid Cytopathology. Repeat FNA can reduce the rate of unnecessary surgeries, but practice guidelines should consider individual and institutional circumstances. The ratio MR:ADR (AUS diagnostic rate) may be a better indicator of performance.
Collapse
|
7
|
Balancing the benefits and harms of thyroid cancer surveillance in survivors of Childhood, adolescent and young adult cancer: Recommendations from the international Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium. Cancer Treat Rev 2018; 63:28-39. [DOI: 10.1016/j.ctrv.2017.11.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/08/2017] [Indexed: 12/18/2022]
|
8
|
Ozdemir D, Bestepe N, Faki S, Kilicarslan A, Parlak O, Ersoy R, Cakir B. Comparison of thyroid fine needle aspiration biopsy results before and after implementation of Bethesda classification. Cytopathology 2017; 28:400-406. [DOI: 10.1111/cyt.12437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 01/21/2023]
Affiliation(s)
- D. Ozdemir
- Department of Endocrinology and Metabolism; School of Medicine; Ankara Yildirim Beyazit University; Ankara Turkey
| | - N. Bestepe
- Department of Endocrinology and Metabolism; School of Medicine; Ankara Yildirim Beyazit University; Ankara Turkey
| | - S. Faki
- Department of Endocrinology and Metabolism; School of Medicine; Ankara Yildirim Beyazit University; Ankara Turkey
| | - A. Kilicarslan
- Department of Pathology; Ataturk Education and Research Hospital; Ankara Turkey
| | - O. Parlak
- Department of General Surgery; School of Medicine; Ankara Yildirim Beyazit University; Ankara Turkey
| | - R. Ersoy
- Department of Endocrinology and Metabolism; School of Medicine; Ankara Yildirim Beyazit University; Ankara Turkey
| | - B. Cakir
- Department of Endocrinology and Metabolism; School of Medicine; Ankara Yildirim Beyazit University; Ankara Turkey
| |
Collapse
|
9
|
Kim M, Park HJ, Min HS, Kwon HJ, Jung CK, Chae SW, Yoo HJ, Choi YD, Lee MJ, Kwak JJ, Song DE, Kim DH, Lee HK, Kim JY, Hong SH, Sohn JS, Lee HS, Park SY, Hong SW, Shin MK. The Use of the Bethesda System for Reporting Thyroid Cytopathology in Korea: A Nationwide Multicenter Survey by the Korean Society of Endocrine Pathologists. J Pathol Transl Med 2017; 51:410-417. [PMID: 28609825 PMCID: PMC5525040 DOI: 10.4132/jptm.2017.04.05] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 01/21/2023] Open
Abstract
Background The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has standardized the reporting of thyroid cytology specimens. The objective of the current study was to evaluate the nationwide usage of TBSRTC and assess the malignancy rates in each category of TBSRTC in Korea. Methods Questionnaire surveys were used for data collection on the fine needle aspiration (FNA) of thyroid nodules at 74 institutes in 2012. The incidences and follow-up malignancy rates of each category diagnosed from January to December, 2011, in each institute were also collected and analyzed. Results Sixty out of 74 institutes answering the surveys reported the results of thyroid FNA in accordance with TBSRTC. The average malignancy rates for resected cases in 15 institutes were as follows: nondiagnostic, 45.6%; benign, 16.5%; atypical of undetermined significance, 68.8%; suspicious for follicular neoplasm (SFN), 30.2%; suspicious for malignancy, 97.5%; malignancy, 99.7%. Conclusions More than 80% of Korean institutes were using TBSRTC as of 2012. All malignancy rates other than the SFN and malignancy categories were higher than those reported by other countries. Therefore, the guidelines for treating patients with thyroid nodules in Korea should be revisited based on the malignancy rates reported in this study.
Collapse
Affiliation(s)
- Mimi Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Hyo Jin Park
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Sook Min
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Hyeong Ju Kwon
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Pathology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seoung Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Ju Yoo
- Department of Pathology, Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Mi Ja Lee
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
| | - Jeong Ja Kwak
- Department of Pathology, Soon Chun Hyang University Hospital, Bucheon, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hoon Kim
- Department of Pathology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hye Kyung Lee
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Ji Yeon Kim
- Department of Pathology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Sook Hee Hong
- Department of Pathology, Seegene Medical Foundation, Busan, Korea
| | - Jang Sihn Sohn
- Department of Pathology, Konyang University Hospital, Daejeon, Korea
| | - Hyun Seung Lee
- Department of Pathology, Yangji General Hospital, Seoul, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soon Won Hong
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Kyung Shin
- Department of Pathology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| |
Collapse
|
10
|
Straccia P, Rossi ED, Bizzarro T, Brunelli C, Cianfrini F, Damiani D, Fadda G. A meta-analytic review of the Bethesda System for Reporting Thyroid Cytopathology: Has the rate of malignancy in indeterminate lesions been underestimated? Cancer Cytopathol 2015; 123:713-22. [DOI: 10.1002/cncy.21605] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/23/2015] [Accepted: 07/23/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Tommaso Bizzarro
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Chiara Brunelli
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Federica Cianfrini
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Domenico Damiani
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| |
Collapse
|
11
|
Collins J, Rossi ED, Chandra A, Ali SZ. Terminology and nomenclature schemes for reporting thyroid cytopathology: An overview. Semin Diagn Pathol 2015; 32:258-63. [DOI: 10.1053/j.semdp.2014.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
12
|
Melo-Uribe MA, Sanabria Á, Romero-Rojas A, Pérez G, Vargas EJ, Abaúnza MC, Gutiérrez V. The Bethesda system for reporting thyroid cytopathology in Colombia: Correlation with histopathological diagnoses in oncology and non-oncology institutions. J Cytol 2015; 32:12-6. [PMID: 25948937 PMCID: PMC4408670 DOI: 10.4103/0970-9371.155224] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: To determine the correlation between the results of thyroid fine-needle aspirations interpreted using the Bethesda system and final histopathological reports for patients at an oncology hospital (OH) and non-oncology hospitals (NOHs). Materials and Methods: A retrospective, cross-sectional, descriptive study was performed to compare the cytology and histopathology results for patients with thyroid nodules in three Colombian hospitals. The final correlation of diagnoses between the two methods is reported. In Colombia, the health system provides the existence of general care hospitals and hospitals specializing in care of patients with cancer. Results: A total of 196 reports were reviewed, of which 53% were from OH and 47% were from NOHs. A greater proportion of category V (37.5%) was diagnosed at the OH, whereas NOHs diagnosed a greater proportion of category II (42.3%). The global correlation between diagnoses made using cytology and histopathology was 93.3% for categories V and VI (based on the final malignant diagnosis) and 86.9% for benign category II. Significant differences between institution types were observed when category IV and V and malignant histopathology were compared (56.3% OH vs. 23.5% NOH; P = 0.05 for category IV, 97.4% OH vs. 82.3% NOH; P = 0.03 for category V), while no significant difference between institution types was observed when category II and final benign diagnosis were compared (P = 0.6). Conclusions: The Bethesda system for thyroid cytology correlates adequately with final histopathological diagnosis in Colombia. Significant differences were identified in the diagnostic correlation for malignant lesions between the OH and NOHs in categories IV and V caused by selection bias of the population.
Collapse
Affiliation(s)
| | - Álvaro Sanabria
- Department of Surgery, Universidad de Antioquia-Hospital Pablo Tobón Uribe, Colombia
| | | | - Gabriel Pérez
- Department of Pathology, Universidad Industrial de Santander, Colombia
| | | | | | - Víctor Gutiérrez
- Department of Pathology, Hospital Central de la Policía Nacional, Colombia
| |
Collapse
|
13
|
Kantola S, Virani N, Haus C, Hipp J, Zhao L, Jing X. Prospective evaluation of impact of using the Bethesda System for Reporting Thyroid Cytopathology: an institutional experience. J Am Soc Cytopathol 2015; 4:25-29. [PMID: 31051669 DOI: 10.1016/j.jasc.2014.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The Bethesda System for Reporting Thyroid Cytology (BSRTC) refines the definition of and provides specific diagnostic criteria for fine-needle aspiration (FNA) assessment of thyroid lesions. This study was conducted to prospectively evaluate the diagnostic and clinical impact of using BSRTC for management of thyroid lesions and to compare diagnostic performance of post-BSRTC period with that of pre-BSRTC period. MATERIALS AND METHODS The study included FNA specimens obtained in our institution 2.5 years prior to and 2.5 years after implementing BSRTC. Nondiagnostic rate, distribution of the diagnostic categories, rate of surgical follow-up, cytohistologic concordant rate, and risk of malignancy were calculated and compared between pre- and post-BSRTC periods. RESULTS In comparison to the pre-BSRTC period, the post-BSRTC period generated a lower nondiagnostic rate (19.9% versus 15.8%), a greater proportion of benign (65.3% versus 69.2%) and atypia of undetermined significance or follicular lesion of undetermined significance (4.4% versus 7.4%) in contrast with a decreased proportion of follicular neoplasm or suspicious for follicular neoplasm categories (5.6% versus 2.2%). Rate of surgical follow-up decreased for benign (13.8% versus 7.6%) and atypia of undetermined significance or follicular lesion of undetermined significance (61.5% versus 42.1%) categories, and overall surgical rate reduced (24.2% versus 18.1%). Implementation of BSRTC did not affect overall rate of cytohistologic concordance (78.4% versus 80.5%) or the overall rate of histologically proven malignancy (30.6 versus 36.9%), whereas the individual cytohistologic concordant rate and the malignant rate for each of the diagnostic categories did not differ between pre- and post-BSRTC. CONCLUSIONS The implementation of BSRTC resulted in a decreased overall surgical rate, particularly for benign and follicular lesion of undetermined significance categories, without affecting overall cytohistologic concordance and rate of malignancy.
Collapse
Affiliation(s)
- Scott Kantola
- Department of Pathology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, Michigan
| | - Nilam Virani
- Department of Pathology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, Michigan
| | - Carolyn Haus
- Department of Pathology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, Michigan
| | - Jennifer Hipp
- Department of Pathology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, Michigan
| | - Lili Zhao
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Xin Jing
- Department of Pathology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, Michigan.
| |
Collapse
|
14
|
Çuhaci N, Arpaci D, Üçler R, Yazgan AK, Kıyak G, Yalçin S, Ersoy PE, Güler G, Ersoy R, Çakir B. Malignancy rate of thyroid nodules defined as follicular lesion of undetermined significance and atypia of undetermined significance in thyroid cytopathology and its relation with ultrasonographic features. Endocr Pathol 2014; 25:248-56. [PMID: 24532158 DOI: 10.1007/s12022-014-9298-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Fine-needle aspiration biopsy (FNAB) has been widely accepted as the most accurate, safe, and cost-effective method for evaluation of thyroid nodules. The most challenging category in FNAB is atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS). The Bethesda system (BS) recommends repeat FNAB in that category due to its low risk of malignancy. In our study, we aimed to investigate the malignancy rate of thyroid nodules of AUS and FLUS and whether there were different malignancy rates among the different patterns in this category, and to evaluate the presence of biochemical, clinical, and echographic features possibly predictive of malignancy related to AUS and FLUS. Data of 268 patients operated for AUS and FLUS cytology were screened retrospectively. Ultrasonographic features and thyroid function tests, thyroid antibodies, scintigraphy, and histopathological results were evaluated. Of the 268 patients' results, 276 nodules are evaluated. Malignancy rates were 24.3 % in the AUS group, 19.8 % in the FLUS group, and 22.8 % in both groups. In the evaluation of all nodules, the predictive features of malignancy are hypoechogenicity and peripheral vascularization of the nodule. We determined that the malignancy rates in these nodules are higher than that in the literature rate. This high ratio may be due to the fact that we studied only patients who underwent surgery. The ultrasonographic features alone may be insufficient to predict the malignancy; therefore, all the clinical and ultrasonographic features must be considered in the evaluation of the thyroid nodules. In addition, we think that the recommended management of repeat FNAB in these groups must be reconsidered with the clinical and ultrasonographic features.
Collapse
Affiliation(s)
- Neslihan Çuhaci
- Department of Endocrinology and Metabolism, Atatürk Education and Research Hospital, Ankara, Turkey,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Sullivan PS, Hirschowitz SL, Fung PC, Apple SK. The impact of atypia/follicular lesion of undetermined significance and repeat fine-needle aspiration: 5 years before and after implementation of the Bethesda System. Cancer Cytopathol 2014; 122:866-72. [PMID: 25078420 DOI: 10.1002/cncy.21468] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/05/2014] [Accepted: 07/07/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Limited studies have examined the impact of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) and specifically the category of atypia or follicular lesion of undetermined significance (AUS/FLUS). We studied their effects on reporting rates, subsequent management, and surgical outcome over a 10-year period, 5 years before and after implementation of the BSRTC. METHODS A retrospective review of thyroid fine-needle aspiration (FNA) reports from 2003 to 2012 was performed. Diagnoses made before BSRTC were reclassified into the most appropriate category. Repeat FNA results for all AUS/FLUS cases were recorded. Surgical follow-up results were matched by side and size of the targeted nodule. Incidental microcarcinomas were not considered "malignant" on excision. Malignancy rates were calculated based on excision and by all aspirated specimens. RESULTS Initial AUS/FLUS cases increased from 3% to 7% (P = .001) with implementation of the BSRTC. The nondiagnostic rate decreased from 19% to 10% (P = .026). Differences in malignancy rates before and after implementation of the BSRTC were not significant for all diagnostic categories. More repeat FNAs and fewer surgical excisions were performed after an initial AUS/FLUS diagnosis. Repeat FNA reclassified 56% of AUS/FLUS cases into a definitive category. The malignancy risks for AUS/FLUS plus benign and AUS/FLUS plus AUS/FLUS repeat FNAs were elevated compared with single benign and AUS/FLUS diagnoses. CONCLUSIONS AUS/FLUS cases are increasing with the implementation of the BSRTC. Given the potential increase in repeat FNAs as a result, it may be important to alert the clinician regarding the elevated malignancy risk of a benign or AUS/FLUS diagnosis associated with a prior AUS/FLUS finding.
Collapse
Affiliation(s)
- Peggy S Sullivan
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | | | | | | |
Collapse
|
16
|
Srbova L, Gabalec F, Ryska A, Cap J. Results of retrospective classification of thyroid FNAs according to the Bethesda system: would this have improved accuracy? Cytopathology 2014; 26:231-7. [PMID: 25077794 DOI: 10.1111/cyt.12171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To retrospectively reclassify the results of fine needle aspiration (FNA) cytology at our institution according to the Bethesda system for reporting thyroid cytopathology (TBSRTC), and to determine whether the introduction of the new classification system would have influenced the diagnostic accuracy compared with our existing system in which suspicious/indeterminate categories (categories III-IV) are managed according to clinical findings and cytopathologists' recommendations. METHODS FNAs performed under ultrasound guidance between 2001 and 2012, and subsequently verified by histology or repeat FNA and follow-up, were reviewed and retrospectively reclassified according to TBSRTC. RESULTS Among a total of 1310 histologically verified FNAs, the positive predictive values (%) for malignancy and neoplasia (carcinoma + follicular adenomas) for category I-VI according to the TBSRTC were 5.7/11.3, 2.6/5.5, 14.4/34.2, 23.6/55.0, 57.0/64.5 and 92.2/94.2, respectively. Although all the categories predict malignancy closely, the difference in malignancy rate between categories III and IV was not statistically significant; however, the difference in total neoplasia rate reached statistical significance. When patients with cytological and clinical follow-up were included, the malignancy rated dropped in category I to 2.4%, whereas, in category III, it remained at 13%. Repeat FNA instead of direct surgery spared half of the patients from surgery. The cytopathologists' recommendations for histological verification in category III were associated with an insignificant increase in malignancy rate, but the total neoplasia rate reached 57.5%. CONCLUSIONS At our institution, the application of the TBSRTC did not improve the diagnostic accuracy for the detection of malignancy compared with current practice. In selected cases with cytological results falling into category III (according to clinical data and cytopathologists' opinions), direct lobectomy seems to be justified.
Collapse
Affiliation(s)
- L Srbova
- Department of Clinical Endocrinology, The Institute of Endocrinology, Prague, Czech Republic
| | - F Gabalec
- 4th Dept. of Internal Medicine, University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - A Ryska
- Fingerland's Department of Pathology, University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - J Cap
- 4th Dept. of Internal Medicine, University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| |
Collapse
|
17
|
Güneş P, Demirtürk P, Aker F, Tanrıöver Ö, Gönültaş A, Akkaynak Ş. Evaluation of Fine-Needle Aspiration of Thyroid Nodules in a Series of 1,100 Patients: Correlation Between Cytology and Histopathology Original Article. Indian J Surg 2014; 77:990-5. [PMID: 27011496 DOI: 10.1007/s12262-014-1102-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/08/2014] [Indexed: 01/21/2023] Open
Abstract
In this study, our aim was to test the usefulness of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in indeterminate lesions in which cytological and histological diagnosis discordance was high and to investigate the contribution of TBSRTC in this indeterminate diagnostic group. The medical records of the patients who presented to the Haydarpasa Numune Training and Research Hospital in Istanbul, Turkey, between October of 1999 and September of 2010, for the cytological and histological diagnosis of thyroid nodules, were reviewed retrospectively. We reclassified these patients according to the Bethesda method, which features well-defined cytological criteria for each category within a six-tiered system. For each patient, the diagnosis and reasons for discordance were discussed and a final decision was made for each discordant case. The overall distribution of the cytological diagnoses using an in-house system was as follows: 811 benign (73.7 %), 87 suspicious follicular cell/follicular neoplasia (7.9 %), 52 suspicious for malignancy (4.7 %), and 45 malignant (4.1 %). We reclassified the diagnoses using the Bethesda system and the results are as follows: 797 benign (73.7 %), 48 follicular lesion of undetermined significance (4.3 %), 68 follicular neoplasia (7.9 %), 40 suspicious for malignancy (3.6 %), and 44 malignant (4 %). Our results showed that using TBRSTC for the lesions in the indeterminate category decreased the ratios of false-positive and false-negative diagnoses.
Collapse
Affiliation(s)
- Pembegül Güneş
- Department of Pathology, Haydarpasa Numune Training and Research Hospital, 34668 İstanbul, Turkey
| | - Pelin Demirtürk
- Department of Pathology, Haydarpasa Numune Training and Research Hospital, 34668 İstanbul, Turkey
| | - Fügen Aker
- Department of Pathology, Haydarpasa Numune Training and Research Hospital, 34668 İstanbul, Turkey
| | - Özlem Tanrıöver
- Department of Family Medicine, Yeditepe University Faculty of Medicine, İstanbul, Turkey
| | - Aylin Gönültaş
- Department of Pathology, Haydarpasa Numune Training and Research Hospital, 34668 İstanbul, Turkey
| | - Şerike Akkaynak
- Department of Pathology, Haydarpasa Numune Training and Research Hospital, 34668 İstanbul, Turkey
| |
Collapse
|
18
|
Sheffield BS, Masoudi H, Walker B, Wiseman SM. Preoperative diagnosis of thyroid nodules using the Bethesda System for Reporting Thyroid Cytopathology: a comprehensive review and meta-analysis. Expert Rev Endocrinol Metab 2014; 9:97-110. [PMID: 30743753 DOI: 10.1586/17446651.2014.887435] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fine-needle aspiration biopsy (FNAB) is the test of choice for the evaluation of nodules, arriving at a cancer diagnosis, and guiding surgical management. This review and meta-analysis aims to objectively evaluate the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) based upon literature reports of histopathological outcomes following cytopathological diagnoses. Thirteen studies were reviewed and the risk of malignancy (ROM) for each of the BSRTC diagnostic categories were calculated as: Non-diagnostic 11-26%, Benign 4-9%, AUS/FLUS 19-38%, FN/SFN 27-40%, SFM 50-79%, and Malignant 98-100%. In typical clinical utilization, the sensitivity and specificity of thyroid FNAB diagnosis using the BSRTC were 96% and 46%, respectively. The BSRTC represents an important advance in standardizing thyroid FNAB cytopathological reporting. Close attention should be paid to the observation that the AUS-FLUS and FN-SFN DCs have overlapping ROMs, and the potential clinical implications of this finding on patient management.
Collapse
Affiliation(s)
- Brandon S Sheffield
- a Department of Pathology and Laboratory Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Hamid Masoudi
- a Department of Pathology and Laboratory Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Blair Walker
- a Department of Pathology and Laboratory Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Sam M Wiseman
- b Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
19
|
Olson MT, Boonyaarunnate T, Altinboga AA, Ali SZ. 'Suspicious for papillary thyroid carcinoma' before and after The Bethesda System for Reporting Thyroid Cytopathology: impact of standardized terminology. Acta Cytol 2014; 58:15-22. [PMID: 24192286 DOI: 10.1159/000355696] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/02/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND The high-risk 'suspicious for papillary thyroid carcinoma' (SPTC) is a clinically relevant diagnosis in the cytological interpretation of thyroid aspirates. While The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has provided invaluable terminology standardization, a performance comparison for this diagnostic category has not been performed. Therefore, this study evaluates the SPTC diagnosis before and after the introduction of TBSRTC in a large meta-analysis and at a single institution. MATERIALS AND METHODS The meta-analysis analyzed publications of SPTC or similar diagnoses before and after the introduction of TBSRTC. Similarly our own institutional experience was analyzed for the 8 years surrounding the introduction of TBSRTC. A correlation of the cytopathology and surgical pathology diagnoses was performed. RESULTS The introduction of TBSRTC coincided with a significant decrease in the fraction of cases called SPTC in the meta-analysis (4.5-3.1%, p < 0.00001) and in the institutional review (1.7-0.9%, p = 0.005). Meanwhile, the malignancy risk for those cases increased significantly in the meta-analysis from 62.5 to 80.5% (p < 0.00001) and trended upwards in the institutional review from 69 to 79% (p = 0.4). The follow-up rate was similar in both time periods in the meta-analysis and the institutional review. CONCLUSIONS The introduction of TBSRTC coincided with a decrease in the fraction of cases called SPTC and an increase in the malignancy risk associated with that diagnosis.
Collapse
Affiliation(s)
- Matthew T Olson
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Md., USA
| | | | | | | |
Collapse
|
20
|
Mondal SK, Sinha S, Basak B, Roy DN, Sinha SK. The Bethesda system for reporting thyroid fine needle aspirates: A cytologic study with histologic follow-up. J Cytol 2013; 30:94-9. [PMID: 23833397 PMCID: PMC3701345 DOI: 10.4103/0970-9371.112650] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: The Bethesda system for reporting thyroid cytopathology represents a major step towards standardization, reproducibility, improved clinical significance, and greater predictive value of thyroid fine needle aspirates (FNAs). Aims: To elucidate the utility of the Bethesda system in reporting thyroid FNAs. Materials and Methods: We retrospectively reviewed thyroid FNAs between April 2009 and March 2012, classified them using the Bethesda system, found out the distribution of cases in each Bethesda category, and calculated the malignancy risk for each category by follow-up histopathology. Results: Of the 1020 FNAs, 1.2% were non-diagnostic, 87.5% were benign, 1% were atypical follicular lesion of undetermined significance (AFLUS), 4.2% were suspicious for follicular neoplasm (SFN), 1.4% were suspicious for malignancy (SM), and 4.7% malignant. Of 69 cases originally interpreted as non-diagnostic, 12 remained non-diagnostic after re-aspiration. In 323 cases, data of follow-up histopathologic examination (HPE) were available. Rates of malignancy reported on follow-up HPE were non-diagnostic 0%, benign 4.5%, AFLUS 20%, SFN 30.6%, SM 75%, and malignant 97.8%. Conclusions: Reviewing the thyroid FNAs with the Bethesda system allowed a more specific cytological diagnosis. In this study, the distribution of cases in the Bethesda categories differed from some studies, with the number of benign cases being higher and the number of non-diagnostic and AFLUS cases being lower. The malignancy risk for each category correlated well with other studies. The Bethesda system thus allows standardization in reporting, improves perceptions of diagnostic terminology between cytopathologists and clinicians, and leads to more consistent management approaches.
Collapse
|
21
|
Mufti ST, Molah R. The bethesda system for reporting thyroid cytopathology: a five-year retrospective review of one center experience. Int J Health Sci (Qassim) 2013; 6:159-73. [PMID: 23579269 DOI: 10.12816/0005991] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED Fine-needle aspiration (FNA) of the thyroid gland is a widely accepted and accurate method for triaging patients with thyroid nodules. Thyroid FNA suffers from a reporting confusion due to multiplicity of category terminologies. To address this, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was recently introduced for unifying the terminology and morphologic criteria along with the corresponding risk of malignancy. OBJECTIVE The aim of this study was to report the diagnostic utility of TBSRTC at our institution and report the malignancy risk for FNA of thyroid lesions among Saudi patients using this system at KAUH (King Abdulaziz University Hospital), Jeddah, Saudi Arabia. MATERIALS AND METHODS A retrospective study identifying 250 thyroid FNAs performed among Saudi patients between Jan 2005-Dec 2010 was undertaken. Cytology specimen data was collected through a computerized search of our cytopathology archives. RESULTS Among the 250 thyroid FNAs, 84 were followed by surgical resection. The overall surgical yield of malignancy was 23.8%. The malignancy rate for the 6 categories was as follows: non diagnostic: 20%, benign: 3.1%, atypia of undetermined significance: 50%, suspicious for follicular neoplasm: 20%, suspicious for malignancy: 80%, malignant: 100%. CONCLUSION Retrospective classification of FNAs of thyroid lesions among Saudi patients using TBSRTC at KAAUH, Jeddah, Saudi Arabia, validates the diagnostic reproducibility of this system and yields similar results for risk of malignancy as reported by others. However the associated rates found for non diagnostic (20%) raise the possibility of malignancy risk in this category and validate the past observations that sample inadequacy is a common cause of false negative thyroid FNAs.
Collapse
Affiliation(s)
- Shagufta Tahir Mufti
- Associate Professor, Department of Anatomic Pathology, Faculty of Medicine, King Abdulaziz University and Hospital, P.O. Box 80215, Jeddah 21589, Saudi Arabia, , Mobile no: 00966545250730
| | | |
Collapse
|
22
|
Abstract
The Bethesda system for reporting thyroid cytopathology formulated in 2007 has standardized reporting of thyroid cytology specimens and streamlined management algorithms. Although 3 of the categories (benign, malignant, and nondiagnostic) are standardized and improved, the remaining 3 (follicular lesion of undetermined significance, follicular neoplasm, and suspicious for malignancy) remain fraught with interobserver variability and uncertainty regarding management algorithms. Recent and ongoing morphologic and molecular studies that aim to resolve these issues are summarized.
Collapse
|
23
|
Misener VL, Gomez L, Wigg KG, Luca P, King N, Kiss E, Daróczi G, Kapornai K, Tamas Z, Mayer L, Gádoros J, Baji I, Kennedy JL, Kovacs M, Vetró A, Barr CL. Cytokine Genes TNF, IL1A, IL1B, IL6, IL1RN and IL10, and childhood-onset mood disorders. Neuropsychobiology 2009; 58:71-80. [PMID: 18832862 DOI: 10.1159/000159775] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 06/15/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Inflammatory cytokines induce a behavioral syndrome, known as sickness behavior, that strongly resembles symptoms typically seen in depression. This resemblance has led to the theory that an imbalance of inflammatory cytokine activity may be a contributing factor in depressive disorders. Support for this is found in multiple lines of evidence, such as the effects of cytokines on the activities of the hypothalamic-pituitary-adrenal axis, serotonin and brain-derived neurotrophic factor, and hippocampal function, all of which are implicated in the etiology of depression. In addition, associations between inflammatory activity and depressive symptomology have been documented in a number of studies, and the depressogenic effects of cytokine therapy are well known. Accordingly, given that depression has a substantial genetic basis, genes involved in the regulation of inflammatory cytokine activity are strong candidates for involvement in genetic susceptibility to depressive disorders. Here, we have tested 6 key genes of this type, TNF, IL1A, IL1B, IL6, IL1RN and IL10, as candidates for involvement in childhood-onset mood disorders. METHODS In this study of 384 families, each ascertained through a child with depression diagnosed before the age of 15 years, 11 polymorphisms of known or likely functional significance (coding and regulatory variants) were analyzed. RESULTS Testing for biased transmission of alleles from parents to their affected offspring, we found no evidence for an association between childhood-onset mood disorders and any of the polymorphisms, either individually or as haplotypes. CONCLUSION The present study does not support the involvement of the TNF, IL1A, IL1B, IL6, IL1RN and IL10 variants as major genetic risk factors contributing to early-onset mood disorders.
Collapse
Affiliation(s)
- V L Misener
- Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|