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Indian Journal of Pathology: Research and Practice

Volume  9, Issue 2 (Part-1), May-August 2020, Pages 61-66
 

Original Article

Risk Stratification of Thyroid Cytology Specimens by Bethesda Reporting System: An Institutional Experience

Nausheen S Khan1, Pooja Jaiswal2, Mousumi Sharma3, Megha Agarwal4

1,4 Assistant Professor, 2,3Associate Professor, Department of Pathology, Integral Institute of Medical Sciences and Research, Lucknow, India.

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DOI: http://dx.doi.org/10.21088/ijprp.2278.148X.9220.10

Abstract

Background & Objective: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a universally accepted and standardized system to categorize thyroid fine needle aspiration (FNA) smears in patients with thyroid nodules. The system assigns a malignancy risk and gives recommendations for patient management in each category. The objective of the current study was to analyze the thyroid FNA by the Bethesda system, to correlate the cytopathology with histopathology and to assess the risk of malignancy in each category. Methods: The current study was conducted on 324 retrospective cases of FNA smears of thyroid nodules over a period of two years from October 2017 to September 2019. Cytohistopathological correlation was observed in 52
cases. Subsequently, cytomorphological features were further classified according to TBSRTC into six groups, and correlated with clinico histopathological features along with assessment of risk of malignancy.
Results: Diagnostic sensitivity and specificity of FNAC was 62.51% and 100%, respectively. The positive predictive value was 100% and negative predictive value was 92.6%. The number of cases in each diagnostic category and the risk of malignancy (ROM) were as follows: nondiagnostic – three cases (ROM – 0%), benign – 33 cases (ROM –
3.03%), atypia of undetermined significance – one case (ROM – 0%), follicular neoplasm – 3 cases (ROM – 33.33%), suspicious for malignancy – 2 cases and malignant – 4 cases (ROM – 100%) in both.
Conclusion: The Bethesda System is a uniform and effective modality in diagnosis and planning management of patients with thyroid gland lesions. Risk based stratification may guide the clinicians towards a more comprehensive approach to patient management.

Keywords: Bethesda system; Thyroid nodules; Follicular neoplasm.
 


Corresponding Author : Nausheen S Khan