The bethesda system for reporting thyroid fineneedle aspiration. The bethesda system for reporting thyroid cytopathology is. Rapid on site evaluation helps assess adequacy after sampling. The introduction of the bethesda system for reporting thyroid cytopathology tbsrtc, following the national cancer institute thyroid fine needle aspiration state of the science conference held in bethesda, md, in 2007, offered the opportunity to establish a uniform sixtiered reporting system for thyroid fna 1the. The bethesda system for reporting thyroid cytopathology moderator dr g k parvathidevi presenter dr dhanya a n 2. The bethesda system for reporting thyroid cytopathology book. Thyroid association aaceameeta task force combine bethesda. Nodules that grow larger or produce symptoms may eventually need medical care. A comparative study between conventional system and the. An update to the bethesda system for reporting thyroid nodule cytopathology is set to alter clinical practice, with the primary aim of reducing the number of unnecessary thyroid surgeries. Table 1 thyroid cytopathology reporting by the bethesda.
Pdf bethesda categorization of thyroid nodule cytology. The bethesda system for reporting of thyroid cytopathology. Fine needle aspiration of thyroid nodules using the. The bethesda system for reporting thyroid cytopathology will provide the reader with a unified approach to diagnosing and reporting thyroid fna interpretations. C professor, department of pathology mcgill university director, cytopathology laboratory. How to interpret thyroid fineneedle aspiration biopsy. The 2017 bethesda system for reporting thyroid cytopathology. This atlas is the offspring of the the national cancer institute nci thyroid fine needle aspiration fna state of the science conference, hosted by. Comments this document replaces the 1st edition of guidance on the reporting of thyroid cytology specimens, published in 2009. This can happen when a cyst is aspirated or when the specimen is almost entirely composed of blood. The bethesda system for reporting thyroid cytopathology tbsrtc was formalized in october 2007 by experts in thyroidology at the national institute of health in bethesda, maryland. Pdf the bethesda system for reporting thyroid cytopathology tbsrtc is an evidencebased standardized reporting system for thyroid. To compare the conventional and the bethesda system for reporting thyroid. Update on the bethesda system for reporting thyroid cytology.
An autonomous thyroid nodule or hot nodule is one that has thyroid function independent of the homeostatic control of the hpt axis hypothalamicpituitarythyroid axis. Nature of the nodule location, size, cystic component skills of operator and reader. Bethesda classification of thyroid nodule fine needle aspirations i. Small, asymptomatic nodules are common, and often go unnoticed.
Incidentally detected lesions in the surgical specimens that were not the target of the thyroid fna were excluded from the analysis. History introduced and formed in 2007, nci thyroid fna state of science conference bethesda, maryland, by various cytopathologists and summarised by baloch et al. Fineneedle aspiration fna remains the most effective and safe method of evaluating thyroid nodules for potential surgical management. The bethesda system for reporting thyroid cytopathology tbsrtc established a standardized, categorybased reporting system for thyroid fineneedle aspiration fna specimens. Thyroid association aaceameeta recommend to combine.
In the bethesda classification system for thyroid lesions, bethesda iii is the most heterogeneous category because it merges follicular lesions. The conclusions of the meeting led to the bethesda thyroid atlas project and formed the framework for the bethesda system for reporting thyroid cytology tbsrtc. Bethesda system for reporting thyroid cytopathology. Classifying your thyroid fna specimens using bethesda terminology. The bethesda system for reporting thyroid cytolopathology. The bethesda system for reporting thyroid cytopathology bsrtc is a standardized reporting system for classifying thyroid fineneedle aspiration results comprising of 6 diagnostic categories with unique risks o malignancy and recommendations for clinical management. Malignancy rate in thyroid nodules classified as bethesda. Proposed modifications and updates for the thyroid bethesda.
The bethesda system for reporting thyroid cytopathology. Twentythree items of feedback were received and the document was. Contents introduction bethesda categories nondiagnostic or unsatisfactory benign atypia of undetermined significance or follicular lesion of undetermined significance follicular neoplasm or suspicious for a. The american thyroid association guidelines task force on thyroid nodules and. A twoyear prospective study in an academic institution table 1 the bethesda system for reporting thyroid cytopathology. This study aimed to examine the results of thyroid fna using the bethesda system for reporting thyroid cytopathology tbsrtc to establish the level of accuracy. The bethesda system for reporting thyroid cytopathology categorizes thyroid cytology findings into six groups, with each group assigned a putative malignancy risk. The bethesda system for reporting thyroid cytopathology is effective for clinical management of thyroid nodules jerome m. The bethesda system for reporting thyroid cytopathology is one of the main. Research article thyroid nodules with atypia or follicular. The bethesda system for reporting thyroid cytopathology, 2017 laila khazai 11417. Thoroughly revised and updated, the bethesda system for reporting thyroid cytopathology, second edition will provide the reader with a unified approach to diagnosing and reporting thyroid fna interpretations. It is expected that the many benefits, clinical and investigational, of the bethesda cervical terminology will. This atlas is the offspring of the the national cancer institute nci thyroid fine needle aspiration fna state of the science conference, hosted by the nci and organized by dr.
Subsequently a monograph the bethesda system for reporting thyroid cytopathology tbsrtc which includes definitions, diagnosticmorphologic criteria, explanatory notes, and a brief management plan for each diagnostic category was published. A comparative study between conventional system and the bethesda system applied for reporting thyroid cytopathology available online at received on. Thyroid cytopathology recent advances october 21, 2017 dr. Sporea et al 39 reported combining two elastographic methods could obtain a high. It serves as a reference guide not just for pathologists, but also endocrinologists, surgeons, and radiologists. Bethesda classification of thyroid nodule fine needle aspirations. W ith its inception, the bethesda system for reporting thyroid cytopathology tbsrtc established a standardized reporting system with a limited number of diagnostic categories for thyroid fineneedle aspiration fna specimens. In accordance with the colleges prepublications policy, this document was on college website for consultation from 27 october to 24 november 2015. Definitions, criteria and explanatory notes 2010th edition, kindle edition by syed z. Click on the thumbnails to see the intermediate images.
Thyroid cytopathology reporting by the bethesda system. The recent reclassification of some thyroid neoplasms as noninvasive follicular thyroid neoplasm with papillarylike nuclear features niftp has im plications for. Thyroid nodules are nodules raised areas of tissue or fluid which commonly arise within an otherwise normal thyroid gland. Thyroid thyroid cytopathologycytopathology recent advances. Present 3 uk rcpath 2015 italy 2014 usa bethesda 2008 australasia classification 2014 japan thyroid association 20 diagnostic category diagnostic category terminology categories terminology. The bethesda system for reporting thyroid cytology tbsrtc was proposed in 2007 at the national cancer institute thyroid fine needle aspiration state of the art and science conference held in bethesda, maryland. It will serve as a reference guide not just for pathologists, but also endocrinologists, surgeons, and radiologists. It represents the results of the multidisciplinary national cancer institute thyroid fine needle aspiration state of the science conference, held in bethesda, md in october, 2007.
Fine needle aspiration fna remains the firstline diagnostic in management of thyroid nodules and reduces unnecessary surgeries. The objective of this study is to evaluate the thyroid cytology smear by tbsrtc. The bethesda system for reporting thyroid fineneedle aspiration fna specimens 1 undoubtedly represents a major step toward standardization, reproducibility, and ultimately improved clinical significance, usefulness, and predictive value of thyroid fna during the past decade, several classification schemes for thyroid gland fna have been proposed by various professional. To assess the usefulness of thyroid imaging reporting and data system tirads for cytological bethesda category iii thyroid nodules tns. Ata initiatives to reduce the extent of surgery for many low risk thyroid cancers 4 cm or smaller, without extra thyroidal extension and lacking. Apr 25, 2018 the 2017 bethesda system for reporting thyroid cytopathology. Aug 27, 2011 the conclusions of the meeting led to the bethesda thyroid atlas project and formed the framework for the bethesda system for reporting thyroid cytology tbsrtc. Ata initiatives to reduce the extent of surgery for many low risk thyroid cancers 4 cm or smaller, without extra thyroidal extension and lacking regional nodal metastasis and decreased routine use of postoperative radioactive iodine treatment increasingly raise the possibility for lobectomy as initial surgical management. Bethesda classification of thyroid nodule fine needle. In these biopsies not enough thyroid cells were obtained to render a diagnosis. The bethesda system for reporting thyroid cytopathology, 2nd edition, 2018. This accounts for 10 percent of the biopsies, even in the most. Tbsrtc is a sixcategory scheme of thyroid cytopathology reporting table 1. Oct 15, 2015 the bethesda system for reporting thyroid cytopathology bsrtc dr.
Pdf introduction to the second edition of the bethesda system for. Of note, the cytopathologist cannot combine cells present in two or more nduns. Indeed, combining our suspicious for papillary carcinoma. The bethesda system for reporting thyroid cytology tbsrtc was proposed in 2007 at the national cancer institute thyroid fine needle aspiration state of the art and science. The 2017 revision reaffirms that every thyroid fna report should begin with one of six diagnostic categories, the names of which remain unchanged since they were first introduced. The bethesda system for reporting thyroid cyto pathology bsrtc is a standardized reporting system for classifying thyroid fineneedle aspiration results comprising of 6 diagnostic categories with unique risks o malignancy and recommendations for clinical management. However, it is still challenging since cytological results are not always straightforward. Proposed modifications and updates for the thyroid. The bethesda system for reporting thyroid cytopathology bsrtc dr. Implied risk of malignancy and recommended clinical management open in new tab a repeated aspiration with ultrasound guidance is recommended for nduns and clinically or sonographically worrisome cfo cases and is diagnostic in 50% to 88% of cases, 2, 6, 9, 11, , 14 but some nodules. The aim was to address the inconsistent and sometimes confusing reporting terminologies used for thyroid fna throughout the world. Using tbsrtc, cytopathologists can communicate their interpretations to the referring physician in terms that are succinct, unambiguous, and clinically. Review the bethesda system for reporting thyroid cytopathology tbsrtc the pathologists perspective individual categories with case examples emphasis on the indeterminate category and potential options the dawn of noninvasive follicular thyroid neoplasm with papillarylike nuclei niftp the updated bethesda system 2017.
Malignancy rates for bethesda iii subcategories in thyroid fine. Pdf the 2017 bethesda system for reporting thyroid. The thyroid web atlas contains 300 images of key thyroid lesions in an easytosearch format. They may be hyperplastic or tumorous, but only a small percentage of thyroid tumors are malignant. The bethesda system for reporting thyroid cytopathology bsrtc has standardized. Evaluation of thyroid nodules classified as bethesda category iii on. This retrospective study included 121 patients with 121 tns classified as bethesda category iii at fine needle aspiration fna cytology and thereafter underwent surgery. The bethesda system for reporting thyroid cytopathology, 2017. The bethesda system for reporting thyroid cytopathology tbsrtc has attempted to standardize reporting and cytological criteria in aspiration smears.
Guidance on the reporting of thyroid cytology specimens. Classifying your thyroid fna specimens using bethesda. Risk stratification of thyroid nodules with bethesda category iii. Click on document the bethesda system for reporting thyroid cytopathology. The bethesda system for reporting thyroid cytopathology is the standard. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules. Use of adjunct molecular reflex testing constantine theoharis, md assistant professor david chhieng, md, mba, mshi professor director of cytology department of pathology yale university new haven ct. Thyroid imaging reporting and data system in assessment of. The adoption of the system will facilitate communication among the cytopathologist, surgeon, endocrinologist and radiologist and also allow easy and reliable sharing of data from. An inspiration for the thyroid proposal was the bethesda system for reporting cervical cytology interpretations, first developed at an nci workshop in 1988 and widely adopted in the united states for reporting papanicolaou test results. Application of the bethesda classification for thyroid fineneedle.
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